"There's a lot of throwing medications at people without thinking about what the problem is," he added. "Once somebody has a label, it is highly unlikely that label will be questioned. And by the time a person has been on 20 different drugs, you can no longer figure out what's wrong."
Donna DeHart Burson agrees. Her 13-year-old daughter has taken more than a dozen drugs since her diagnosis several years ago. "If one doesn't work, the doctors' answer is to just keep adding more and more medications" or increasing the doses, said Burson, who lives near Winchester, Va.
Experts are questioning the rise in pediatric diagnosis of bipolar illness.
(Randy Mays For The Washington Post)
|
_____Live Discussion_____
•
Kids and Bipolar Disorder: Dr. Jon McClellan discussed the growing number of pre-adolescent children diagnosed with bipolar disorder.
|
| |
|
Don't Blame the Parents
Many parents say that a bipolar diagnosis meant they were no longer blamed for their children's behavior.
"At first he only had meltdowns in front of me," recalled Rebecca Goolsby of Springfield, a Navy scientist whose son was diagnosed last year at 5. "Everyone told me it was me, that I was just not handling him well. It was the most horrible thing to sit there every day and have people telling you that."
"It is not a parenting issue," said Karen Leatherdale, of New Brunswick, N.J. She said she finds it hard to ignore the stares when her 6-year-old son, diagnosed at 3, has a meltdown in Wal-Mart. "We can't stop this from happening. It is nothing we can control or the child can control."
The University of Washington's McClellan has a different view.
"There are a lot of kids who have problems regulating their behavior," he said, but he is concerned that the singular focus on drugs may give short shrift to behavioral strategies or personal responsibility.
"There's something very seductive about being told that your kid has a neurobiological disorder and needs to be medicated," said McClellan, who is chairing a committee on pediatric bipolar disorder for the American Academy of Child and Adolescent Psychiatry. "It lets people off the hook."
McClellan, who directs a state hospital program for children, said that proper treatment requires a careful diagnostic evaluation. Such an evaluation can take four hours or more and includes interviews and observations of the parents and child, psychological testing, a physical exam, detailed family history and information from teachers, coaches, day care staffers and others who know the child.
But psychiatrists say that insurance reimbursement is skewed in favor of medication -- and little else. A psychiatrist can make two or three times as much from an hour of medication checks than from an hour of therapy.
Although it's not discussed much, misdiagnosis can have a profound impact.
One woman, who agreed to be interviewed on the condition that her name not be published to protect her daughter's privacy, said that when the girl was 14, she was handed a prescription for lithium after a single visit to a psychiatrist. Four years later, doctors discovered that her severe depression and mood swings were the result of an undiagnosed pituitary tumor.
"She's really angry at the doctors and at me because I accepted the diagnosis too fast," the woman said. Her daughter, she said, "barely got through high school" and had side effects from the lithium, which made her hair fall out.
Now 19, she said, her daughter is caught in a Catch-22: Because the family was open about her diagnosis, she feels the need "to tell everyone she's not bipolar. And the reaction she's encountered is not what she thought. It's, 'Oh sure, the bipolar doesn't think she's bipolar.' "•
