I’ve just finished reading Jerome Groopman’s thoughtful piece about bipolar disorder and children, published in the April 9th issue of The New Yorker, and I am not happy. I earned my PhD in clinical and personality psychology ten years ago, just before giving birth to Ben and deciding to stay at home to raise him (and then Jack). So I know a reasonable amount about psychopathology. And let me tell you that the trend we are witnessing in this country, about which Groopman writes so lucidly, is more than a little frightening.
It started in the 1990’s with ADHD. That’s attention-deficit disorder with hyperactivity. It should be neither more nor less rare than any other psychiatric disorder. Psychiatric disorders typically occur in somewhere between one to four percent of a given population. So, in Ben’s elementary school, which serves 250 students, one might expect to find 5 or 6 kids with ADHD.
But in the 1990’s, diagnoses of ADHD shot through the roof, encouraged, I think, by the success of drugs like Ritalin and Adderall. In some areas of the United States as many as twenty percent of schoolchildren (think fifty of Ben’s schoolmates!) were being diagnosed with ADHD and treated with drugs. Remember the stories about children lining up at the nurse’s office for their daily dose of Ritalin? Ritalin made kids calmer, or so teachers thought. More teachable. Or, if you ask me, more docile, more obedient. Many more boys than girls are diagnosed with ADHD, and as far as I can tell, Ritalin made the boys more like the girls, at least insofar as their classroom behavior was concerned.
Now it looks like the same ugly trend is appearing in relation to another psychiatric disorder, this time a disorder of mood: bipolar disorder (also known as manic-depressive disorder). With regard to ADHD, no one can deny that children suffer from it. What was and is still in dispute is how many children. In contrast, for bipolar disorder, no one is even quite sure that children manifest its symptoms, which are cyclical bouts of depression and mania, mania being a mood state characterized by inappropriately extreme elation, reduced need for sleep, irritability, expansiveness, and accelerated speech, among other symptoms. (Many of our most distinguished writers and artists are said to have had bipolar disorder, the manic phase leading to bursts of creative energy.)
The difficulty is this: how do we know what is manic in a child? Isn’t it hard to tell where the natural exuberance of childhood leaves off and pathology begins? I would think so. And diagnosing bipolar disorder in children has much more serious implications than diagnosing ADHD, because the treatment for bipolar disorder is lithium, a powerful drug which requires consistent and frequent monitoring of blood levels.
I don’t doubt that some children have bipolar disorder. Children can be depressed, they can have ADHD; why can’t they be bipolar? It’s just that there are likely so few children who should receive this diagnosis. As things stand, the potential for false positives (diagnosing bipolar disorder when the disorder is in fact not present) is so great, given children’s wide and frequent mood swings. And the cost of false positives could be enormous because of the dangers inherent in taking lithium.
We don’t really want a country filled with unnecessarily medicated children, do we? I hope not. Does this worry you as much as it does me?
[tags]adhd, Attention deficit hyperactivity disorder, bipolar disorder, manic-depressive disorder, Ritalin, school, medicine, questionable diagnosis[/tags]
Photo graciously provided by -RobW-, under a Creative Commons license, some rights reserved
14 responses so far ↓
thordora // Apr 26, 2007 at 2:39 pm
As someone raising daughters and diagnosed bipolar, with a genetic predisposition, this shit freaks me out (pardon my french)
I have NO intention of mentioning my diagnosis to any of their future teachers because I do not want their behaviour, which may be normal, to be judged a problem. I worry enough about them possibly being nuts as well as I.
I know in my experience, while I remember the mood swings when I was a child, they did not impact my life as much as they ended up doing so when I was an older teenager. Most doctors I’ve ran into through the years were VERY hesitant to give strong drugs to children, baring extreme cases. I’d personally rather try to work with my children to try and establish better habits to allow them to manage their disorder, if they have it.
I’m blathering, but this is one of my biggest fears-my daughters being medicated into submission….Bipolar can be an incredibly creative disorder while being destructive-I’d rather try and teach how to live with it rather than against it.
Carol // Apr 26, 2007 at 3:19 pm
I’ve actually got some experience with the ADHD factor. My daughter could easily obtain a dx of ADHD but we decided not to go in that direction. The school wanted her evaluated, they wanted her diagnosed, classified and even medicated. When the our developmental ped agreed with me that no dx or med was required since it did not affect her ability to learn, the school asked me to go get another opinion. They said it was affecting her ability to learn. WRONG. It was affecting her ability to sit at a desk for hours on end working on meaningless worksheets. How do I know they were meaningless? Because they sent all the ones she didn’t finish home for her to do!
I began homeschooling her after that. Trust me, she’s got no problem at all with grade level work. If anything, she’s ahead of her peers. She still does much of her work standing up, humming or doing other things they would have never allowed in school but who cares? Everything I’ve read about ADHD indicates that over time the effects are diminished, the person learns ways to control or compensate or both happens. In the meantime, she’s learning and growing and that’s what counts to me.
I have no doubt that there are so many children given these diagnosis and put on medication simply because the school system isn’t able to handle children who don’t sit down like statues and do their meaningless worksheets. And yes, it worries me!
Slouching Mom // Apr 26, 2007 at 3:30 pm
Thank you both for sharing these stories. My older son, who does not have ADHD, is nonetheless extremely high energy and prefers to stand at his desk to work.
We are so lucky that to date (he is only in third grade) his teachers have accommodated, even encouraged, his active learning style.
Doodaddy // Apr 26, 2007 at 3:34 pm
Hear, hear. I worked as a sub for a while, and there was nothing that made me angrier than another teacher saying “Oh, that kid’s got ADD (sic), it’s just not diagnosed yet.” The teachers put huge amounts of pressure on parents, counselors, and special ed teachers to get as many kids diagnosed and medicated as humanly possible.
That said, I think that diagnostic criteria for both ADHD and bipolar disorder need to be more well publicized throughout the teaching community. A psychiatric diagnosis is made on the basis of the presence of a certain number of diagnostic criteria or behaviors out of a long list. My kid’s ADHD might not look the same as your kid’s, nor should they be treated the same way. These diagnoses become buzzwords for teachers (and equivalent to “we can ignore that kid ’cause he’s got problems”). In my opinion, the teachers shouldn’t even know the diagnosis.
InTheFastLane // Apr 26, 2007 at 3:55 pm
OH Man! I could go on an on about this topic. There is no doubt in my mind that there are kids with serious mental health issues, even diagnosable and medicate-able mental health issues. However, the great majority of the students that I see at my school with these “diagnosis” are not bi-polar (or more commonly ADHD). The vast majority do have, however, severe behavioral issues that stem from chaotic home lives in which boundaries and limits are not very well enforced (if at all). I don’t want this to sound like a “blame the parents” rant. But as I say in any conference in which an ADHD diagnosis is discussed “medication will not erase the issue, if the behavioral component is not also addressed and the bad habits that have been learned are unlearned and replaced by good habits and good behaviors and good study skills.” No matter what the diagnosis (or non-diagnosis), someone has to be there to lead and teach and guide kids. Some kids are harder to teach and guide because their personalities don’t fit the “mold.” but that does not always mean that medication is the answer. OK – off of my soap box now.
Suz // Apr 26, 2007 at 4:20 pm
I really loved Thordora’s comment because it pretty much sums up my experience with ADHD. I was diagnosed in graduate school and it explained so much to me. No matter how hard I tried, I was never able to keep my room clean or organize anything around me. It took me three or four times as long to complete school-work than those around me. I wish that I would have had the diagnosis sooner, much sooner, because it would have kept me from internalizing all of those things that I couldn’t do and seeing them as personal failures. However, medication has never worked for me. What has worked is slowly and steadily putting into place strategies to help me cope. I don’t have any problem (other than the social stigma) of diagnosing these illnesses early, but I do with thinking that medication offers the one and only “cure”
SusieJ // Apr 26, 2007 at 5:48 pm
So glad to hear I’m not the only one who thinks we are over-evaulating and over-drugging our children. And, and I’m so relieved that you, with a PHd also thinks so! It just seems to be such an easy way out for teachers today, to just get the kids medicated, so the teachers won’t have to accommodate any different learning styles. I love Slouching Mom’s comment — her son stands at his desk, and the teachers accommodate him. We need to see more of that.
A.L. Hatch // Apr 26, 2007 at 6:37 pm
I read that article, too. It made me so nervous. The Poo has high energy and lots of mood swings – because she is two.
I think you are spot on when you speak of the dangers of misdiagnosis.
mary g // Apr 26, 2007 at 8:15 pm
I think the overdiagnosis comments are exactly right. ‘Anything for a quiet life!’ But the plight of the busy, bright, jittery kids does worry me, by times, because the school system is not really set up for them. And yes, they get blamed and they internalize the blame. Some of them drop out when they are old enough, which is tragic. And some of them make teachers’ lives hell. No question.
One of mine is, I believe, marginally bi-polar. As am I. She got lots of lumps in grade school, and I was told she was ADHD, by the way. I would no more have medicated her than I would have flown to the moon. She is a very successful adult and I had the chance to tell her complaining kindergarten teacher that not too long ago. It was a sweet moment, believe me.
Heather // Apr 26, 2007 at 10:00 pm
As a former junior high teacher (now a SAHM with a 2 1/2 year old), I completely agree that children are over diagnosed and over medicated. I also hope that those who have experience with the “medicate them into submission” teachers will also encounter caring, accepting teachers educated in current brain research and learning theories (as I was fortunate to be). Brain research says children process information in various ways— standing, tapping on desks, and (gasp!) talking to themselves. In my first year of teaching, I was shocked to hear other teachers complain about the “ADHD Boys and Girls” most of whom, in reality, were just not auditory or visual learners.
Slouching Mom // Apr 27, 2007 at 4:31 am
Doodaddy: I don’t think teachers should know their students’ diagnoses. But when an IEP is drawn up in order for the student’s family not to have to pay for needed services, confidentiality (in the sense of keeping the teacher out of things) really flies out the window.
And Heather: I’m glad that teachers are starting to appreciate different learning styles. Knowledge in that regard should help teachers not to stigmatize kids who aren’t in sync with most of the other children in the class.
And to eveyone else: Thank you for such interesting and well-articulated comments.
Annie // Apr 27, 2007 at 5:20 am
My son is autistic and has sensory issues. He craves stimulation, so he runs around, puts things in his mouth, etc. and yes, it interferes with his learning. Luckily I have a very understanding teacher.
As a former teacher myself, I agree that sometimes kids are overmedicated. There are kids who are naturally exuberant and learn in different ways. Then there are ones whose conditions really interfere with their (0r others’ learning).
My graduate student teaching was interesting…the teacher I worked with was the father of an autistic son, and so the admin gave him ALL the “special needs kids”. Some were bipolar and ADD/ADHD and refused to take their meds. So it was pretty difficult.
Carol // Jan 11, 2008 at 7:38 pm
As a mother of a 4 year old recently diagnosed with bipolar NOS, you have to live it to understand it. The feeling of helplessness that comes with trying to find information out about how to best help your child. It is even more frustrating that people try to profit from it. As if the medical bills for the therapy are not enough. Alternative approaches to meds (at least the ones that I have found) run hundreds of dollars; money we don’t have. You can’t parent a manic child the same way you do a normal child, and trying to find help and guidance has led me to nothing but frustration. There are no support groups near us either. To hear someone such as yourself who isn’t even dealing with a bipolar child, get up on a soap box and preach, frustrates me even more. If more people and doctors spent the time providing support and guidance to families such as mine on coping, planning and parenting strategies then maybe medication wouldn’t be so easily dished out. But in today’s world, everyone takes the easy “get rich quick” way out.
I will not disagree that there are children out there who are incorrectly diagnosed. But I take offense to you passing judgement and making assumptions on treatment for children who do have it. You try waking up everyday wondering if you child will spend it screaming and crying or so manic that he can’t stop talking or sit long enough to eat a meal, or even be able to play with his brothers. Because a child with bipolar doesn’t have “good” days without therapy and possibly medication, they simple cycle from mania to depressive states only to breeze by a few minutes in time where they seem normal.
My son goes to therapy once a week, an hour away from our home. My husband and I both work full time and leave work every Monday, taking turns with who takes him to therapy and who stays home with our other 3 children. With our incredible pediatrician we fortunately found a clinic where a team of medical professionals work together to develop the best treatment plan for him. We are at the early stages and he may need medication. Don’t think for one minute that it doesn’t scare the heck out of me. But as a mother of 2 children with verbal apraxia, including my 4 year old, and 1 with dyslexia, I research everything to the nth degree; I protect my children, but at the same time, I will not let them suffer. So before you pass judgement, spend the day in the life of a mother with bipolar children, actuall spend a week, and then come back and talk to me about treatment plans.
By the way, Lithium is not the only Rx treatment for bipolar, and there are several types of bipolar disorders.
Slouching Mom // Jan 12, 2008 at 10:03 am
Carol: I am not suggesting that children cannot have bipolar disorder, simply that there is a risk, as there is in diagnosing any disorder in children, of overdiagnosis, particularly in the service of behavior control. In fact, in my essay, I wrote these very words:
I don’t doubt that some children have bipolar disorder.
And I strongly disagree with your suggestion that because I do not have a manic-depressive child, I am unqualified to write about these issues. Practically every one of the professionals with whom your child is bound to come into contact will not have a manic-depressive child. Does that mean that they are not qualified to help your child?
Not that it matters, but I have a PhD in Psychology. To the extent that that makes a person qualified to discuss psychiatric issues, I’d guess that I’m more qualified than most.
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