Monday, November 19, 2007

Should You Medicate Your Child's Mind?

 
 
Pittsburgh Post Gazette
Bipolar kids or bad parents?
At the urging of parents, doctors are medicating far too many kids who just need a better upbringing, according to
Dr. Elizabeth J. Roberts  who is a child and adolescent psychiatrist and the author of "Should You Medicate Your Child's Mind?"  
Sunday, November 18, 2007

In September 2007, researchers at Columbia University reported that there had been a 40-fold increase in the number of children diagnosed with bipolar disorder from 1994 to 2003 -- an increase which has shown no signs of slowing.

Worse than the current frenzy to diagnose children with bipolar disorder is the practice of medicating kids as young as 2 with the kinds of psychiatric medications that were once prescribed only to psychotic adults. The shocking reality is that the use of these potent anti-psychotic drugs in children increased more than 500 percent between 1993 and 2002.

This dramatic rise in childhood bipolar disorder has spurred a raging debate in the mental health field. Some psychiatrists insist that this incredible increase is entirely due to the identification of mentally ill children who had been previously overlooked.

Yet a 4,000 percent increase in childhood mental illness, specifically bipolar disorder, is simply implausible and difficult to justify based solely on improved diagnostic techniques. To the contrary, in the 30-plus years that I have been treating, educating and caring for children -- half of that time as a child psychiatrist -- I have found that the approach to diagnostics in psychiatry clearly has deteriorated over time, not improved.

There was a time when doctors insisted on hours of evaluation with a child and his parents before venturing a psychiatric diagnosis or prescribing a medication. Today many of my colleagues brag that they can complete an initial assessment of a child and write a prescription in less than 20 minutes. Many parents have told me it took a previous doctor less than five minutes to diagnose and medicate their child.

How, then, is it possible that in 2007 doctors are now able to identify hundreds of thousands of previously missed cases of bipolar disorder in children by reducing the time they spend with patients from multiple hours to just a few minutes?

On the other hand, there simply is no possible way that the number of children who actually have bipolar disorder has increased from approximately 20,000 to 800,000 in a nine-year period. Yet the arguments of skeptics are being dismissed by academics in psychiatry. Research psychiatrists appear to be more invested in defending their research conclusions -- funded by pharmaceutical companies -- than engaging in a meaningful discussion to examine these preposterous demographics.

What I find more astounding than the claim that there are 800,000 American children with bipolar disorder is the fact that there are that many children whose conduct is so aberrant that their parents are seeking psychiatric treatment for them.

The symptoms, which are regarded as evidence of bipolar disorder, usually are what most people recognize as ordinary belligerence. Children who have anger outbursts, who refuse to go to bed, who are moody and self-centered under the current standard of care in child psychiatry are being diagnosed with bipolar disorder. To most rational human beings, these behaviors describe an ill-mannered, immature and poorly disciplined child. Nonetheless, the temper tantrums of belligerent children are increasingly being characterized by doctors as the mood swings of bipolar disorder.

The over-indulgent parenting practices of the past 20 years have created a generation of dysfunctional children who are becoming increasingly more entitled, defiant and oppositional. In a poll by Associated Press-Ipsos, 93 percent of people surveyed said that today's parents are not doing a good job when it comes to teaching their kids to behave. According to Dan Kindlon, a Harvard psychologist, 50 percent of the parents he interviewed described themselves as more permissive than their parents had been.

The permissive parents of spoiled children seek refuge from blame by using the excuse that their child's angry outbursts are the result of a chemical imbalance. Since a psychiatric condition is completely beyond a parent's control, a diagnosis of bipolar disorder is the perfect alibi. Once a child has been diagnosed with bipolar disorder, a parent feels absolved of guilt or responsibility for the child's misbehavior and therefore, the parents' discipline practices cannot be called into question.

Parents looking for a psychiatric explanation for their child's misbehavior will find an abundance of support in the media and on the Web for the conclusion that their child's temper tantrums are due to a psychiatric disease rather than the result of bad parenting. Psychiatrists, for their part, are more than willing to accept, without question, the assessment offered by a parent. Doctors have found it easier and less contentious to comply with a parent's wish to have their child diagnosed with a psychiatric condition than to confront the parent with the notion that their own weak parenting is the root cause of the child's aberrant behavior.

Using the diagnosis of bipolar disorder, doctors then justify the sedation of these children with powerful psychiatric drugs. Even though some children treated with anti-psychotics may be temporarily sedated, their belligerent attitude continues unchanged. Of the many children I treat every year who had been previously diagnosed with bipolar disorder, not one of them stopped throwing tantrums after being treated with psychiatric medications. Yet doctors continue to misdiagnose and overmedicate children to appease frustrated parents in spite of the many serious, permanent or even lethal side effects.

Tragically, as in the death of Rebecca Riley, her parents administered the multiple medications prescribed by their psychiatrist for Rebecca's "bipolar disorder" until the meds killed her. A few weeks ago, in an interview on 60 Minutes, Rebecca's mother told Katie Couric that she now believes that her four-year-old daughter had been misdiagnosed, had never been bipolar, and that Rebecca was simply mischievous.

When it comes to misdiagnosing and overmedicating children, doctors have an unwitting, though not unwilling, accomplice -- the parent. Ultimately, it is the parent who is the gatekeeper for their child's health-care delivery. It is the parent who pursues psychiatric treatment for their child, fills the prescriptions and administers the medications. Parents have a duty to protect their children from the folly of this disastrous approach to childhood behavior problems.

Instead of grooming, feeding and educating the next generation of Americans to be the fittest, brightest, most competent contributors on the planet, we have indulged, placated and spoiled our children into dysfunctional misfits. We are teaching our children to use a psychiatric diagnosis to excuse their antisocial behaviors. This will inevitably lead to a greater reliance on psychiatric medications, which unfortunately do not endow an individual with improved self-control or maturity.

Under the guise of treating childhood bipolar disorder, the spoiling of American children not only undermines their healthy social development, but it also puts them at great risk for the serious medical complications inherent in the use of psychiatric medications, including death. 

 

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