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Diagnostic fad versus diagnostic fad

I can’t help thinking that maybe poor parenting skills are behind the current epidemic of childhood “mental disorder” labeling. Newsweek just did a story on the trend of labeling children with bipolar disorder in an article titled Mommy, Am I Really Bipolar?

In the autumn of 1994, a novel idea was afoot in my profession. At the annual conference of the American Academy of Child and Adolescent Psychiatry, I attended a workshop on bipolar disorder in children. About 10 of us attended the meeting, held in a small, poorly lit room. Only one or two doctors reported having actually seen a child with bipolar disorder, but we all agreed to keep our eyes open for other sightings.

Bipolar disorder in a child would have been a much rarer sighting for the experts to make in 1994.

Dubious math is then used to offset the 40 fold, that’s 4,000 %, increase in childhood bipolar disorder that occurred in the USA soon after. Sure, childhood bipolar disorder may have increased in some other places, too, but in no other place would it take off like it has in the USA. The birthplace of kiddy bipolar mania was the good ole’ USA, and that is, of course, where as a diagnosis it has met with the most success.

In adults, bipolar disorder is characterized by cycles in which a patient rotates between two extremes, or poles, of feeling: depression and mania. The cycles may vary in length and intensity, but the adult diagnosis depends on clear-cut episodes of behavior that is distinctively different from normal: severe overexcitement or highs that last for weeks, and crushing, painful periods of deep depression that also last for weeks or months. The description of childhood bipolar disorder by its advocates is dramatically different. Where adult bipolar disorder expresses itself in episodic, out-of-character behavior, a child diagnosed with bipolar disorder will have symptoms that characterize the child’s typical behavior. In this telling, an elementary-school-age child with the disorder may be chronically enraged and have several tantrums per day. But this only points to another problem with the diagnosis: it’s nearly impossible to distinguish between children alleged to have bipolar disorder and those with straightforward anger-control issues. The symptoms may look like mania: irritability, distractibility, and talkativeness. But most of these symptoms can easily be matched to less-trendy conditions like attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). My view is that a diagnosis of bipolar disorder in a child is almost always a case of severe ADHD combined with severe ODD, both fairly common in elementary-school children.

In the “disorder” business, it’s taboo to be caught without a “disorder” on your fingertips, and at your disposal. If it’s not Bipolar Affective Disorder; it must be that other trendy figment of folks collective imagination, Attention Deficit Hyperactivity Disorder. The Attention Deficit Hyperactivity Disorder craze, after all, started long before the Bipolar Affective Disorder craze. This is the primrose path that this bozo leads us down compounding his folly with the addition of another even more dubious disorder, Oppositional Defiant Disorder. ODD is the disobedient children’s disorder that parents have been dreaming about all their lives. ‘You listen to me, kid, or you’re sick!’

I realized this when I met Alexis, a brilliant 11-year-old girl from a prominent family. She was a talented artist who spent her sessions with me crafting elaborate Renaissance-like drawings and discussing her rehearsals in an adult Shakespearean troupe. Alexis, however, had always performed poorly at school, refusing to participate in the classroom and opting instead to chat with the adults in the teachers’ lounge. Her constant urge to move, her refusal to do her homework—these suggested evidence of ADHD. Yet her parents, having been told that she had a far more serious (and lofty) disorder, resisted the diagnosis. When they reluctantly allowed me to stop her mood stabilizers and instead prescribe stimulant medication for ADHD, this talented child quickly became a well-functioning girl who participated eagerly and happily in class with her peers. Her parents canceled their plans to dispatch her to a boarding school for the emotionally disabled.

The key to ADHD, and this whole paragraph, comes with the 2nd sentence in it. “Alexis…always performed poorly at school…” ADHD, in theory anyway, is the magical formula for getting students who perform poorly a top grade education. The theory runs that if we just give them speed then they can keep up with their peers. I happen to believe perhaps counseling, tutoring, and a remedial study skills course might take you farther. Of course, such extras come at a price, and it’s cheaper just to drug the child. Oh, and I don’t mean financially either. I mean in terms of effort, authentic concern and expenditure of energy, it’s just so much easier.

Psychiatrist Stuart Kaplan, the author of this rather disappointing piece, at the end points towards Temper Dysregulation with Dysporia (TDD) projected in the upcoming DSM as a corrective to the Childhood Bipolar Disorder fiasco. The TDD disorder label is seen as corrective as if this projection wasn’t likely to lead to yet another trendy disease label for shrinks and drug company exes to bank on. If ADHD had been popular, if kiddy BAD has become popular, just make way for TDD. The reasoning and the charm of it is, it won’t be seen as the “serious” disorder label that Bipolar Disorder is seen as being. If it’s the beginning of a downward spiral, well, it has lot’s of company.

2 Responses

  1. You’re about my age. And I’m sure it’s the same there as here. You witnessed the proliferation of white trash bourbon and coke parents in the ’80’s and ’90’s.

    OK, I had kids and I drank and smoked. But I talked to my kids and we had had fun. And we weren’t fucked up with religion or the need to pander to religion.

    • I’m actually a lot younger than I look.

      In Never Never Land where I reside we have ‘lost boys’ (& now with feminism lost girls, too) but we really haven’t got a lot of ‘white trash bourbon and coke parents.’ Pirates, maybe, but not so much the ‘white trash parents’ you speak of.

      There are no religions in Never Never Land. They’d all been abolished centuries ago.

      Actually, all this talk of Home Sweet Home puts me in mind of a song you might heard of at one time or another, Everyday People. It has a line in it: And different strokes for different folks. I think it’s a good message to get out there, and its one I want to see observed more often.

      All power to the mad, the odd, the strange and the just plain different!

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