The maze of child psychiatry

The New York Times has published the first two parts of an ongoing series on the experience and difficulties of diagnosing mental illness in children.

The area of child mental illness is controversial, largely because diagnosis is so difficult.

Diagnosing adults is tricky at the best of times, but mental disorder seems to appear differently in children and is often classified using specific diagnoses.

Some disorders, such as conduct disorder or childhood autism, can only be diagnosed in children, while others, such as psychotic disorders, could technically be diagnosed but are incredibly rare in pre-adolescents.

Some diagnoses are subject to significant cultural differences. For example, some American psychiatrists are diagnosing children with bipolar disorder as young as 6-years-old, while most British psychiatrists tend to be quite unhappy with this, and in practice, rarely diagnose anyone under 18 with the condition.

At the moment, awareness of ‘Juvenile Bipolar Disoder’, as it has been christened, is being heavily promoted in America.

For example, the Juvenile Bipolar Research Foundation website even lets you ‘screen’ your own child with an online questionnaire to see if they have the condition.

Cynics may note that the organisation is sponsored by, among others, Novartis Pharmaceuticals and make accusations of disease mongering, while supporters would argue that it is increasing awareness of an under-recognised disorder and hope that it will lead to better treatment for children in distress

One of the concerns of these diagnoses, is that they typically lead to substantial drug treatment, the long-term effects of which are not well understood or researched.

The first NYT article explores the experience of one family who had a daughter who developed behavioural problems and started experiencing psychotic symptoms at the age of 7, a very uncommon occurrence.

The second article looks at the process of diagnosis itself, and what difficulties psychiatrists face when trying to separate bizarre but normal childhood fantasy from troubling thoughts and feelings.

This is an especially difficult task in children who do not necessarily have the language or mental abilities to fully communicate their own experiences.

Both articles have video and a photo essay to accompany them. Presumably, more articles in the series will be forthcoming.

Link to NYT article ‘Living With Love, Chaos and Haley’.
Link to NYT article ‘What‚Äôs Wrong With a Child? Psychiatrists Often Disagree’.

2 thoughts on “The maze of child psychiatry”

  1. My issue is Zyprexa which is only FDA approved for schizophrenia (.5-1% of pop) and some bipolar (2% pop) and then an even smaller percentage of theses two groups.
    So how does Zyprexa get to be the 7th largest drug sale in the world?
    Eli Lilly is in deep trouble for using their drug reps to ‘encourage’ doctors to write zyprexa for non-FDA approved ‘off label’ uses.
    The drug causes increased diabetes risk,and medicare picks up all the expensive fallout.There are now 7 states (and counting) going after Lilly for fraud and restitution.

    Daniel Haszard

  2. I believe bipolar is basically a stress disorder, and if a child is being diagnosed with it, I would worry more about the parents. I’ve only seen bipolar, self included, in poeple who were under stress, had used drugs, or had some other de-stabilizing influence in their lives.

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