This is one of the stickiest subjects ever... Should parents give their children psychiatric medications?
I don't think I have to tell you that I'm not arguing against a straw man here, or at least, a singular couch-jumping, Xenu-loving man. Many people are strongly against giving their children these meds. I've been one of them, until I've lived being The Kid's parent.
We hear stories about young children on psychiatric medications, with diagnoses we didn't know exist in children. There are horrible tragedies which pop these issues before us like the recent murder of Rebecca Riley, the four year old in the Boston area who was overdosed by her parents with a decongestant, an atypical antipsychotic, an anticonvulsant and an antihypertensive. We hear stories like Rebecca's and are quick to judge, and to be honest on this particular case I am among the judgmental--because really, this is a case of child abuse, isn't it? But when I first heard about it, I was able to quickly divorce the abuse issues from the mental illness issues. There is not a direct syllogism that if a) she was diagnosed bipolar so that b) she was given meds so that c) she died, therefore diagnosing children and giving them meds will lead to death. There was abuse, a questionable doctor and a horribly chaotic family situation mixed in there.
But I knew what was coming. I've been looking around the blogosphere in responses to this, and sure enough, there were many connections between giving her psychiatric meds and her death. I'll link a few, here and here, but there are more. There are not a lot of, "what horrible abusive parents" in these blogs, but there is a lot of "what are people thinking by giving children medication at all." Blogs were not alone in reporting in this fashion, most of the television reports that picked this story up were quick to segue into the “should you medicate your child” discussion, as if a malicious, premeditated murder is somehow a natural consequence of giving a child medications for a psychiatric condition.
Not all parents are the Rileys. Thank god. But reading around about this story made me feel like people do think that if you give your child psychiatric meds, you are the Rileys. But I say to the internet (and all 3 of you who read this blog--hi mom!): We are not. See, the Rileys, left to their devises, could have murdered their daughter in any number of ways, and given her circumstances, her father's history of sex crimes, the horrible abusive home, etc. Also, pretty much any prescription med could lead to death when given in excess, but for some reason... But I'm getting off of the point. This is a long lead-in for the meat of this post: why I'm compelled to tell you how I came to give The Kid psychiatric medications. So, let me frame the debate.
There's this assumption that children given meds are somehow similar to someone that a person grew up with. You will hear, "my cousin, growing up, was a spaz, but now he's an accomplished attorney and he never had to take ritalin" or something similar. You don't often hear about "that kid who came to my school in fifth grade, and everyone hated him because he got in fights all the time, cried until he slobbered that one day after he tried to throw an eraser at our teacher, and then in eighth grade he turned into a total dirty stoner guy... And I don't know what ever happened to that guy. Hmmm."
I'm not talking about your spazzy cousin. I'm talking about mentally ill children. Real mental illness in children exists, and there is a vast difference between the child who is often offered up as "energetic" or "creative" or "poorly disciplined" and one who suffers from debilitating anxiety, hears voices, cannot control his rage, does not sleep, masturbates at 5 years old, is compelled by the belief that were he not to count steps and hand washings he will hurt his family. But in most debates I hear on the subject, people stick with the familiar: highly active children vs. ADHD. ADHD is bandied about to the point that it sounds like every kid could be diagnosed with it. And while that's entirely possible that it is over diagnosed, it really does a great disservice to the kids who have it so severely that it hinders their ability to function.
I'm not the greatest fan of the diagnosis. I hate the figures cited that bipolar in children has increased 400% since 1990. An alarming figure, but it is a natural increase, actually, since juvenile onset bipolar disorder has only been included in the Diagnostic Statistical Manual-IV within the last 30 years. No mental health professional would say that the symptoms they list as consistent with bipolar didn't exist in children prior to 1990; it’s just that we didn't call it bipolar. A rose is still a rose by any other name. I would venture a guess and say that eventually, what we're calling bipolar in children today, will be split into different categories and/or called something completely different by future versions of the DSM.
So, if we take this discussion out of the realm of the "ADHD" vs. high energy child, the kids we all know, and into one of the child with serious issues of disability, allow me to describe why I believe The Kid fits into the latter category. Since he was born, he's been MORE. And I mean this literally, he is more of everything.
What I think a lot of people don't realize in the boom of mental illness diagnoses in children is a direct result of parents and schools trying to cater to children’s educational needs under the constraints of their own system. In order to qualify for special education services, kids need a diagnosis. Schools cannot diagnose children. Do you see where I’m heading here? We have to go to doctors for these diagnoses.
I’ve tried to find a definitive source for the average age that ADHD and bipolar is diagnosed in children. Some studies I’ve found state 6, Kindergarten aged, and others state 8, or 2nd grade. Regardless, I don’t think I’m grasping at straws to suggest to correlation to the beginning of school and the diagnosis of mental illness in children.
Regular classrooms cannot handle children with special needs, let alone severe special needs, because of the pressure they have to perform. In this age of results-based teaching, when a school is pressured to prove their “accountability” to teaching their students to tests, special education is a key component to tease out kids that can cause poor scores. Perhaps I’m too cynical, but I see this happening all over the state of Colorado. I recently got a letter from The Kid’s school district listing the percentage of “acceptable” C-SAP scores from last year. The district received passing scores in all demographics except for ‘limited English proficient’ students and ‘IEP’ or special education students. It is nice that they can exempt these students from the rest of their results, is all I’m saying. And isn’t nicer to identify these kids before they gum up your scores?