I have ranted here and to friends for years about the madness that passes as diagnosis of children's mental health problems. In the days since I stopped working with kids -- which I did not long after I had kids of my own -- the fashion changed and it has seemed to me that for the last decade or more it has been medication all the way. It started with seeing every kid who acted out or failed to be an A student as ADHD and putting them on Ritalin. That was already happening 25 years ago. Then Prozac and then bipolar and the slew of drugs for that.
So I felt vindicated today when I read both intueri and The Last Psychiatrist decrying the kind of thinking -- or lack thereof -- that led to the death of a 4 yr old Rebecca Riley who was being treated with 3 different psychiatric medications for bipolar disorder, for which she had been treated since age 2 1/2.
I am gobsmacked that anyone could diagnose a young child as bipolar in the first place, much less using the criteria that intueri cites. And delighted by this from The Last Psychiatrist:
"it is not unlikely a 4 year old has bipolar-- it is absolutely impossible. This is because bipolar disorder is not a specific disease with specific pathology that one can have or not have; it is a description of symptoms that fall together. We decide to call a group of behaviors bipolar disorder-- and meds can help them, for sure-- but this decision is completely dependent on the context of the symptoms. Being four necessarily removes you from the appropriate context, in the same way as having bipolar symptoms during, say, a war, also excludes you from the context. You might still have bipolar, but you can't use those symptoms during the battle as indicative of it. If I transplant you to Brazil, and you can't read Portugese, does that make you an idiot? "
Most kids with behavior problems respond to behavioral treatment approaches. Yes, that treatment takes longer than medication does and means that parents and teachers and other people involved in the child's care have to be taught how to respond more appropriately to the behavior. I am willing to bet that a huge percentage of kids diagnosed as bipolar would be better served by a visit from Supernanny. Better results and no negative side effects!