Debate Over Children and Psychiatric Drugs

sanctus

The Padre
Oct 27, 2006
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By BENEDICT CAREY
Early on the morning of Dec. 13, police officers responding to a 911 call arrived at a house in Hull, Mass., a seaside town near Boston, and found a 4-year-old girl on the floor of her parents’ bedroom, dead.
She was lying on her side, in a pink diaper, the police said, sprawled across some discarded magazines and a stuffed brown bear.
Last week, prosecutors in Plymouth County charged the parents, Michael and Carolyn Riley, with deliberately poisoning their daughter Rebecca by giving her overdoses of prescription drugs to sedate her.
The police said the girl had been taking a potent cocktail of psychiatric drugs since age 2, when she was given a diagnosis of attention deficit disorder and bipolar disorder, which is characterized by mood swings.
The parents have pleaded not guilty, with their lawyers questioning whether the child should have been prescribed such powerful drugs.
The case has shaken a region known for the excellence of its social and medical services. The director of the state’s Department of Social Services has had to defend his agency, which had been investigating the case before the girl’s death.
The girl’s treating psychiatrist has taken a voluntary, paid leave until the case is resolved. And New Englanders are raising questions that are now hotly debated within psychiatry, and which have broad implications for how young children like Rebecca Riley are cared for.
Tufts-New England Medical Center, where the child was treated, released a statement supporting its doctor and calling the care “appropriate and within responsible professional standards.”
Indeed, the practice of aggressive drug treatment for young children labeled bipolar has become common across the country. In just the last decade, the rate of bipolar diagnosis in children under 13 has increased almost sevenfold, according to a study based on hospital discharge records. And a typical treatment includes multiple medications.
Rebecca was taking Seroquel, an antipsychotic drug; Depakote, an equally powerful mood medication; and Clonidine, a blood pressure drug often prescribed to calm children.
The rising rates of diagnosis and medication use strike some doctors and advocates for patients as a dangerous fad that exposes ever-younger children to powerful drugs. Antipsychotics like Seroquel or Risperdal, which are commonly prescribed for bipolar disorder, can cause weight gain and changes in blood sugar — risk factors for diabetes.
Some child psychiatrists say bipolar disorder has become an all-purpose label for aggression.
“Bipolar is absolutely being overdiagnosed in children, and the major downside is that people then think they have a solution and are not amenable to listening to alternatives,” which may not include drugs, said Dr. Gabrielle Carlson, a professor of psychiatry and pediatrics at Stony Brook University School of Medicine on Long Island.
Paraphrasing H. L. Mencken, Dr. Carlson added, “Every serious problem has an easy solution that is usually wrong.”
Others disagree, insisting that increased awareness of bipolar disorder and use of some medications has benefited many children.
“The first thing to say is that the world does not see the kids we see; these are very difficult patients,” said Dr. John T. Walkup, a child and adolescent psychiatrist at the Johns Hopkins University School of Medicine.
Dr. Walkup said that when drug treatment was done right, it could turn around the life of a child with a diagnosis of bipolar disorder.
Dr. Jean Frazier, director of child psychopharmacology at Cambridge Health Alliance and an associate professor at Harvard, said that up to three-quarters of children who exhibit bipolar symptoms become suicidal, and that it is important to treat the problem as early as possible.
“We’re talking about a serious illness with high morbidity, and mortality,” Dr. Frazier said, “and for some of these children the medications can be life-giving.”
Still, most child psychiatrists agree that there are still questions about applying the diagnosis to very young children. Recent research has found that most children who receive the diagnosis are emotionally explosive but do not go on to develop the classic features of the disorder, like euphoria. They are far more likely to become depressed.
And many therapists have found that some patients referred to them for bipolar disorder are actually suffering from something else.
“Most of the patients I see who have been misdiagnosed have been told they have bipolar disorder,” said Dr. Bessel van der Kolk, a professor of psychiatry at Boston University who runs a trauma clinic.
“The diagnosis is made with no understanding of the context of their life,” Dr. van der Kolk said. “Then they’re put on these devastating medications and condemned to a life as a psychiatry patient.”
Details about what happened to Rebecca are still emerging. A relative of her mother, Carolyn Riley, 32, told the police that Rebecca seemed “sleepy and drugged” most days, according to the charging documents.
One preschool teacher said that at about 2 p.m. every day the girl came to life, “as if the medication Rebecca was on was wearing off,” according to the documents.
Defense lawyers are also focusing on the question of medication. “What I want to know,” said John Darrell, a lawyer for Mr. Riley, “is how in the world you diagnose a 2-year-old and give her these strong medicines that are not approved for children.”
A lawyer for Rebecca’s psychiatrist, Dr. Kayoko Kifuji of Tufts-New England Medical Center, did not return calls seeking comment.
Some experts say the temptation to medicate can be powerful.
“Parents very often want a quick fix,” Dr. Carlson said, “and doctors rarely have much time to spend with them, and the great appeal of prescribing a medication is that it’s simple.
“To me one of the miracle of children’s brains is that we don’t see more harm from these treatments.”
Katie Zezima contributed reporting from Boston.

 

tamarin

House Member
Jun 12, 2006
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I am amazed at all the doctored kids these days. ADD, Bi-Polar and then you have to look at all the puffer-addicted children. Never saw them when I was a kid. And we had big classrooms. No ADD, none bi-polar, no asthmatics. Guess it was because most families had a dad at home then, whose word was law. Yup, and smoked like a trooper and drank like a fish. It is bizarre to see all these afflicted and diagnosed young people in the last many years. Something's gone wrong somewhere. It has to be diet.
 

hermanntrude

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Jun 23, 2006
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it was most like because there were less pollutants, rather than any fathers being around. smoking actually CAUSES asthma. Maybe you didnt see many asthmatics back then because those who had it bad enough died.

It's shocking though that a 2 yr old could be given such a prescription. I wonder if they analysed her diet before shoving pills down her throat?
 

tracy

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Nov 10, 2005
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I believed that children couldn't be diagnosed with disorders like bipolar because by definition they apply to adults.
 

Ariadne

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Aug 7, 2006
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I believed that children couldn't be diagnosed with disorders like bipolar because by definition they apply to adults.

Over medicating young children is a very serious problem in today's society.

I couldn't agree more. I remember single mothers 15 years ago that didn't have the energy to keep up with their active, growing, energetic 12 year old boys so they put them on ritalin. The moms then enjoyed the bar and club scene with a docile child that did nothing but eat and stare at the television. What a remedy!

In recent months, my son saw a neurologist for migraine. I was put in touch with the department pharmacist so we could try different medications for ongoing migraine management. We were given one medication at 10 milligrams. After taking it, my son was sooooooooo hyper that I eventually told him to lie on the couch and stick his legs in the air so he could wobble them around without having to keep moving around the house. I notified the pharmacist of his reaction and the dosage was immediately reduced to 5 milligrams. My next question was: which is the correct dosage for a child this age with this weight? Are we using him as a guinea pig? The worst side effect is that the associated weight gain, which they said was temporary, has not yet cleared up after 6 months. He went from a bean pole to a rather chubby little guy.

I have done my best to be vigilant about medications but a few months ago put my trust in the doctors and did everything they said. It made absolutely no difference ... except the guinea pig part.

Best of all, the migraines are caused by Chinook winds. This much has been documented. The latest recommendation ... drum roll ... he should see a psychologist. Now, I wasn't aware that psychologists could cure a physiological reaction to Chinook winds. I do know that anyone that sees a psychologist will come away thinking first, that they have some problem, and secondly (after much treatment), that the problem has been cured. Is that a good idea for a child? I'm skeptical.

I'm just plain skeptical of medical doctors because of some of the funny stuff I've scene.

That's my rant on the topic ... and I definitely think that parents should research before they medicate their children. A 2 year old child diagnosed with bipolar behavior and ADHD ... that is nuts. Did the parents think they were getting a puppy?
 

ShepherdsDog

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Feb 12, 2007
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Gee mood swings in a two year old means they suffer from bi-polar disorder???? Funny, I thought that meant they suffered from being two years old. I have to agree that there is a tendency to over medicate our society and it is getting out of hand. Once upon a time people were just seen as being active, sad, shy, nervous, morose, bubbly, stupid or loners. We were seen as being unique with our own quirky personalities, which made us interesting. Now we are all suffering from disorders that need to be treated. Who has set this standard of what qualifies normal? The Drug companies? Social engineers? What's next Paxil and Prozac coming in different flavours for children? We're humans for Christ's sake, not Vulcans.
 

Ariadne

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Aug 7, 2006
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Gee mood swings in a two year old means they suffer from bi-polar disorder???? Funny, I thought that meant they suffered from being two years old. I have to agree that there is a tendency to over medicate our society and it is getting out of hand. Once upon a time people were just seen as being active, sad, shy, nervous, morose, bubbly, stupid or loners. We were seen as being unique with our own quirky personalities, which made us interesting. Now we are all suffering from disorders that need to be treated. Who has set this standard of what qualifies normal? The Drug companies? Social engineers? What's next Paxil and Prozac coming in different flavours for children? We're humans for Christ's sake, not Vulcans.

The terrible twos ... that stage where children are trying to find their boundaries and when it is really important for parents to be very consistent in defining those boundaries for their children.

You know what I think is going on? I think a lot of people are choosing a career over family. When those people become professionals advising on, or treating, young children ... they simply don't know what they're talking about. A sensible doctor would look at a persistently misbehaving child and wonder what the parents are up to.

Additionally, children are subjected to multiple caregivers, all of which may have differing ideas about childcare. Naturally, children will try to find the boundaries. If 3 people speaking 3 different languages only speak to the child in their own language, the child will learn to respond to each person in the specific language. If there is any compromise ... such that one person decides to speak all 3 languages, the child will come to expect compromises whenever it suits the child.

No wonder children are mixed up while single, or single with a couple of nannies, professionals are making it worse.

I really have to wonder what a 4 year old is doing in diapers ... as though that doesn't tell the whole story!!! Let's keep in mind that some 4 year olds are playing musical instruments and most 4 year olds have learned how to use the toilet. Some parents are too busy to give their child a calm, stable home environment and end up with really mixed up children - on serious pharmaceuticals. This child had so called "behavioral" issues, not neurological ones ... and potty training was obviously one of the behavioral or stress related issues.
 

selfactivated

Time Out
Apr 11, 2006
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Apparently I was wrong. There is no specific lower age limit to the DSM IV diagnosis of bipolar disorder. I found the notion that mania (one defining characteristic of bipolar disorder) is being mistaken for ADHD to be an interesting idea.

http://www.bpkids.org/site/PageServer?pagename=lrn_about


My Critter was diagnosed at 5 to be Bi Polar. Before I was diagnosed the second time and after he molested by his Dad. Manic episods are different in children usually angry and defiant. After years of one med after another it was impossible to keep him on them. And truthfully until his death we all thought he was better without meds. But he died doing a very risky behavior (AeA) and frankly i think if he was medicated it might have saved him.
 

Ariadne

Council Member
Aug 7, 2006
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My Critter was diagnosed at 5 to be Bi Polar. Before I was diagnosed the second time and after he molested by his Dad. Manic episods are different in children usually angry and defiant. After years of one med after another it was impossible to keep him on them. And truthfully until his death we all thought he was better without meds. But he died doing a very risky behavior (AeA) and frankly i think if he was medicated it might have saved him.

I'm sorry to hear about your son. I read the thread about the cause. I am curious about how old your son was and whether bi-polar medications and diagnosis were comman at that time. Freud and Jung are not that old so all of these theories, whether psychiatric or psychological, are only from the last century and basically accepted at face value.
 

selfactivated

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Apr 11, 2006
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I'm sorry to hear about your son. I read the thread about the cause. I am curious about how old your son was and whether bi-polar medications and diagnosis were comman at that time. Freud and Jung are not that old so all of these theories, whether psychiatric or psychological, are only from the last century and basically accepted at face value.

Critter was 5 diagnosed he was 22 when he died. Unmedicated Bi Polars life span is VERY short. During his growing up he had out bursts that Id have to give him controled hugs (basically I straight jacketed him with my body) But as he got older Id get hurt trying. He was just to big. He also practiced cutting.....although Im not sure if that was a learned behavior from me, as I did it too. His IQ was high but his grades were low and he couldnt concintrate on anything but TV for more than 5 mins.

No bipolar wasnt common then
 

Sparrow

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Nov 12, 2006
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Critter was 5 diagnosed he was 22 when he died. Unmedicated Bi Polars life span is VERY short. During his growing up he had out bursts that Id have to give him controled hugs (basically I straight jacketed him with my body) But as he got older Id get hurt trying. He was just to big. He also practiced cutting.....although Im not sure if that was a learned behavior from me, as I did it too. His IQ was high but his grades were low and he couldnt concintrate on anything but TV for more than 5 mins.

No bipolar wasnt common then

I am not surprised about the problems he had after what happened to him. There are children who definitly do have problems that need to be medicated there is no doubt. However today too many children are medicated without extensive testing just the word of the family doctor. For instance the use it Ritalin, they only time is should be given is after extensive neurological testing of brain waves. Even schools have gotten in on the game demanding that a child who they say is over active will not be allowed back in school unless he/she is on ritalin.

Children today are getting a raw deal with all these medications. Sometimes I wonder if the drug companies are not testing the medications through the doctors on children whether they really need them or not. A good example of this is when they were testing hormones for women, they tested them on 40,000 men and not one women. Then they proceeded to convience the doctors to give them to their female patients. When you know this anything is possible.
 

Vereya

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Apr 20, 2006
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I cannot say anything from experience. so I guess you'll correct me if I am wrong. I think that a stable family and proper attention from parents is something that any child needs much more than medication. It is much easier to give your kid a pill or two when he misbehaves, or is being too loud or noisy, than to talk to him, to explain things, to teach and to talk. It takes too much time and effort, so many parents would probably give a pill and go about their own affairs. I am not talking about genetic disorders right now, it is a different things altogether. But putting small children on potent medicines in case they are too active, or absent-minded means (in my opinion) turning them into zombies.
 

Ariadne

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Aug 7, 2006
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I cannot say anything from experience. so I guess you'll correct me if I am wrong. I think that a stable family and proper attention from parents is something that any child needs much more than medication. It is much easier to give your kid a pill or two when he misbehaves, or is being too loud or noisy, than to talk to him, to explain things, to teach and to talk. It takes too much time and effort, so many parents would probably give a pill and go about their own affairs. I am not talking about genetic disorders right now, it is a different things altogether. But putting small children on potent medicines in case they are too active, or absent-minded means (in my opinion) turning them into zombies.

There are probably a few legitimate cases of ADHD and bi-polar disorder, but it can't possibly be as high as the number of children treated for the disorders. When my son was on crazy medications last Spring, he completely lost his sense of humour. It wasn't that he was ill-humoured, he just stopped joking around ... no fun for me.
 

Ariadne

Council Member
Aug 7, 2006
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Critter was 5 diagnosed he was 22 when he died. Unmedicated Bi Polars life span is VERY short. During his growing up he had out bursts that Id have to give him controled hugs (basically I straight jacketed him with my body) But as he got older Id get hurt trying. He was just to big. He also practiced cutting.....although Im not sure if that was a learned behavior from me, as I did it too. His IQ was high but his grades were low and he couldnt concintrate on anything but TV for more than 5 mins.

No bipolar wasnt common then

I've just been reading up on bi-polar disorder in children. Have you ever thought of writing a book about your experience of raising a child with BPD? It would be useful in educating the public about the experience. It seems that medications are not tested on children so doctors use trial and error to find what medications work on children ... seems like a rather dangerous experiment but perhaps necessary in some situations.
 

marygaspe

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Jan 19, 2007
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There are probably a few legitimate cases of ADHD and bi-polar disorder, but it can't possibly be as high as the number of children treated for the disorders. When my son was on crazy medications last Spring, he completely lost his sense of humour. It wasn't that he was ill-humoured, he just stopped joking around ... no fun for me.

I agree. I find that often drugs are used to control children rather than actually dealing with their behavioural problems. I raised three kids, and when they acted up, they got disciplined. when they got out of hand in public, they got taken home and under no circumstances did we allow them to misbehave in public. I think it boils down to who is in control! And these days, I fear it is the children.
 

Curiosity

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Jul 30, 2005
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http://www.pendulum.org/bpnews/archive/001870.html

There may be two separate and distinct syndromes, but regarding a child of two through five I would rather treat behaviorally than with medication alone - each child absorbing the medications in a different way and to be certain I would prefer to ascertain there wasn't a physical abnormality cause as well. Chronic medication for tiny children is a gamble in my book..... and it is often prescribed to relieve the parents than the child - perhaps a mild tranquilizer for the parents and leave the child alone before medicating...some of these medications are hugely potent - even in adults.

February 1, 2007

Extreme irritability -- is it childhood bipolar disorder?

filed under Childhood Bipolar Disorder
Results of a new study may help improve the diagnosis and treatment of two debilitating childhood mental disorders -- pediatric bipolar disorder (BD) and a syndrome called severe mood dysregulation (SMD). When the brain's electrical signals were measured during mildly frustrating situations, researchers from the National Institute of Mental Health (NIMH), of the National Institutes of Health, found a very different pattern in children with SMD, compared with children who had BD. The results indicate that different brain mechanisms may lead to irritability in children with SMD, suggesting that they may have an illness other than BD and may require different treatments.
"These aren't children with the occasional bad moods you see in most kids. They're typically very ill, with symptoms that interfere with their lives in major ways. Establishing clear diagnostic criteria is an essential step toward making sure they get the help they need," said NIMH Director Thomas R. Insel, M.D.
Children have a comparatively low rate of BD, but the rate increases with age, to approximately 1 percent among adolescents. About 3 percent of pre-adolescent and adolescent youth are estimated to have SMD. Mood-stabilizing and antipsychotic medications are used to treat children with BD, although the data on their effectiveness are limited and several studies are underway. Since SMD was only recently defined, there are no systematic studies on its treatment, and children with SMD are often treated as if they have BD.
Defining pediatric BD is a major issue in child psychiatry, because the disorder tends to be severe in this age group and the rate of diagnosed cases is rising. Until recent years, most studies of BD were conducted in adults. Some researchers maintain that pediatric BD should be defined more broadly to include children with SMD, an assertion countered by the new finding. Results of the study were published in the February 2007 issue of the American Journal of Psychiatry.
The classic definition of BD includes extreme, sustained mood swings that range from over-excited, elated moods and irritability -- the manic phase of the disorder -- to depression. In contrast, children with SMD are extremely irritable and hyperactive, but do not have clear-cut manic episodes.
One component of irritability is the tendency to get acutely frustrated when a goal is not met. Thus, through electroencephalograms (EEGs), the researchers could observe the brain's electrical signals that occurred during frustration while children with either disorder performed simple tasks.
The new study shows that clinicians some day could use biological measurements, such as EEGs, to help make psychiatric diagnoses, in combination with clinical symptoms. Currently, clinicians diagnose mental illnesses based on symptoms alone. The difficulty of diagnosing BD in children is compounded by the frequent co-occurrence of one or more other mental disorders.
"We're approaching the day when we'll be able to use neuroscience techniques to improve psychiatric diagnoses. Pediatric BD has some of the most pressing needs in this regard, because of its severity and because of questions about how to best make the diagnosis," said senior author Ellen Leibenluft, M.D., Chief of the Unit on Bipolar Spectrum Disorders in the Emotion and Development Branch of the NIMH Mood and Anxiety Disorders Research Program.
In this study, scientists obtained EEGs of 35 children with classic BD, 21 children with SMD, and 26 healthy children (average age 12 to 13) while they performed a task repeatedly; each time they did the task, they won or lost 10 cents. The task was frustrating because the children often lost money.
The researchers found that while both the children with BD and those with SMD became more frustrated than did healthy children performing the same task, the brain mechanisms associated with their frustration differed. Children with BD had an abnormality in the brain's P3 electrical signals, which measure ability to purposefully direct attention, but children with SMD had abnormalities in N1 signals, which occur when a stimulus grabs someone's attention. Both abnormalities suggest deficits in the brain's attention-related activity, but in different phases of that activity.
"If future research indicates that BD and SMD are two separate disorders, this could guide parents and physicians toward the right treatments," said first author Brendan Rich, Ph.D., of the NIMH Unit on Bipolar Spectrum Disorders. "A good example is that medication prescribed for symptoms seen in SMD, such as stimulant medication, might be inappropriate for a child with classically defined bipolar disorder," he said.
Source: NIH/National Institute of Mental Health
Posted by szadmin at February 1, 2007 9:35 AM

More Information on Childhood Bipolar Disorder
 

Ariadne

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Aug 7, 2006
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I agree. I find that often drugs are used to control children rather than actually dealing with their behavioural problems. I raised three kids, and when they acted up, they got disciplined. when they got out of hand in public, they got taken home and under no circumstances did we allow them to misbehave in public. I think it boils down to who is in control! And these days, I fear it is the children.

I met a woman once that had a very difficult teenage daughter. The mom said that her daughter has been in control since she was 2. I was shocked. Children want and need boundaries and are much happier and well balanced when they know where they are.

I'm no perfect parent, but I firmly believe that children need their parents to parent them when they are in their formative years ... up to the age of 6. Multiple caregivers are probably fine for most children, but some children need a parent around that can recognize specific needs in their child ... something that a paid caregiver may not be able to see. If a child is acting out, caregivers just deal with the symptoms but parents are in a position to recognize patterns of behavior and modify the behaviors to be more socially acceptable. Migraines are like that ... no one would understand why a young child always has headaches and vomits but a parent can take the time to chart the symptoms, identify the causes and try to manage the situation.

One of the symptoms associated with childhood BPD is separation anxiety. If a child is placed in public care from an early age and has separation anxiety, the situation will become much worse. The caregiver will treat the symptoms, but the problem is never resolved.
http://www.bpkids.org/site/PageServer?pagename=lrn_about