Troubled Children Face Difficult Diagnoses
> 11/13/2006 12:02:45 PM

Quite a few laymen respond with suspicion when reading of bipolar diagnoses in children, considering it a strictly adult affliction and placing blame on an increasingly aggressive tendency to solve childhood behavioral problems with medication. One must, however, consider the endless spectrum of analysis and treatment, knowing that successful diagnosis often evolves over time and requires an intimate knowledge of a patient's medical history and disposition. The concept of trial and error may be difficult for young people, but it is an essential tool for eventually developing more specific and effective treatments. Such techniques require patience and devotion on all sides.

Recent federally-funded research estimates that as many as 7% of children seeking psychiatric care display clear symptoms of bipolar disorder. Studies by The National Institute of Mental Health state that 26% of the general population regularly report symptoms that could qualify for mental health-related diagnoses. At least half of all cases become visible by age 14 and two-thirds show themselves by age 24, though treatment often comes years or decades later. If these intial symptoms pass unnoticed or dismissed, they can easily lead to compounded problems in adulthood. Early diagnosis may, at the very least, allow for gradual reduction of the potentially debilitating effects wrought by mental illness.

In the second installment of a continuing New York Times feature on "disturbed" children (the first of which was also covered by Treatment Online), the authors refer to childhood psychiatric treatment as an "imperfect" practice that often amounts to "more of an art than a science." What they fail to properly consider is the fact that such treatments evolve over time as doctors move to further understand the mental states of their patients and address them accordingly. While children are often unaware of their own symptoms or hesitant to discuss them, this does not make them any less real or observable through regular analysis. Of course, depression and its related disorders are not as simple as the common cold, and children displaying complex or contradictory symptoms often require long-term, multi-faceted forms of response. Such is the nature of the problem.

Mental illness often surfaces in the prime of young adulthood, when it threatens to permanently alter the course of a patient's life. The relative scarcity of psychiatrists specializing in childhood afflictions only reinforces the weight of this problem. Those who would explain away the twofold increase in bipolar diagnoses among young men from 1995 to 2000 with a "boys will be boys" retort are downplaying a very serious issue. The rate of overall mental illness diagnosed in young people has tripled in the last fifteen years, and this sea change cannot be wholly attributed to the ulterior motives of pharmaceutical representatives encouraging more frequent medication and greater profit margins.

The mood swings common to many young people make the bipolar issue particularly difficult, as periods of increased activity can be falsely attributed to mania or ADHD, but the number who find satisfactory treatments makes the larger effort worthwhile. While some instance of misdiagnosis is inevitable, the majority of children whose parents seek psychiatric help could benefit from some form of treatment or medication. According to Jane E. Costello, a Duke University professor of psychiatry and behavioral sciences...

If a family can find some combination of treatments that help a child improve, “then the diagnosis may not matter much at all.”

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