The doctors from the Bipolar Institute in Pittsburgh say that it can take years to properly diagnose bipolar disorder. Yet there has been a 4,000% increase in childhood bipolar diagnoses in recent years.
There are a couple of things happening here. First, the doctors I interviewed say they are simply better at identifying bipolar in children today than they were ten years ago. They believe these kids have always existed, but that doctors failed to recognize the symptoms of bipolar and called these children oppositional or diagnosed them with ADHD. But, at the same time, because there is still confusion about how to diagnose bipolar in kids, many doctors I interviewed told me that it´s very likely that the 4,000% increase in bipolar includes some number of misdiagnoses.
One of the doctors in your program refers to treating mood disorders in children as an “experiment” and a “gamble,” but we see him continually upping a four-year-old’s medication throughout the program. Why are doctors so willing to experiment with untested drugs in these cases?
Doctors are in a bind. They want to help families and kids that are suffering, and kids respond to medication. The problem is that, often, one medication will stop working or cause some side effect, so doctors, hoping to stabilize a child, are pushed to either increase a dose or add a second medication. It does seem that doctors sometimes are too quick to prescribe drugs to the kids. I felt in the course of making this film that many doctors quickly looked to medication to solve every problem. In the case you are referring to, for instance, the doctor suggested Xanax to help with a child’s anxiety before going to school. But was that really necessary? Many kids get anxious going to school. Also, I often wondered if doctors had enough time to really assess what was going on in a child’s life. HMOs don’t reimburse therapy as willingly as they reimburse medication management, so you have to wonder if the system isn’t being set up to favor medication over other forms of treatment.
I was surprised at how young many of these children were when they were diagnosed – four or five, or younger. How common has it become for children this young to be diagnosed with attention or mood disorders?
There are no epidemiological studies on bipolar in kids at the moment, but many doctors told us that they are seeing younger and younger children in their offices. Doctors also talkI was actually surprised by how little is known about most medications used in children. about genetic loading and genetic anticipation, a phenomenon where mental illness is happening at younger and younger ages. The symptoms of the illness are also more severe with each generation.
One set of parents in the film complains that doctors prescribed heavy medications like lithium when their child was practically a toddler, without ever suggesting therapy or alternative medicine. In your observation, is this common practice?
Many doctors told me that they don’t think young kids respond to behavior therapy as well as they do to medication – they say they don’t have the language skills to really make use of it. Others point out that some of these kids are so sick that they simply can’t benefit from therapy unless they are already on some medication to bring their symptoms under control. It is important, though, to note that the top studies sponsored by the National Institute of Mental Health suggest that medication alone is less effective than medication and behavior therapy in combination.
Do you think the FDA should be taking more responsibility for what’s getting prescribed to children?
I was actually surprised by how little is known about most medications used in children. The FDA spokespeople were very candid with me. They told me that there simply aren’t enough studies on drugs’ effects on kids and that every time they do learn something, it generally renforces the fact that what is true for adults isn’t true for kids.
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