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.
Obviously, it is often difficult to separate normal childhood anxieties from more serious signs of a disorder. Is this burden largely falling to parents? What can parents do to be better informed about the risks and benefits of medication?
Parents need to realize that the field of child psychiatry is in its infancy. That doesn’t mean that it’s not advancing nor that the medications don’t work, but there is a long way before the field catches up with the rest of mainstream medicine. I think parents need to ask hard questions of the doctors they see. And as often as possible, they should try to see specialists in a given field.
You take a brief look at Brain Matters, a Dr. Phil-endorsed company that has offices in shopping centers and malls, where children are diagnosed with various disorders using brain scans. But brain scans aren’t yet considered a reliable clinical tool. What accounts for the popularity of Brain Matters? Is it setting a dangerous precedent?
Diagnostic centers like Brain Matters exist because parents are desperate for answers. They’d like to find conclusive evidence that something is physically wrong with their child before they resort to medication. But the scans used by these centers just show blood flow patterns in the brain, and none of the experts we spoke to said these patterns were any real help in making a diagnosis in a single patient. The brain is the most complex organ in the body, and some of the top researchers cautioned that these scans are not reliable.
Hypothetically, after researching this special, would you be more or less likely to consider prescription drugs for your children?
I have to admit that I entered this project believing in the benefits of psychiatric medications and have come away knowing that they can be incredibly helpful, but I’m also wary of them. This film is a call to action. Families and children deserve more research. As a seven-year-old, I was diagnosed with bone cancer. That was back in 1975, where 90% of kids did not survive a cancer diagnosis. I was given many experimental drugs that ultimately saved my life. There was no research on many of these protocols back then, but ultimately pediatric oncologists set up a system whereby every child that received treatment was part of a clinical trial. In the thirty years since, the survival rate of pediatric cancer patients was turned around. This film advocates a similar model.
This documentary was a follow-up to one that you produced in 2001 about the same topic. What changes have you observed between then and now?
I am surprised by how the number of children on psychiatric medications continues to rise. It seems as if ADHD paved the way for even more complicated diagnoses like bipolar. In 2001, the issue of medicating kids with psychiatric drugs was boiling over. There were heated hearings nationwide and the scientologists were actively protesting and shouting. The debate exists today, but it’s on the internet, in blogs and chat rooms across the country. I feel this debate really needs to be taken to a different level. Six million children are on psychiatric medications. They deserve to have the research that tells doctors which drugs work best, what combinations work least, what is the long term impact of being on these drugs, can you outgrow some of these mental illnesses, what are the long term outcomes of some of these disorders. Right now we don’t have these answers. And that is a tragedy.
The Medicated Child airs Tuesday, January 8th, 2008, at 9 p.m. on PBS.