Thursday, February 11, 2010

More on Diagnoses and Medication

And some RTC (Response to Comments)

I learned today that the proposed DSM-V is available online for review and commenting! The site is easy to navigate and provides a pretty comprehensive outline of what is being taken out, left in, or modified in the new manual. If you work (or live!) with anyone affected by mental health issues, I encourage you to not only go look it over - but give them feedback!

Overall, it sounds like some of the changes may reduce the number of people being diagnosed - and in my opinion, that is a good thing. It also appears that they are trying to get doctors to focus on the symptoms and severity - instead of a label - which is HUGE in my book. I believe its less important to diagnose than it is to treat the symptoms and their root causes. I believe that mental health issues can start in infancy - but also believe that is when they are most treatable! (See my post for more about my experience with Infant Mental Health.)

The amount of overlap between disorders is vast, especially in children. A child presenting with irritability, frequently losing their temper, refusing to obey requests, impulsivity, aggression, and sleeplessness could be diagnosed with ADHD, ODD, Bipolar, Intermittent Explosive Disorder, or Major Depressive Disorder - just for starters.

But is it really so important what we call it? Or is it more important to find a way to help that child (and that parent) manage those symptoms? I'd go with the latter. (For more on Diagnosing Young Children see my post here.)

Most psychotropic medications are not tested or approved for use in children or adolescents. NO psychotropic medications have been tested or approved for children under 6 years old - NONE. Therefore, psychiatrists rely on case studies and "trial and error" in order to find mediciations that may or may not alleviate the child's symptoms. Even if a combination of medications if found which helps the child to function at a higher level - we do not know the long term effects of putting children of any age on medication.

We do know that some of the short term side effects include weight gain, increased aggression, sleep disturbance, tics and increased risk of suicide. You wouldn't cut off the child's leg just because they skinned their knee or developed a allergic rash, would you? Of course not. These are issues that need to be considered - medicine is not the "easy way out" for the child. As with any illness - the least invasive treatments should be considered first. That is my professional opinion.

******Response to Comments******

SanitySrchr - I agree. Parents today need to be EDUCATED about appropriate childhood behavior. This SHOULD be done by their psychiatrist prior to prescribing medication. Parents are often not told about the severity of side effects or given the alternatives such as behavior modification or therapy. They are not educated about all of their options - they are written a prescription.

Sarah - I've known more than one two year old diagnosed with Bipolar. It makes me want to scream.

Anonymous - You are correct, I am neither parent nor psychiatrist. I am, however, trained and authorized to diagnose individuals and children with mental disorders.

Does every doctor have to have had an illness before they can appropriately treat it? Does every lawyer have to have been on trial before they can represent a client? Does every interior decorator have to live in the house before they can suggest carpet? No.

I do have perspective - a clinician's perspective. Sometimes the person IN the situation can not see things as clearly as someone on the outside.

I clearly state above that no ONE person knows everything and therefore, I recommend that parents do a lot of thinking, research, and talking to many professionals before deciding on the best course of treatment - medicinal or otherwise - for their child.


  1. oooh smack down on the anonymous comment lady. i like your response- it was well put.

  2. Well said!

    I left you an award over on my blog! Come check it out!

  3. Well said!

    I left you an award over on my blog! Come check it out!

  4. I think there needs to be more access to (and more providers trained in) non-invasive therapies for children. For example, some promising research has been done on neurofeedback to treat ADHD. I recently learned about something called the interactive metronome that is supposed to assist with impulsivity, to include oppositional behaviors. When I asked how much it would cost to get trained in this I was told the price tag is probably about $1500. Ouch! If the training was affordable I'd definitely get it!!! The more providers who are trained in these techniques the more these treatments are available to children.


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