Children and mental disorders – when is too soon for diagnosis?
I spend a decent chunk of my time cruising chat boards and reading journals, news, social media posts and such about mental disorders. My own “specialties” are Bipolar Disorder, Adult ADHD, Autism Spectrum Disorder… Borderline Personality Disorder, Anxiety Disorder, Depression, Abuse Disorders, OCD… nevermind – I really “specialize” in them all, because I know most of these disorders within my social circle, and I know them on a professional level.
Anyway, I was on a Facebook page the other day for ADHD. (attention deficit hyperactivity disorder) A woman posted a question about how to manage a kid with ADHD who wakes up and wreaks havoc within the house while everyone is trying to get ready for school and work. Naturally he was disagreeable, confrontational, oppositional, had “meltdowns” – and it was all exhausting. (pretty typical behavior for a truly ADHD kid) A therapist once told me that the ADHD brain doesn’t “wake up” right away and cause all this trouble partly because their brain is not actually engaged yet. The mom was asking for advice.
Comments on the page gave some really good answers. Some of them are common. Like plan your morning before you go to bed (get out clothes, get backpack ready, make lunch), let the kid make some choices – blah blah blah, stuff we have all heard.
Others were less common, but possibly better advice. Advices like; give the kid an extra 30 minutes to “wake up” in silence, give the child an incentive to get dressed NOW – like playing Minecraft after he is dressed. I handle mine with the “don’t talk to him yet” option – waiting about 20-30 minutes before making him get busy. His siblings aren’t allowed to bug him during this time either. He can wrap himself in a blanket, stare at the wall or whatever – just don’t go back to sleep.
One lady suggested that the kid should be woken to take his meds an hour before he has to be out of bed. Then let him go back to sleep so that his medicines are working by the time he actually gets up. I found that last piece of advice to be very helpful. My husband with adult ADHD takes his meds about 4 am and gets up at 6, ready to go rather than rude, obnoxious and unhelpful.
What troubled me was a comment from a woman who didn’t actually give advice, but chimed in to complain about how hard her four-year-old was to manage. She said that he had been diagnosed with ADHD and was on meds, but also said that he had bipolar disorder, and still was a screaming banshee in the morning. This gives me pause for concern.
I certainly can’t do anything about this particular kid, and I don’t really know the exact circumstances but I find the dual diagnosis with bipolar disorder very troubling for a four-year-old child. Certainly, kids can exhibit ADHD symptoms at 4, and some will benefit from treatment. But the medications weren’t working, and I am not so sure about the bipolar disorder.
Traditionally, until a few years ago, no one was willing to consider bipolar disorder as a pediatric concern. Still today, though bipolar disorder obviously exists in childhood – most of the major issues don’t come out until adolescence.
The Diagnostic and Statistical Manual of Mental Disorders does not recognize the bipolar disorder in children under the age of 13
The National Institutes of Mental Health does acknowledge that bipolar disorder in children MAY exist but also warns that many children are misdiagnosed when the main problem is ADHD. NIMH recommends that these children be labeled with Mood Dysregulation Syndrome until such time as a diagnosis can be relied upon.
The main problem in diagnosing young children with any mental disorder is that symptoms in children are vastly different from those in adults. To complicate matters, symptoms of various disorders in children are similar to one another.
Symptoms such as irritability, excessive mood swings, meltdowns, oppositional behavior, trouble in school, social inadequacies, explosive behavior, frequent frustration, and hyperactivity, etc. can point to a number of disorders. Frankly the child may be ADHD, Bipolar, Depressed, Autism Spectrum… or even have food intolerance.
Because of our family history (not just mine), I watch my children very carefully. I do analyze everything that happens, and I know that all of them probably have a disorder of one type or another. Two may have ADHD, one is likely bipolar and one has Asperger’s or mild ASD. I have sought treatment for some issues – but with others, I hesitate to run to a physician – likely a pediatrician who just doesn’t really know.
Our understanding of mental disorders is still evolving
I was personally diagnosed with the wrong disorder for over 15 years – and I was an adult. How damaging would it have been if I had been labeled with a disorder that I did not have when I was only four years old?
The particular woman I described with the dual diagnosis child was beside herself. Despite the fact that the four-year-old was receiving medical treatment for both disorders – it wasn’t working. To me, this means that the treatment was with the wrong meds and for the wrong disorder(s). In addition, her management skills weren’t the best.
As I said, I know that my children are likely to have disorders of their own but I don’t want to treat them for just any disorder. I will want them to be treated for the right disease. My advice to this parent, or any parent whose child had been put on medication that wasn’t working would be to seek a second opinion.
I am more emphatic about that advice if the doctor was willing to “add” a diagnosis to provide more medication; she should definitely seek another opinion. Preferably the opinion of a pediatric psychiatrist – or even a pediatric behavioral neurologist. These specialists are few and far between, but it isn’t worth doing anything, but suffering through all the misery because the treatment isn’t working.
Medications are beneficial in the treatment of some types of mental disorders, but they do “change the brain”. That is how they work – changing the brain can be harmful if you are changing it in the “wrong” directions. Just seems like common sense.