A Note From A Child Psychiatrist

By Elizabeth J. Roberts
Sunday, October 8, 2006

I have been treating, educating and caring for children for more than 30 years, half of that time as a child psychiatrist, and the changes I have seen in the practice of child psychiatry are shocking. Psychiatrists are now misdiagnosing and overmedicating children for ordinary defiance and misbehavior. The temper tantrums of belligerent children are increasingly being characterized as psychiatric illnesses.

Using such diagnoses as bipolar disorder, attention-deficit hyperactivity disorder (ADHD) and Asperger's, doctors are justifying the sedation of difficult kids with powerful psychiatric drugs that may have serious, permanent or even lethal side effects.

There has been a staggering jump in the percentage of children diagnosed with a mental illness and treated with psychiatric medications. The Centers for Disease Control and Prevention reported that in 2002 almost 20 percent of office visits to pediatricians were for psychosocial problems -- eclipsing both asthma and heart disease. That same year the Food and drug Administration reported that some 10.8 million prescriptions were dispensed for children -- they are beginning to outpace the elderly in the consumption of pharmaceuticals. And this year the FDA reported that between 1999 and 2003, 19 children died after taking prescription amphetamines -- the medications used to treat ADHD. These are the same drugs for which the number of prescriptions written rose 500 percent from 1991 to 2000.

Some psychiatrists speculate that this stunning increase in childhood psychiatric disease is entirely due to improved diagnostic techniques. But setting aside the children with legitimate mental illnesses who must have psychiatric medications to function normally, much of the increase in prescribing such medications to kids is due to the widespread use of psychiatric diagnoses to explain away the results of poor parenting practices. According to psychiatrist Jennifer Harris, quoted in the January/February issue of Psychotherapy Networker, "Many clinicians find it easier to tell parents their child has a brain-based disorder than to suggest parenting changes."

Parents and teachers today seem to believe that any boy who wriggles in his seat and willfully defies his teacher's rules has ADHD. Likewise, any child who has a temper tantrum is diagnosed with bipolar disorder. After all, an anger outburst is how most parents define a "mood swing." Contributing to this widespread problem of misdiagnosis is the doctor's willingness to accept, without question, the assessment offered by a parent or teacher.

What was once a somber, heart-wrenching decision for a parent and something children often resisted -- medicating a child's mind -- has now become a widely used technique in parenting a belligerent child. As if they were debating parental locks on the home computer or whether to allow a co-ed sleepover, parents now share notes with each other about whose child is taking what pill for which diagnosis.

These days parents cruise the Internet, take self-administered surveys, diagnose their children and choose a medication before they ever set foot in the psychiatrist's office. If the first doctor doesn't prescribe what you want, the next one will.

There was a time in the profession of child psychiatry when doctors insisted on hours of evaluation of a child before making a diagnosis or prescribing a medication. Today some of my colleagues in psychiatry brag that they can make an initial assessment of a child and write a prescription in less than 20 minutes. Some parents tell me it took their pediatrician only five minutes. Who's the winner in this race?

Unfortunately, when a child is diagnosed with a mental illness, almost everyone benefits. The schools get more state funding for the education of a mentally handicapped student. Teachers have more subdued students in their already overcrowded classrooms. Finally, parents are not forced to examine their poor parenting practices, because they have the perfect excuse: Their child has a chemical imbalance.

The only loser in this equation is the child. It is the child who must endure the side effects of these powerful drugs and be burdened unnecessarily with the label of a mental illness. Medicating a child, based on a misdiagnosis, is a tragic injustice for the child: His or her only advocate is the parent who lacked the courage to apply appropriate discipline.

Well-intentioned but misinformed teachers, parents using the Internet to diagnose their children, and hurried doctors are all a part of the complex system that drives the current practice of misdiagnosing and overmedicating children. The solution lies in the practice of good, conscientious medicine that is careful, thorough and patient-centered.

Parents need to be more careful with whom they entrust their child's mental health care. Doctors need to take the time to understand their pediatric patients better and have the courage to deliver the bad news that sometimes a child's disruptive, aggressive and defiant behavior is due to poor parenting, not to a chemical imbalance such as bipolar disorder or ADHD.

The writer is a child and adolescent psychiatrist in California and the author of "Should You Medicate Your Child's Mind?"

Some history Part 3

"I see that the old flagpole still stands. Have your troops hoist the colors to its peak, and let no enemy ever haul them down." - Douglas MacArthur

Just a day or two before Munchkin and Silver met, she had pulled a knife on me and said she was going to kill me, and then she'd cut herself up till she bled to death. I didn't know what to do, so I just grabbed the knife out of her hand, grabbed her and held tight while she screamed and fought me off like a tiger. I just kept telling her I loved her, and somehow we'd fix what was wrong with us. I think it had taken 2 hours to get her calmed down, that was the scariest night of my life, and all I could think was "How much worse is this going to get before we can make it better?"

The weekend prior to that, she had broken her bed for the second time on return from her father's, in a rage at him for having been drunk all weekend again. Somehow, I just couldn't get too overly upset with her for that. 

I knew though that something had to be done. I also knew I wasn't a very good parent. What I didn't know was how to fix any of it. I knew too that I needed better parenting skills, but where do I go for that? My parents? I don't think so, I didn't get anything good from them to begin with obviously! The doctor's? Apparently not, as all they did was medicate us. I knew Munchkin and I needed help, but everything I did made things worse. She was now up to 100 mg of Serequil per dose, and I was at my wits end.

I asked Silver about getting help, but didn't really think he'd know as he didn't have kids, but that just goes to show how little I knew about him at that time.

I wish I had the vocabulary to explain all that Silver has taught me about first and foremost being a woman. Secondly, about liking who I am, and more importantly accepting it. He also taught me about being a parent, and about what it means to be a single mother (you'd be surprised how different that is from being a parent). And last, but most definitely not the least, what it means to be a lover! It's amazing how tied together these all are and yet how separate. I'm still learning in all these areas, and I'm sure I will be till I die, but at least now I know how to learn!

I think the biggest thing I have learned so far is that without love and respect for myself, I can not show it to anyone else, nor and more importantly, teach Munchkin how to love and respect herself or anyone else.

I seem to have gotten off track here a bit and yet at the same time, I haven't. Once Silver took it upon himself to teach us, he had me talk to Munchkins teacher and have her watch for changes in her behavior at school. I also had her watch for consistencies.

One of the first things Mme C noticed was Munchkins withdrawn, almost to the point of appearing sick, behavior every other Friday. Well that coincided with her visits to her father on the following Saturdays. Another thing Mme C made a note of was Munchkins being a bully to her and her classmates the following Mondays to Wednesdays or Thursdays. Her behavior in school became so predictable that Mme C had Munchkin assigned a "Big Sister" so she could spend an hour with her every week and get a lot of her frustrations off her chest.

Thanks to Silver, the school and I became a team in helping Munchkin learn to express herself in a beneficial manner.

After that, the only problem we really had was how whatever Munchkin would learn at home and school in the 2 weeks without her father, was completely undermined in the 2 days with him. It was 1 step forward, and sometimes 5 steps back. I must say, that was quite frustrating to say the least.

In case you didn't know, I have Munchkin in French Immersion because she was bored with school, getting her work done before the rest of the class, and would then become disruptive. Since regular English classes were too easy, I made the decision to transfer her to French. Well, unfortunately, that is starting to become too easy for her as well. When it comes to the sciences and math's, she is still finished long before her classmates and she begins to distract the others from their work, but at least the teacher understands this and has her do some French reading lessons.

After one particular weekend with her father, Munchkin went back to school on the following Monday, looked Mme C in the eye and said, "My father says French is for stupid people and I'm not supposed to listen to you anymore!" Mme C just let it go at that, left Munchkin to her own devices for the day, and let me know what happened. That got her a much-deserved smack when she got home from school, and of course it took the rest of that week as well as the next week to re-train her.

That all happened in the beginning of Grade 2, by the end of the school year, Munchkin had learned so much about her father, that she realized how much better off she was without her father in her life.

Backtracking again, (yes I'm bad at keeping things chronological), I should remember to tell you that the very first thing Silver had me do was wean Munchkin off the Seroquel which in turn ended her breathing problems, not so surprising I suppose! Then he threw out my Amytriptiline and I thought he was nuts until I started to get better of course!

It was last May/June that Munchkin decided her father was no longer part of her life. That came 1 year after Silver entered our lives. Now one year without Munchkin's father we have indeed become a family. Yes Munchkin is still an 8 year old, acting as 8 year olds do, but without all the previous drama. She and I are no longer a dysfunctional family, we're finally happy!

Thank you Silver, I know I don't say it enough!

*PS

Remember that I wrote these over 2 years ago :-)*

Munchkin is now a thriving 10 year-old-going-on 30 year old...lol.  The biggest regret she has is that Silver is not her actual father.  As a matter of fact, her biological father calls once a year to talk to her and convince her to go to his house.  Usually she refuses to take the phone, this time however, she didn't, she actually talked to him!  Guess what she said!?!

If you guessed that she told him not to call anymore, that she has a real Dad now, you'd be right.

There Nobody, that's the kick-in-the-teeth that the ex got from Silver, and I dare say, it couldn't have been a better one!

Some history, part 2

“Too often we give children answers to remember rather than problems to solve.” – Roger Lewin

How about if I go back to the beginning of all this!

I married my second husband when Munchkin was 11 months old because I believed him when he said he’d kill me if I didn’t. To make a long story short, our life together was fraught with abuse, most of which Munchkin was witness to.

I had him arrested for the second and last time when he threatened Munchkins life, and when she started to cry he said, and I quote “You’re nothing but a fucking little slut you bitch, and if you don’t shut up soon I’ll hit you so hard you’ll never make another sound again!”

That was the last straw. Prior to that he had never said anything nor done anything against her. It was always against me, and I thought I could handle that.

Munchkin was just 3 ½ at the time and suffered terrible nightmares after that. She would wake up screaming, and once calmed down enough to talk, she’d tell me what she had dreamt. One was much like the next, always with the same theme. I won’t go into the detail she did, but they always involved her father breaking into the house and making her watch him kill and dismember me in one way or another. Needless to say, it didn’t take long for her to start acting out.

Soon the divorce was finalized and despite what had happened, the judge ordered supervised visitation every other Saturday. The day before she was to see her father and for a few days after, Munchkins behavior was terrifying to say the least. So I started to take her to a child psychologist. After a few meetings the psychologist had a co-worker who was licensed to prescribe medication to come in and observe the next few sessions. This led to Munchkin being diagnosed with ADHD and Bi-polar disorder and was put on 25 mg of Seroquil 2 times/day. At the time, I did not know that Seroquil had not been tested for use on children under the age of 18, and here my little girl who was just about to turn 4 was put on it.

Because visitations with her father were supervised, the judge was still monitoring what was going on with the help of a family conciliation mediator. She told the judge that the visits seemed to be going well so she suggested that after 6 months visitations should become unsupervised and be from Saturday 10 am to Sunday’s 6 pm, and because I still had a standing restraining order against him, the exchange of “the child” should take place at the home of one of my ex’s brothers. I was to drop Munchkin off, leave and then my ex’s new wife was to pick her up. With just the opposite happening on Munchkins return to my care.

With every visitation Munchkins behavior became worse. She was soon put on a steroid inhaler because she was beginning to have a hard time breathing as well. Not only that, but her Seroquil was doubled to being 50 mg 2 times a day.

Sadly I didn’t question the psychologists/psychiatrists in regards to Munchkins care. I later found out that 98% of the children these 2 women care for medically were diagnosed with ADD, ADHD, Bi-Polar disorder, Aspergers disease and so much more. It seems there is no such thing as normal children anymore. The funny thing is, when I was her age, just barely 30 years ago now, these diseases didn’t even exist. Children that displayed any personality, were just kids being kids.

Munchkin was started on the Serequil at roughly 4 years of age and at 4 and a half she was given the inhaler to help her breathing. Somewhere around 5 months of non-supervised visitations Munchkin started to get violent. She broke her toys and would push and hit her friends. This culminated in her breaking her bed and her Serequil being upped once again, she was now on 75 mg twice daily at 5 ½ years of age. Her behavior started to stabilize, meaning she wasn’t getting worse, but she wasn’t getting any better either.

Part of the mediators suggestion to the judge about visitation was that after a suitable trial period of unsupervised visits, providing nothing “bad” was happening and my ex was still with his 3rd wife, visitations during summer holidays could be held for a week at a time. I grudgingly agreed to this. These extended visitations also included x-mas holidays and long weekends. I didn’t like it, and had my misgivings, but like I said I did agree to it.

Munchkin was still acting out prior to and after visitations with her father, but the year she turned 7 she started her week long visitations during summer. Little did I know, but it wasn’t going to be pleasant to say the least.

Backtracking just a bit, I had met Silver that same May, and later introduced Munchkin to him in June. I suppose neither of us will ever truly understand why he didn’t cut and run on the spot, but he didn’t, he stayed! When he was at my place for the first time, and saw the way I was allowing Munchkin to behave, and my phone never stopping with it’s incessant ringing, not to mention my mother showing up out of the blue, he saw me literally fall apart at the seams. 

I guess he realized that he was the only one who could help me. In that 1 day at my place, he saw that everyone, including Munchkin’s doctors were doing us more harm than good. I, myself, was on a rather high daily dose of antidepressants that was leaving me at a disadvantage for being able to think clearly, but that’s no excuse for how terrible I let the situation get to be. I am the one who trusted blindly, I was happy to keep my head in the sand and blame the world around me for the way my life had become.

A little bit of past history

I'm posting this from an old blog of mine, so keep in mind that this is 2.5 years old.  I think I'll be doing this as a series, as that's how it makes most sense, even if it's not necessarily in chronological order:

Well to be honest, my daughter used to be the world’s biggest brat! She has broken a couple of beds (consequently slept without one for a while), and has pulled knives on me wishing I was dead. I took her to a child psychologist, who of course prescribed heavy-duty medication, Siroquel to be precise.

Thanks to the new man in my life, these problems are going away. She is no longer on those meds, and nor does she throw temper tantrums or break things. She hasn't had a nightmare in god knows how long either. Knives are now only used for helping with meals (exactly what they're meant for). So suffice it to say that doc's don't know as much as they pretend to. Sometimes it's like Silver says, if you don't discipline properly, you've got war in your home with the child being the general and the parent being the private. 

Thanks to Silver, I am now the general and my daughter is the private with no say in what happens. She may still gripe and complain as all children do, but she now does as she's told without fighting about it. She also even respects me now, and the only time I really have a problem with her is when she comes home from her fathers’ house after being there for a weekend with him.

I just wish that my parents knew how to raise children. As long as they are alive I'll always be their daughter. The trouble is that they don't like me. Never really have I don't think. 

I suppose this is a word of advice to parents’ everywhere. Please don't put your children down. My mother has called me the devil's spawn for as long as I can remember, and now she doesn't understand why I don't want her to come over, nor can she understand why I don't go there, (even for gatherings). She had even told me how, when I was about 12 or 13, she tried to abort me just 2.5 weeks before I was due to be born. It has left a lot of psychological scars that will never heal, because she doesn't acknowledge that any of this happened, let alone apologize for it.

I'm not looking for help here, I have all the help I need in Silver. He is teaching me to deal with my problems as well as how to deal with my daughter.