Early Diagnosis of Childhood Mental Illness

This post was a reaction to another mother blogger who worried that her three year old was autistic, when it appears he just didn't fit in with his daycare center.

Reading parent blogs, I have been taken aback by how frequently mothers worry that their preschool boy is autistic. I don't want to offend any of you great parents, trying to do what is best for your child. In all my years around young children(5 brothers, 45 younger cousins, 4 daughters) none were tested for autism as a preschooler. Has autism increased so dramatically or is there now so little tolerance for divergent thinking and unconventional minds? I am desperately uncomfortable with psychiatric diagnoses for preschoolers. And some of the softer austic symptoms bother me.

 I always wondered why I was different, but being told I was a manic depressive at age 7 when my mom worried about my worrying would have been nightmarish. My dad just told me I was smarter than other people and read much more, and I could live with that:) I wouldn't have dared to have my 4  wonderful children if I knew I was mentally ill. Thank God I was not diagnosed until the youngest was 4.

If being a scientist happily working all hours in a lab is being a loner, so what? Both chemistry professors, my brother met his wife in the lab at MIT, and they are happy loners together.  Another brother who is an elementary school teacher is very dubious about special ed for kids within normal limits. He thinks the stigma is far worse than the extra services justify.

People who weren't diagnosed, who wish they had been, haven't been exposed to the stigma and discrimination and mistreatment that accompany diagnoses. They possibly exaggerate the wonderfulness of the special services they didn't receive. We are not an enlightened society; stigma is very real. I would have never gone to social work school at age 46 if I had realized that  many mental health professionals obviously don't believe in the efficacy of their own treatments and would fear an open wounded healer..

Loners and losers outgrow it, invent software, have TV shows made about them:) Nerds and geeks are the new prince charmings; they make great husbands. Diagnoses are forever. How do kids "along the autistic spectrum" do with chemistry sets and microscopes? Are they your own computer geeks?  I recall a kid in my daughter Jane's traditional kindergarten class. The teacher insisted he be tested for developmental disability. He tested at genius level.

My kids desperately needed to be intellectually challenged, and only the two-day-a-week pullout gifted program was adequate.  I let Michelle, my scientist,stay home from school so much because she was obviously learning at a higer level than she could reach at school. Using her sister's math textbook, she brought herself up two grade levels in three days. She managed to run fevers only on nongifted days.

 I always thought I could do something for my kids, that I knew and understood them better than the "experts."I admit my dad's legacy was intellectual arrogance.  I could read the same books and journals as the experts, and I knew my weird kids better. Certainly that approach was the key to taming my own bipolar disorder 15 years ago. I researched psychiatric journals and the net to find the best possible medication and shopped for a psychiatrist who was willing to prescribe it. My psychiatrist has frequently expressed his gratitude for my educating him, since he now frequently prescribes the med I told him about.. I needed a psychiatrist who was a partner, who would discuss journal articles with me as a peer, who was as willing to learn from me as I was from him, who would admit when he didn't know and when he was wrong. Only then would I feel comfortable enough to be fully honest with him about my medication.

Using what you learn from blogs, books, and journals about autism is brilliant. I am sure they would have helped me cope with my dad, two brothers, two husbands, and two nephews:) I am very curious to read them; I love to think about how different minds work. Learning all you can is different than a formal diagnosis that might convey to a child, his teachers, his peers that there is something wrong with him. Different, original minds  can't and shouldn't be fixed.

Do read For Her Own Good: 200 Years of Experts Advice to Women, by Barbara Ehrenreich and Deirdre English. Thank God I first read it when it only covered 150 years in 1979, the year after my writer was born. Thank God I never consulted experts about her. Some minds are too mysterious to be meddled with. She probably would have qualified for bipolar disorder, autism, and social anxiety disorder, with a subtle oppositional defiant disorder.

The label "autistic" might be less frightening to your generation, but in 62 years I have never personally known a child so labeled. I have known many children who could have been so labeled, but they found their ideal career niche and the spouse who can translate for them. The more I read about it, the more I suspect it explains so much about my men:)  My father was an actuary. Two brothers are accountants; one is a chemistry professor. My first husband is a radiation physicist; my second husband is a computter programmer.

Drugging Kids Instead of Changing America

I am a psychiatric social worker and children's and young adult librarian. I  have 5 younger brothers, 4 grown daughters, 4  sons-in-law, 5 grandkids, 4 and under, 11 first cousins, 7 great nieces and nephews,  and 45 Younger first cousins, the mother of 4, the grandma of 4. I am also a manic depressive. It took ten years to find a medication that helped; I read about it on the Internet and shopped for a psychiatrist that would partner with me to experiment.   The other meds did far more harm than good.

I am not denying a role for medication.  I am not talking about ADHD drugs like ritalin. However, childhood bipolar disorder has only been discovered in the last 15 years, mostly in America. Many discovers have close ties to Big Pharm. Until 1995 conventional psychiatric wisdom was that bipolar disorder could only be diagnosed in the late teens.  There is no conclusive study that proves childhood bipolar disorder leads to adult bipolar disorder. Psychiatrists still debate whether it exists.

 I believe you should not decide to drug your kids before you  take the meds for at least a month. Too often kids are being given anti-psychotics for behavior problems, anti-psychotics not tested with children. I was given them when I was hospitalized for mania in 1973, between 87 and 96. They made me much crazier when they weren't obliterating whole days. My intellect and education have not been able to withstand their devastating cognitive effects. Giving such drugs to a young mind until all alternative have been exhausted seems like malpractice.

 Until all the usual mood stabilizers went generic, anti-psychotics were intended to treat schizophrenics and hospitalized manics.  There is a shameful record of using them on Alzheimer's sufferers. As recently as the 2004 American Psychiatric Meeting in NY, drug reps were marketing bestsellers such as abilify and seroquel for those patients. Now they are being heavily advertised for depression and bipolar disorder as maintenance drugs.  The newer atypical anti-psychotics are heavily implicated in causing huge weight gain and sudden onset diabetes.

When my kids were young, 25-30 years ago, even in therapy-obsessed Manhattan, preschool kids weren't seeing psychiatrists, weren't taking psychiatric medications, so I am skeptical about this epidemic of very young children with serious problems requiring psychiatric drugs. If our kids were having problems in nursery school, we might decide to wait another year and find a better school.

What is going wrong with the way we are raising children? Why do we look in children's brains for the answers to be found in social reform?  Who is blowing the whistle? Who is questioning the wisdom of babies and toddlers being cared for by strangers? Who is wondering whether group care is appropriate for most children under three or four? Thirty-five years ago, children were five or six before they were expected to adapt to group standards of behavior. Who is crusading for a shorter work week and greatly increased parental leaves? Who is is dedicated to make caring for preschoolers a viable career path for college graduates, comparable to teaching in salary and benefits?

Who is demanding the economic changes required to enable parents to care for their babies and toddlers themselves? Who is comparing our rate of childhood mental illness with rates in the rest of the Western world? Who is outraged about preschoolers taking multiple psychiatric drugs that have never been tested on children? Who is fighting to outlaw drugs ads in magazines and on TV? Why are we teaching our kids that drugs are the solution to every problem? Thirty years ago we felt like bad parents if we let our kids have caffeine.

The aggressive drug treatment of mental illness in the last 30 years hasn't been a success story. When yesterday's wonder drug becomes generic, its ineffectiveness is suddenly discovered and its dangerous side effects are no longer covered up. Today's expensive wonder drug will supposedly save your life after being tested for a shockingly short time on shockingly few people who don't share your diagnoses. 

Preschoolers are so unformed, so in process. This year's four year old can seem like a different creature than last year's three year old. These diagnoses disorder

imply lifelong, incurable brain disorders for which there are no medical tests, no verifiable proof of their existence. Why do we expect little boys to adapt to schools better suited to girls? Why don't we train and recruit more male teachers in preschools, who might be better role models for little boys and help create more welcoming schools?

Why would you accept that your young child has a permanently broken brain? Why not take him out of day care or fine a different one, investigate family day care, share a nanny with a friend, change nursery schools, reduce your working hours, live more frugally, borrow money and take a leave of absence from work, ask your parents and relatives for help, search out books and activities about his particular obsessions, learn the recommended interventions yourself?

Does your child need more relaxed time with his overscheduled parents rather than tense sessions with experts comfortable with diagnosing him after a few testing sessions?Why not wait until the picture becomes clearer? Why it is so urgent to find the answer when he is 2 or 3? We are not dealing with meningitis or childhood leukemia. When I hear a 7 year old rattle off all his psychiatric labels, it breaks my heart and makes me want to man the barricades. I would love to find some comrades.