Thinkkids.org blog

[Allan-Matlem]

Hi,
For those parents who feel comfortable with the collaborative problem solving approach , I recommend keeping up with all the blogs http://thinkkids.org

On the question of dxs and in particular BiPolar (BP) , I found the following interesting

Is A Child You're Treating Bipolar? Why It May Not Matter

5/23/2007


So what do you make of the diagnosis of bipolar disorder in children? Controversial, to be sure, but you’ve no doubt worked with a few kids to whom you thought the diagnosis might apply. Of course, your perspective on pediatric bipolar disorder probably hinges, at least partially, on the extent to which you find psychiatric diagnoses to be useful in general.

Here in the Collaborative Problem Solving Territories, we find it most helpful to understand challenging kids in the context of the cognitive skills they lack and the problems or triggers that precipitate their challenging moments. And so our perspective on pediatric bipolar disorder is, in many ways, the same as our perspective on other psychiatric diagnoses: since they don’t provide any information whatsoever about the cognitive skills a challenging child is lacking or the problems precipitating the child’s challenging moments, diagnoses aren’t especially useful for helping adult caretakers understand a child’s difficulties or pinpoint targets of intervention.

Of course, diagnoses can be useful on the fringes. They help researchers identify supposedly homogeneous groups of clinical populations that can be studied. They may bestow an official “stamp of impairment” so that a child’s difficulties are taken more seriously. They may help parents identify support groups to which they can belong. Sometimes they help practitioners get reimbursed for their services by managed care. And some practitioners have been trained to believe that a diagnosis provides useful information to guide decision-making on pharmacologic intervention (“you can’t know what medication to use until you know the child’s diagnosis,” goes the mantra).

But – and we do try to be open-minded about such things – we find that the downside of diagnoses frequently outweigh the upside, and this is perhaps especially the case with pediatric bipolar disorder. The lack of consensus criteria for the disorder is extremely problematic, as different researchers have adapted the adult criteria for bipolar disorder in variable ways to fit children (even while acknowledging that bipolar disorder in children bears little resemblance to the adult form of the disorder)…and the adaptations often test the bounds of credibility. Researchers have reported that features such as grandiosity, rapid flight of ideas, a driven pursuit of reckless activities without regard to consequences, and pressured speech are more common in children than previously known. Of course, what you’re seeing and believing is completely a function of the lenses you’re wearing…in other words, the criteria you’re using. Alas, the devil truly is in the details, and the fact that diagnoses are supposed to reflect a significant level of developmental deviance seems not to have been a major – or even minor – consideration. So we are left to ponder the developmental deviance of criteria such as “class clown relative to other children” and “immature, babyish” (these have been used as indicators of elevated mood); “bathroom humor” and “off-color jokes” (hyper-sexuality); “talkative relative to other children…even if only during a rage episode” (pressured speech); statements like “You don’t care about me” and “You don’t love me” (paranoia); and “extreme defiance beyond mere ODD,” and “controlling” (grandiosity).

Of course, one of the biggest concerns about diagnosing bipolar disorder in children is the fact that the diagnosis typically places the child on a pharmacologic “slippery slope,” usually in the direction of mood stabilizing medications. These medications are often used in combination, yet they haven’t been adequately tested for use in children even when prescribed alone. Their side-effect profiles are often quite concerning. Most troubling, perhaps, is the fact that diagnosing a child with bipolar disorder pathologizes the child and therefore often obscures the fact that challenging behavior in kids is a complex, transactional phenomenon also involving the child’s interaction partners and environments.

Back in the 50s, a prominent psychiatrist named Thomas Szasz characterized psychopathology as “problems in living.” How apt a description for kids being diagnosed with bipolar disorder! What are their problems in living? They lack the skills to handle frustration, regulate emotions, and solve problems adaptively. Can these skills be identified and taught? Indeed, they can. Can medication be helpful in setting the stage for such teaching? In some cases, yes. Does medication teach lacking thinking skills or solve problems? No, medication does not. Is diagnosing a child with pediatric bipolar disorder a necessary first step? In general, no.

 

[gcvmom]

Thank you for posting this article. I agree that an official diagnosis is not always in a child's best interest. I also agree that some people lose sight of the fact that medication alone will not teach kids the life skills they need to effectively cope with their world and the one they will live in as they mature. Often this is the case with our school administration. I've found that many times teachers and staff expect that once a child is on the appropriate medication, everything else will fall into place. This is not always the case. Some things just do not come intuitively to some children, and they must be modeled and taught the desired behaviors. And that is hard work, but necessary if the child is to succeed in function well in life.

I plan to look at the link you've listed -- thanks!

 

[Wishing]

Thanks for the article. I like Szasz's approach and think that Problems in living is more useful than Bi-polar. It narrows it down to what this child needs. It may be medications or it may be a certain structure or learning of skills or use of language. Sometimes being overfocused on the diagnosis one has to think how is this helpful.