Value of diagnosis's and medications

Discussion in 'General Parenting' started by Allan-Matlem, May 25, 2008.

  1. Allan-Matlem

    Allan-Matlem Active Member


    I have noticed that solutions offered here to help our challenging kids tend to focus solely on the diagnosis and the right medication. in my humble opinion I think we need to relate to the whole child and his environment , the pathways and triggers , the lacking cognitive skills such as executive functions, language processing skills, emotional regulation skills, social skills and cognitve flexibility etc. I am sure most parents don't see medications as a long term solution.
    here is an article by Ross Greene , from his blog . I find all the blogs , not only the one for parents very helpful . The title refers to BiPolar (BP) , but applies to diagnosis's in general.

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


    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.
  2. gcvmom

    gcvmom Here we go again!

    While I agree with much of this, I also believe that medications serve a purpose to the degree that they help get the individual to a state of mind where they can learn the lessons they need to know in order to continue their development of emotional, cognitive, and social skills. Without medication, some people are simply unreachable, and they will continue to flounder.

    Without understanding the underlying disorder, one cannot know what medications are appropriate for a given set of symptoms, and often without medication, one cannot hope to be in the optimal, most receptive mental state for learning life skills. So in this regard, I think a diagnosis can be critical. It is the first step towards healing and helping one become whole.

    Just my 2 cents.

    Thanks for posting this :)
  3. Nomad

    Nomad Guest

    I read this fast and will re-read it to be sure.
    I think a diagnosis sometimes helps a child and a family because they might find comfort in attaching a "name" to what is going on. This opens the door to meeting others who have experience in this area. This might include professionals to treat or it might include other families for support.

    I also believe medication often plays a role in helping to treat individuals diagnosis'd with a mental illness. And without a diagnosis, medication is usually not available. However, this is only one part in a complicated system.

    Of course, the down side with diagnosis is the stigma that often comes attached and the concern of a downtroden mindset.

    Perhaps one possible solution is to treat for the disorder, but to de-emphasis the diagnosis and to emphasize abilities and potential.

    Believe me...this is one area I'm trying to figure out as we speak.

    I appreciate this post and again, will re-read the article.

    Thank you.
  4. KTMom91

    KTMom91 Well-Known Member

    I am curious as to how you would relate to the entire child without acknowledging that child's differences. How do you understand the environment without recognizing that many of these broken bonds stem from those differences? How do you determine the pathways and triggers for our children that are so often very different from an average child's triggers without acknowledging these differences? How do you teach those important social, language, emotional, etc. skills to a child with these differences? It seems to me that, while our children are not solely their diagnoses, that is an integral part of who they are and what they have become. I don't believe you can separate that.

    Speaking solely as KT's mom...if she did not have ADHD/ODD/etc., I would be able to interact with her in a different way. I can't say if we would be getting along better, or if we would still be having difficulties, but our relationship would be different than it is today. Dealing with my whole child means medication to help her with her ADHD.

    If I misinterpreted your meaning, then I apologize. I simply don't understand how we can be dealing with the entire child while not dealing with a portion of who they are.
  5. Christy

    Christy New Member

    For many conditions, especially bipolar disorder, medication is a long term necessity. If a child is not stable, it is impossible to work on collaborative problem solving.
  6. MyFriendKita

    MyFriendKita Member

    What I took from the article is the idea that by medicating our kids, we're taking a shortcut in trying to improve their behavior, one that will work only for the short term. Whereas if we would just take the time to listen to them and learn more about why they behave the way they do, we could teach them better ways to cope other than acting out, and they wouldn't behave in ways that are unacceptable to us and the rest of society.

    Which would be great, except I don't think it's realistic. While I agree that a kid with a psychiatric diagnosis should be in therapy to help him learn how to live with his illness, I don't agree that therapy can take the place of medication. The analogy of a diabetic is used frequently on this board, and I think it applies here. A child diagnosis with diabetes should undergo counseling to help him learn how to live with his illness, but we wouldn't expect that counseling to take the place of insulin.

    I'm not sure why there's such a stigma about medicating mental illness. We don't expect those suffering from any other kind of illness to overcome their illness just by changing their behavior, but we seem to think that will work with mental illnesses.
  7. DazedandConfused

    DazedandConfused Active Member

    This echoes my opinion. Even though Son takes medication, it certainly didn't "cure" the cognitive and developmental issues that he has. However, at least they can be addressed. Whereas before, they simply couldn't. He was unreachable. Bottom line, the quality of his life, and that of our family, improved immensely and we got something we never had before-hope.

    Otherwise, I think that some valid points were made.:peaceout: