Diagnosis Diatribe

ONO is the director of a large-ish sleep disorder clinic. He's been in the field for roughly 20 years and tells me that in recent years there's been an increase in younger children being seen for sleep studies.

This week he came home and told me there was a six year old girl who was in for a sleep study. She had a diagnosis of Bipolar Disorder. Six. Years. Old. This just doesn't make sense to me. AND, it really annoys me.

Maybe she is one of the 7% percent of children who are now being diagnosed with bipolar disorder. You know what that means? If you have a group of 100 children, 7 of them will have this diagnosis. In a group of 20, there will at least be one, maybe two kids with this diagnosis. And it’s believed that kids who actually should be diagnosed with bipolar disorder have been misdiagnosed with ADHD. This really annoys me too.

According to one study, the diagnosis of ADHD in kids increased by 381% between 1989 and 2000, and even more frightening, the diagnosis of bipolar disorder among youth (age 0 to 19) increased by 4000% between 1995 and 2003 according to another study.

Are our children really becoming more hyperactive and inattentive? Are six year olds really having mood swings erratic enough to fit the DSM IV criteria for bipolar disorder? I don’t think so. In fact, Bipolar disorder is not even included in the section titled “Disorders of Infancy, Childhood or Adolescence,” but I bet it will be included in the DSM V.

If anyone’s wondering what I think the cause of these increases in diagnoses are due to, I’d be happy to tell you (and here’s where the diatribe begins. You’ve been warned.)

I think it’s a combination of a number of factors, but NOT an increase in kids actually meeting the DSM criteria. Parents with complaints about their kids’ behavior (“He’s so hyper!” “She gets SO angry!” “He won’t listen to me.” “She throws these awful tantrums!” ) usually start with their pediatricians. Most pediatricians have only a cursory knowledge, if that, of the DSM. But many, who want to pacify parents (and drug companies), will prescribe some medication for kids and voila, the kid has a diagnosis (read “label”) but without meeting the DSM criteria for a disorder.

Now parents can point to the diagnosis as the cause of their kid’s challenging behavior, rather than, oh, say….the crappy food they feed them, or the crappy screen content they let them take in, or the lack of emotional support and empathy they give them, or the lack of clear expectations and guidelines for acceptable behavior.

I really think the increase in ADHD and bipolar disorder diagnoses is the result of the most self-centered generation ever becoming “parents,” and I use that term loosely. It’s also the result of a broken public education system that expects too much from too few teachers. Many teachers of kindergartners (5 and 6 year olds) have upwards of 30+ kids in their charge. That is WAY too many! And if the boys in that classroom are being typical boys (active and aggressive), those teachers would want some type of help in classroom management. Let’s call those teacher’s aids “Ritalin” and “Adderall.”

What a heavy burden for such little children.