The DSM-V which is being created as we speak and this issue of Bipolar Disorder in children is being discussed. A new disorder has been created, "Temper Dysregulation Disorder with Dysphoria" to describe what is currently diagnosed as Bipolar Disorder in children. (See The Child Psychology Research Blog's article, "Childhood Bipolar Disorder is not Bipolar? DSM-V and the Temporal Dysregulation Disorder with Dysphoria" for the full story).
My question is, "Why do we need yet another disorder?" What if it's not a disorder? What if the child is just angry at how they have been treated? What if they have been abused by someone who is violent and are simply mirroring the violence they see at home when they rage out of control? I've seen this happen too many times to count. Medicating the child into oblivion does not address the cause of the behavior. It just puts them in a mental straight jacket. And may even put them at risk. If you medicate an abused child and send them back home to their abuser, abuse it likely to reoccur. You have not addressed the source of the problem.
I also find it interesting that what this new diagnosis seems to be calling a disorder is anger. When did getting angry become a diagnosis. Perhaps the child has something to be angry about. These types of outbursts are typical in boys with trauma. And guess who is diagnosed with ADHD the most? Boys. It seems we are pathologizing and medication unpleasant emotions. But this is nothing new.
I see the same thing happening with anxiety and ADHD. A child is so anxious they can't sit still. Solution? Diagnose them with ADHD and medicate them. Why not look at the source of the behavior, the child's home life? You absolutely have to see the child interact within their family system to know what is going on. Too often the child is brought into the therapist's or psychiatrist's office and identified by the parents and/or family as "the problem". But I truly believe that children merely react to what happens to them. If they are a "problem", look at the parents and the living situation at home.
Sometimes there are deep seated issues at home which must be addressed like substance abuse, domestic violence or forms of child abuse. Sometimes there are simple dynamics causing the child's behavior. The parents may unwittingly be triangulating the child. The parental unit may not be functioning properly. Boundaries may need to be strengthened. But none of these require medication and none of them are an indication of "mental illness". They are merely less functional ways in which humans interact with each other that can be improved and made more healthy with counseling.
Some parents are beginning to fight the medicalization of their children's problems. I'm working with one mother right now whose son was sexually and physically abused by his father. Every court hearing, every psychiatric hospitalization, every psychological evaluation, she has to fight the entire system to keep her child off of medications. She has to fight for the diagnosis of PTSD over Bipolar Disorder and ADHD. She has been having this fight for four years and it continues as we speak. But she fights.
I wish more parents would engage in this fight. Medicating children should only be used as a last resort, not as the first line of defense.
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