When families are in crisis
There's no blood test or genetic marker for mental illness. Doctors rely on their own assessment of a child's behavior -- and a parent's reporting of it -- to make the call, and sometimes arrive at a diagnosis after a single visit. When the diagnosis isn't right, or the prescribed treatment doesn't work, parents end up going from doctor to doctor in hope of relief.
Susan Wagner of Oklahoma City has a "bright, wonderful six-year-old son with an alphabet soup of diagnostic labels in his medical file." Henry has been diagnosed with ADHD, NLD (nonverbal learning disability), SID (sensory integration dysfunction), and GAD (general anxiety disorder). As an infant and toddler, he didn't interact with his parents, slept poorly, and was in constant motion, even when Wagner read him a story. "Before Henry was diagnosed, I spent a lot of time second-guessing myself and wondering if I was just imagining all these quirks," she says. "As difficult as it was to hear that my son really is different, it was also a huge relief to me because it meant that I was not a horrible mother."
In the two years since his diagnosis, Henry has gone on to do many things his doctor said he would never do -- such as show love and empathy for his brother, Charlie, 5. But finding the right treatment for Henry's array of problems remains a challenge. The Wagners have tried three different schools, occupational therapy, dietary changes, sticking to a predictable schedule -- and, finally, medication. In one six-month period, Henry tried four different ADHD drugs; all caused problematic side effects like insomnia and facial tics. Wagner is still looking for the right therapy, or combination of medication and therapy, to help him. "At every step of the way, I have felt simultaneously that I was doing exactly what I needed to do to help my son and that I was completely failing him," says Wagner.
Those who decide not to put their children on medication can also have a difficult time. Mary Tyson's* 5-year-old son, Justin*, was diagnosed at age 3 with ADHD, but he's not on Ritalin. "My child's brain is still developing, and we don't know what these drugs will do to him. I'm also concerned that if we start medicating him now, we will never teach him to help himself when he feels out of control," she says. Instead, she has opted to modify Justin's diet and treat his allergies, which seems to help somewhat, though the outbursts are far from over. "He can be defiant and violent, and when he gets into one of these episodes, there's no reasoning with him," says Tyson. "Keeping him from hurting himself or someone else is what we do."
The decision not to medicate has earned Tyson the disapproval of her son's therapist and pediatrician -- and even members of her own extended family. "It's so isolating to know that my own family doesn't understand," she says.
Though doctors recommend caution in prescribing medication to a child, most agree that ADHD meds have been around long enough and studied extensively enough to be considered generally safe. "Ritalin doesn't hurt anybody if used properly; it's just a performance enhancer. But Ritalin is candy compared to Risperdal and other antipsychotics," says Dr. Diller. "Every few months a new danger -- like Type 2 diabetes is discovered with these drugs."
In August the Food and Drug Administration approved Risperdal to treat kids over 10 with bipolar disorder. But that doesn't stop medical professionals from recommending it and other antipsychotics for little kids. Five-year-old Kendall Boger of Dover, Idaho, once received a diagnosis of a developmental disorder because of her uncontrollable rages and a recommendation for Risperdal after a short consultation with a psychologist she'd never seen before. Her parents didn't fill it.