At the heart of the controversy over medicating little kids is disagreement over how to characterize and diagnose psychiatric disorders in this group. Doctors may need to use developmentally different criteria to define some disorders because symptoms may present differently in young children. After all, whether it's a kicking fit in the candy aisle, an unprovoked smack of a sibling, or a sobbing session over a lost barrette, almost all preschoolers and toddlers can behave in ways that seem, well, a little crazy. That's because the parts of the brain that regulate emotion are still being formed. “Many symptoms that are abnormal in adults may be typical in children,” says Dr. Gleason. “Crying might be a sign of depression—or just of being three years old.”
Most specialists agree that some children are so consistently restless, moody, or fearful that they can legitimately be diagnosed with ADHD, ODD, depression, or anxiety. But scientists are still working out how symptoms in young children are different than those in older kids or grown-ups. For example, Washington University researcher Joan Luby, M.D., has pointed out that depressed preschoolers usually don't talk about suicide, but they may act out morbid themes during play. The growing diagnosis in young children of bipolar disorder, which is characterized by long periods of energy followed by long periods of depression, is especially controversial. “Preschoolers don't have good months and then bad months the way adults do,” says Dr. Klein. “They may have a problem, but it's probably not bipolar.”
To get the right diagnosis, parents need to consult the right expert: a child psychiatrist or psychologist with a background in pediatric mental health, according to the American Academy of Child & Adolescent Psychiatry (AACAP). The specialist should observe the child over many hours, especially the way he interacts with his parents, and collect a complete history, including a report from at least one person outside the home, such as a teacher. Easier said than done. There are fewer than 10,000 child and adolescent psychiatrists in the U.S., as well as a shortage of child psychologists. “There are so few doctors who see children under five. You wait two months for an appointment and they might look at your child for ten minutes,” says Victoria, Shelby's mom.