NO CLEAR LINES

Katie8217;s middle child 8220;has always had a lot going on in her head,8221; says her mother. And much of it has been a mystery to Katie, who has coped with her daughter8217;s escalating tantrums, combative behavior, bouts of fearfulness and just-plain-oddity since the 11-year-old was a toddler.
In October, Katie, a 38-year-old Los Angeles-area mother of three, brought the child to a psychiatrist. The child8217;s behaviour and performance in school were exemplary, but an ill-tempered outburst had gotten the preteen kicked out of a Girl Scout troop she had joined at age 5. The girl was confused and heartbroken over her ejection.
The daughter came away from the appointment with a diagnosis of bipolar disorder. Katie, who asked that her full name be withheld to protect her daughter8217;s privacy, came away with a list of 10 powerful psychiatric medicines and a momentous decision to make. Some combination of these mood-stabilizing, anti convulsive and anti psychotic drugs, Katie was told, would probably control her daughter8217;s problematic behaviors, referred to by her psychiatrist as symptoms of a disease.
She8217;s not reassured by the suspicion that the psychiatric profession is as confused about diagnosing and treating mental illness in children as she is. All these psychiatric labels and pills may keep many kids on track and even save lives, Katie says. But both seem to be dispensed with little certainty as to what they mean and how they work8212;and even less debate over their long-term consequences for children.
A welter of studies has shown that kids are being diagnosed at younger ages, with a wider range of disorders and with more severe disorders than ever before. And in growing numbers, they are being medicated with drugs whose safety, effectiveness and long-range effects on children have not been demonstrated by extensive research.
A study published in September found that the diagnosis among children of bipolar disorder, a mental illness long thought not to exist in kids, grew 40-fold over the last decade. The prescribing to kids of anti psychotic drugs typically used to treat the symptoms of bipolar illness have soared as well, despite continuing concerns over side effects such as weight gain, metabolic changes that can lead to diabetes, and tremors.
Psychiatrists admit they haven8217;t drawn clear lines between problem behaviours and mental illness, especially in kids, and they are debating future fixes. But until those fixes are made, parents8212;with their kids8217; futures on the line8212;are left with little to guide them when a child is tagged with a psychiatric label.
Katie8217;s maternal instincts tell her she must protect her child. But from what, she asks8212;a disease that threatens health, happiness and future? A bogus label applied to an admittedly challenging kid? Or drugs with potentially harmful and little-studied side effects?
Mental-health professionals have long warned that the stigma of mental illness and the cost of its treatment have left millions of Americans with psychiatric disorders to suffer untreated. But as childhood diagnoses of mental illness have surged, some in the profession charge the field of child psychiatry with the opposite problem. A scourge of overdiagnosis, says a growing body of critics, has come to child psychiatry.
The trend, say these critics, threatens to turn kids such as Katie8217;s daughter8212;a preteen whose behaviour is certainly odd but whose school life remains on track8212;into potentially lifelong patients. Critics warn that as psychiatric diagnosis and medication of children becomes more widespread, teachers, well-meaning neighbours and relatives, and parents themselves are becoming less willing to accept youthful misfits for who they are and to help them adapt without prescribing drugs or attaching labels.

Conditions such as bipolar disorder and schizophrenia were long thought so unlikely to appear in children that they were almost never diagnosed. If psychiatrists were going to start , they needed to fathom how symptoms of adult psychiatric illness might look in kids, whose brains are developing and whose social skills are immature. For instance, troublesome behaviours stemming from extreme shyness, inflexibility, impulsiveness8212;even stuttering or tics8212;might prompt a diagnosis of anxiety disorder, bipolar disorder or attention-deficit hyperactivity disorder, even though those problems will recede or disappear with age for many children.
Thomas Insel, director of the National Institute of Mental Health, acknowledges that these translations may often be imperfect. Responding in September to the report of a 40-fold increase in bipolar diagnoses among kids, Insel warned that overdiagnosis and misdiagnosis probably accounted for some of the surge.
All told, only 12 medications have been approved by the Food and Drug Administration for treatment of psychiatric disorders in children under 18. Six8212;mostly stimulants8212;are used by an estimated 3.5 million kids to treat ADHD. Six8212;fluoxetine Prozac, sertraline Zoloft, clomipramine Anafranil, fluvoxamine Luvox, lithium and risperidone Risperdal8212;are used to treat symptoms of 8220;mood disorders,8221; including depression, anxiety disorders and bipolar disorder, in kids.
-Melissa Healy Los Angeles Times