July 17, 2007

Experts, Testing, and Misdiagnosis

Warning: by nature I am a skeptic and a heretic who hasn't forgotten her radical pacifist youth. Joan of Arc is my patron saint. I birthed two children at home, nursed them for years, sent them to a hippy school of 50 kids from 5 to 18. But I am not an ignorant nutcase grandma, ignorant of the "magnificent" advancements in child psychiatry. Before children, I edited psychiatry books for 7 years; our authors were world-famous psychiatrists who knew how to heal people without drugs. I have a master's degree in library science and a master's degree in social work, specializing in mental illness and families.

As the oldest of 6, the mother of 4, the oldest cousin of 45, a children's librarian, a playgroup coordinator, a breastfeeding counselor, a nursery school membership coordinator, a school volunteer, a family therapist, I have known many hundreds of young children. I have reassured countless mothers that their different child just seems a creative divergent thinker, not a psychiatric case or a potential psychopath; I have often been thanked for my sane, helpful advice.

This week buy a copy of: For Her Own Good: Two Centuries of Expect Advice to Women by Barbara Ehrenreich and Deirdre English. I am baffled that this generation of young parents, the most high educated parents in history, are sometimes willing to trust their young children to so-called experts, testing, possible medication. When I was worried about my preschool kids, I called my mother or mother-in-law who had raised 11 kids between them. I asked my grandmother with 7 kids and 31 grandkids whether I should be worried. I went to the library and read all I could about creative children. I researched my worries.I had honest discussions with other mothers and teachers who knew them. Twice I switched nursery schools. I did not take them to a psychiatrist or psychologist. I already knew that my pediatrician's childrearing advice was misguided; I learned not to ask them questions when I was probably going to disagree with his answers.

Twenty-two years ago, at the age of 40, I was diagnosed with bipolar disorder. The diagnosis hasn't exactly improved my life. I spent ten years taking horrible meds that felt like they were lowering my IQ by 40 points when they weren't producing physical side effects. I met any number of unhelpful, even destructive, psychiatrists. But far worse were the tremendous stigma and discrimination I encountered in both social work and librarianship. Once anyone knows your diagnosis, you have to be a perfect employee, or people fear you will go postal at any moment. My only dangerous weapons have always been my tongue and my pen.

If a young child is diagnosed autistic, or bipolar, or ADHD as a preschoolers, that diagnosis will affect his entire life. Even his loving parents, aunts, uncles, siblings will regard him differently. When I was in social work school in 1993, it was psychiatric dogma that bipolar disorder could not be diagnosed until late adolescence. Now kids are being diagnosed as preschoolers and treated with antipsychotics, which are only approved for chronic schizophrenics. Psychiatrists seem reluctant to prescribe traditional mood stabilizers because, after all, they are generic now. They can't be much good, can they? Some antipsychotics cause tremendous weight gain and are implicated in childhood diabetes. Before medicating their child, perhaps parents should take the meds themselves and experience their effects. Most college students know ritalin will improve their performance on the SATs or final exams.

I am skeptical about the usefulness of testing young children. We endlessly agonized over subjecting our kids to an IQ test to get them into the only public school in Manhattan for gifted children. Anne, my oldest, was a bit too creative for her own good. When asked to complete figure drawings, she ignored the missing eyes or ears to adorn the figure with gorgeous hats featuring birds on top and with princess gowns. Some kids won't talk to their parents' friends upon command. Why would they open up to a stranger?

Little kids are not fooled by being told the nice lady is going to play games with them. They sense they are falling short, that they might not be good enough, that their parents are worried. That must affect their behavior during the test, at preschool, at home.

We had created a very hostile world for children. Far too many experts seem interested in labeling and drugging children so they fit into that world, rather than reforming society so children's amazing creativity and individuality can flourish. I am not denying that some troubled children could benefit from professional evaluation and help. Certainly parents can research and implement some of the stimulation suggested for certain learning difficulties. But how can an expert spend a few hours dealing with a possibly uncooperative child and convince you that they "know" what is wrong with them? When I was growing up, the diagnosis "brat" was used freely, but you were expected to outgrow brattyness. "Oppositional defiant disorder" can sometimes sound like the same thing.

I have gone to psychiatric lectures on childhood mental illness where home, parental work hours, school, neighborhood are never mentioned. The assumption is the child has a lifelong biological brain disorder. even though no physical test can validate that diagnosis. I suspect 100 years from now current psychiatric treatment of children will be seen as a disgraceful episode in medical history, one more flagrant example of experts giving mothers destructive advice "for their own good."

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