Katie's middle child "has always had a lot going on in her head," says her mother. And much of it has been a mystery to Katie, who has coped with her daughter's escalating tantrums, combative behavior, bouts of fearfulness and just-plain-oddity since the 11-year-old was a toddler.
A month ago, Katie, a 38-year-old L.A.-area mother of three, brought the child to a psychiatrist. The child's behavior 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 daughter's privacy, came away with a list of 10 powerful psychiatric medicines and a momentous decision to make. Some combination of these mood-stabilizing, anticonvulsive and antipsychotic drugs, Katie was told, would probably control her daughter's problematic behaviors, referred to by her psychiatrist as symptoms of a disease.
Now it's Katie who has the racing thoughts and the alternating bouts of fear, anxiety, relief and anger. As she ponders whether her daughter's strange behavior really amounts to mental illness -- and whether medication is the answer -- she says, "I feel like I'm flying blind."
And she'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 work -- and even less debate over their long-term consequences for children.
In 2005, the latest year for which statistics are available, at least 2.2 million American children over the age of 4 were being treated for serious difficulties with emotion, concentration, behavior or ability to get along with others. It's a figure mental-health professionals say has exploded in the last decade and a half, along with sales of a wide range of psychiatric medications for use by 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 antipsychotic 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 haven't drawn clear lines between problem behaviors and mental illness, especially in kids, and they are debating future fixes. But until those fixes are made, parents -- with their kids' futures on the line -- are left with little to guide them when a child is tagged with a psychiatric label.
Katie's maternal instincts tell her she must protect her child. But from what, she asks -- 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?
And protect her exactly how -- by resisting or by medicating?
"I don't want to face her as an adult and say I didn't do everything I could to make her well. I feel like I'm answering to her future self," Katie says. "But so much of this is a crapshoot. No one wants to feel that their child is a guinea pig."
Perception of kids changes
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 like Katie's daughter -- a preteen whose behavior is certainly odd but whose school life remains on track -- into potentially lifelong patients.
And, they add, it has changed the way Americans think about children. Critics warn that as psychiatric diagnosis and medication of children becomes more widespread, teachers, well-meaning neighbors 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.