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.
