The boundary between troublesome behavior and mental illness is indistinct in adults, psychiatrists acknowledge; in children, whose brains are still a work in progress, it is fuzzier still.
"To tell the truth, I feel bad for parents," says Greene, who directs the Institute for Collaborative Problem Solving at Massachusetts General Hospital. "I don't think diagnoses help us understand how to help the kid."
It's a frustration felt by Katie. At times, she welcomes the diagnosis that tells her she's not a bad parent or that might solve the riddle that is her middle child. But rather than a golden ticket to a fix, she says, it feels like a can of worms.
"What is a diagnosis?" she says. "All it is is permission to medicate. We could try this drug -- and then what, if it doesn't work? Do you go to the next drug, up the dose, decide the diagnosis was wrong?"
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Profession in transition
By the mid-1990s, the effort to prevent or mitigate mental illness began to focus on kids, who had long been considered too young, before adolescence, to treat with anything but love, time and therapy aimed at redirecting their behavior.
The profession's new focus would require a few leaps of faith and some significant reinterpretation of its diagnostic formulas, says Dr. Lawrence Diller, author of "Running on Ritalin" and "The Last Normal Child," two books that are critical of the trend.
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 behaviors stemming from extreme shyness, inflexibility, impulsiveness -- even stuttering or tics -- 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.
And a psychiatrist might have to reinterpret, in a child, the classic pattern of "cycling" between manic and depressive episodes that is the hallmark of bipolar disorder in grown-ups. Instead of taking months to swing from high to low, a mercurial, expressive child such as Katie's daughter might be seen as "ultra-rapidly-cycling" between mania and depression.
