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.
Indeed, to some in mental health the behavior of Katie's daughter might be a classic presentation of pediatric bipolar disorder; others might see a strong-willed child who needs to learn better to recognize and cope with powerful emotions.
Katie says that when her daughter was a toddler, the girl's tantrums were frequent and stormy. As she grew, she picked fights with strangers and dreamed up projects too big for a little girl to accomplish.
Now, her mother says, the preteen's raging episodes are briefer but more intense and that she hates herself afterward. During a recent trip to an amusement park, the child stormed away from her mother and deliberately, it seemed, got herself lost. During the school day, she seems able to hold herself in check and works well in class. At home, she can be unpredictable. She'll fight with her little brother one minute and fawn over him the next.
"I've had this idea that if I can just get her through being a child, that she'll be fine, that she'll be high-achieving," Katie says. Her daughter's ambitious ideas, strong will, assertiveness with authority figures: Katie had long believed that in adulthood, these exasperating traits might make her a leader.
Now that they've been cast as symptoms of early mental illness, she's not so sure. Perhaps, she thinks, it would be better to curb them with medications.
"I don't want her to be some kind of crazy loner," Katie says.
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Medication grows popular
In spite of the questions about diagnosing mental illness in children, the medication of children for psychiatric conditions has shot up. At three major U.S. medical centers studied in the early 1990s, antidepressant use among children aged 2 to 19 increased 2.9-fold, 4.6-fold, and 3.6-fold, according to a study published in 2002 in Pediatrics.
Another study found that among low-income children insured by the state of Tennessee, the use of new antipsychotic medications doubled in a five-year period in the late 1990s.
