The Patriot Ledger
How many more Rebecca Rileys?
To diagnose a 2-year-old as bipolar by adult standards is crazy
By Jacob Azerrad
Jan 10, 2009
QUINCY ”” In a 2007 “60 Minutes” episode, Katie Couric focused on the short life of 4-year-old Rebecca Riley of Hull. Diagnosed with bipolar disorder at age 3, she was dead one year later from an overdose of a psychotropic drug cocktail. At one point, Couric asks Rebecca’s mother, who has been charged with her daughter’s murder, if she thinks her child’s behavior might have been normal. That in fact, maybe little Rebecca was just exhibiting Terrible Two’s behavior.
Couric might well ask mental health professionals: Whatever happened to the Terrible Two’s?
We use a medical model developed by Freud, not a behavioral model, to measure behavior. Freud believed that if a behavior works, it’s healthy, and if it doesn’t, it’s sick. So if a 3-year-old is drawing inside the lines of the coloring book, parents don’t have a thing to worry about, but if he or she is drawing on the wallpaper, the stage is set for a clinical diagnosis.
And there’s a pill to fix it. There are pills for yelling, biting, throwing, kicking, cursing, punching, name-calling and lying. There are pills for whispering in class, for when grandma dies and for bad habits. There are pills for daydreaming.
There’s a big difference between using medicines to treat genuine mental illness and designing new drugs to medicate perfectly healthy children. Today, as the mental health industry systematically pathologizes more and more childhood behavior, we see a raft of drugs aimed at “curing” them.
But the medical model of behavior overshot its target. Now it’s treating learned responses as though they were diseases, and almost all human behavior is based on learned responses.
Studies in the 1970s and ’80s concluded bipolar disorder was rare in children, but between 1994 to 2003, there was an astounding 40-fold increase diagnosing bipolar disorder in children. Children as young as Rebecca are now given powerful drugs not approved for children.
In Massachusetts alone, from 1988 to 2003, the prescription of stimulants, antidepressants and anti-psychotics given to children rose more than 300 percent, and the number of teenage users is even greater.
From 1993 through the first three months of last year, 1,207 children who were given Risperdal suffered serious problems, including 31 who died. Among the deaths was a 9-year-old who suffered a fatal stroke 12 days after starting therapy with Risperdal.
A key issue is the misuse of psychiatric diagnostic labels to explain bad behavior in children. This has resulted in the drugging of young children to a degree unprecedented in our history. To diagnose a 2-year-old as bipolar by adult standards is crazy.
The behavior of a 2-year-old is filled with curiosity about everything and anything. The young child has extraordinary ability in terms of emotions and cognitions. They can be very upset very quickly, very angry, very depressed, because their emotions are so fluid, so available. When a guy in the Terrible 50s tries to diagnose the Terrible Two’s on an adult level, that is craziness and dangerous.
By prescribing strong medicines instead of teaching children new choices using proven behavioral methods, we short-circuit a child’s learning process and, even worse, lay the tracks for a lifetime habit of responding to challenge and disappointment with avoidance, denial and chemical dependency.
Growing up is not a condition. Childhood is not a disease. Children act up and defy authority and they need adults to teach them how to manage difficult feelings and handle disappointment appropriately.
There are ways for parents to do this that are quite effective and don’t involve drugs, but they do involve parents being teachers. Our preschool children are far too young to defend themselves.
It’s up to parents to “say no to drugs” and teach their children that life is meant to be learned and experienced – it’s not just a pill to be swallowed.
Jacob Azerrad, a clinical psychologist in Lexington, is the author of “From Difficult to Delightful in Just 30 Days,” published by McGraw-Hill.