Did you forget to take your meds?

17 02 2011

The kids I work with are nuts. I think we all know that is said with affection. At times I get concerned, but for the most part, they’re a hoot and a half. If you can’t be crazy at age eight, when can you?

Not everyone shares my view of childhood.

I got a referral for a six year old the other day. Presenting problem? “Child plays around and is very silly.”

It’s high time for this lad to settle down. That mortgage is not going to pay off itself.

I’m sure there’s something there. It’s distressing his mother. But what was recommended for this child? The all-powerful psych eval.

I have one eight year old waiting on a psych eval. Family court is insisting. What behavior is she getting up to? She stopped doing homework and her grades dropped. Then her mother beat her with a belt. (Hence the ACS case.) The kid had just been diagnosed with diabetes over the summer. Her life changed. To make up for it, she got tons of attention from her family and friends. By the time school started, the attention had faded, but the diabetes was still there. She acted out.

But we need a psych eval. Even though the kid’s mother doesn’t really want it. Even though the kid is doing much better.

I’m not against medication. My cousin was prescribed Ritalin for ADHD, right when everyone was saying that it was incredibly overprescribed, and that those kids were just being kids.

I saw what Ritalin did for this kid. He didn’t turn into a zombie. It allowed him to be himself. He was still energetic and hard to keep up with, but he was able to channel this into his love and talent for sports. He was no longer angry at everyone and frustrated with himself. It made a huge, positive impact on his life, and our family.

That being said–not all of my kids need medication. And yet I’m being told that they do. ADHD isn’t even enough anymore.

I was working with a seven year old recently, who had what everyone thought was a pretty clear case of ADHD. He was bright, but doing poorly in school because he couldn’t concentrate or sit still. He was delightful in counseling, but required constant one on one attention. He got up to do the running man at random moments. (I admit, I never wanted that one to end.)

His mother was against a psych eval. She felt that he would be drugged and his personality changed. In this case, I felt the evaluation was really necessary. As did my supervisor, and the kid’s teachers and doctor. The mother and I talked about it at length. We went over her concerns, and her right ask questions. She finally felt comfortable with it.

Also, she couldn’t take another homework session interrupted by this boy’s need to express himself through 80s dance moves.

They were on three waiting lists for months. Mental health services in the Bronx are frighteningly hard to come by. Finally, though, the kid was in.

After three meetings, this seven year old had been diagnosed as bipolar and sent home with a free sample of Abilify.

Who doesn’t love samples?!  The little packets, so fun.

Being a responsible, loving mother with an internet connection, this woman did a little Googling. Reading the fine print for any medication will terrify you, no matter what. WebMD convinced me that taking more than one Tylenol causes internal bleeding, asphyxiation, talking in tongues, and the ability to fly.

Abilify, though, is serious business. For bipolar disorder, it’s only approved in ages ten and up.

Not to mention that the psychiatrist met this child three times. A grand total of 135 minutes. Her first thought was a label like bipolar, and a powerful antipsychotic? The mother’s very legitimate concerns were brushed aside. Just try the medication, keep an eye on him, he’ll be fine.

Ultimately, mom couldn’t go through with it. She returned the samples, and discontinued mental health services.

And I supported what she did.

Again, I’m not anti-medication. But I think we can all agree that not everyone is bipolar. A third of the kids I work with have had a doctor or counselor speculate that they might be bipolar. About the same number are on psychiatric medications.

I would think that this is a nationwide issue, but I recently spoke with a nurse in a lovely, wealthy suburban community. She was shocked to hear that a sixteen year old she knew was diagnosed with bipolar disorder. “They try not to put a label like that out there until age 18, because the kids are changing so much.”

What?!

She couldn’t believe what I was telling her about my experiences. Apparently, likelihood of serious mental illness decreases as tax bracket increases. Curious.

People should be open to medication. They should not be ashamed to admit to having a mental illness. But why the disparity? Why is the future of a child of affluent parents in an impressive zip code so important that he can’t be saddled with a serious diagnosis, while my kids and their parents, many of whom are rather young and rather not-white, are told to just be good and take their meds?

Stories like this seven year old’s are exactly what people are afraid of when the idea of a psych eval is raised. It drives people away from mental heath treatment that their children may really need.

It’s hard as a social worker to question the opinion of a doctor. Who the hell do we think we are?

We are the ultimate advocates for our clients. And for our kids’ right to be nutty kids.

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17 responses

17 02 2011
MH

This is just terrifying.

Bipolar disorder? I mean, really?

18 02 2011
socialjerk

Terrifying is the word. It’s scary when you start to realize how important trends are in mental health.

And I’m glad someone else still enjoys Placebo.

17 02 2011
MH

Also, great song. Just throwing it out there.

17 02 2011
Carolyn

A six year old “plays around and acts silly”! Is that not in the job description of six year olds everywhere! I agree that meds (particularly those dealing with mental health disorders) are being thrown around pretty loosely. And strangely enough, it is particularly to the kids seen in the hospital and are low income (the higher income kids pay and avoid waitlists, etc.) Of course, then there’s the question of just who is going to pay for those medications. And while I love my job (resourcing) and am ever so proud of myself when I can get a medication covered, I want that medication to be truly needed. Not just to make a child easier to deal with. (Fortunately, I am not working for the mental health program here.)

18 02 2011
socialjerk

It was definitely the strangest referral I’ve seen…which is really saying something.

Getting the meds and treatment paid for is so important, and so difficult. It’s great that you are doing that work, despite the issues with why the kids are getting mediated.

17 02 2011
Social over worker

So true. I worked with children’s mental health for 10 years and saw this so often. They were all bipolar… what?!

It’s good to question authority (but not me).

18 02 2011
Carolyn

Love your avatar. So often it is assumed that we social workers have a magic wand in our back pocket.

18 02 2011
socialjerk

Wait…were you not issued your wand when you were hired? I’ll send someone over right away.

18 02 2011
socialjerk

It’s funny how all of a sudden, everyone has the same diagnosis. They all used to have ADHD, now it’s bipolar.. I wonder what’s coming next?

Psychiatrists have been very frustrating for me to work with. They did not seem to respect social work too much. I’m sure there are some good ones out there, but I wish I knew where they were in the Bronx!

18 02 2011
sarahk

I don’t think the problem is that people are getting a psych eval – that just seems responsible – but that the psychiatrists are so diagnosis-happy. Bipolar in a child is extremely, EXTREMELY rare. There was a Frontline episode (you can watch it free on Hulu) called the Medicated Child or something like that, about exactly this.

I feel lucky that the psychiatrists at my agency are pretty responsible and don’t try to push meds. Several of my clients (who definitely do have paranoid schizophrenia) don’t want to take meds and the psychiatrists still see them anyway and respect that decision.

I’m not much of a conspiracy theorist, but it seems like the companies that make the meds have gotten really good at convincing people they’re sick.

18 02 2011
socialjerk

I don’t think a psych eval should be a problem. But I don’t like when people are pushed into it when it’s unnecessary, and not what they want. Also, once the evaluation is done, parents are often told that if they don’t want to medicate their child, they’ll be charged with medical neglect. I can understand why a parent wouldn’t want to go down that road.

Oh, I also want to definitely recommend the Frontline special “The Medicated Child.” I actually saw it because my cousin worked on it, but it is extremely eye-opening.

18 02 2011
nechakogal

Another great post socialjerk. You captured the extremes in mental for children (and for adults quite frankly) very well. I think I worry most about the people who are happy to accept the fast fix prescription and don’t question whether it is the best option.

18 02 2011
socialjerk

Thanks! Questioning is key. But someone with a medical degree can be so intimidating, especially in a public hospital when they don’t have much time to work with patients.

18 02 2011
mjfrombuffalo

15 years ago it was “Borderline Personality” and “Conduct Disorder,” at least for my inner-city black teenaged boys in the group home. Who, BTW, were “PINS” admissions but almost all had (uninvestigated) abuse histories… meaning when the parents couldn’t beat the crap out of them any more for misbehaving, they took out the PINS on them. (Thank God for PINS Diversion, being used so much more now than before.)

20 02 2011
socialjerk

Ah yes, BPD was before my time. Maybe I’ll declare it “throwback week” in social work, and try to really bring it back. Along with Seattle grunge. 🙂

That’s good to hear about PINS diversion. I get a lot of cases through them. The parents are very unhappy that it’s so difficult to get a PINS warrant now, but I shudder to think that some of the cases that come to me would have just been handed a warrant back in the day. Most of them have just given up on their teens for acting completely reasonably in the face of their circumstances.

20 02 2011
Doris

Great post. I have experienced this problem in my own family. My stepson who is now 10 has been labeled for years with Asperger’s, ADHD, OCD, Depression, Anxiety… and all kind of diagnosis–I wonder if the next one will be “Bipolar”. I would say, ADHD would be the most accurate. His mother takes pride on displaying his photo and bio on Autism Awareness exhibits all over the town–Should “Munchausen by Proxy” be included in this discussion?? LOL. He was at some point on 4 medications… finally, after nagging my husband, he steeped in and the child started psychotherapy. He has done well since then, and right now he is only on one med.

20 02 2011
socialjerk

I’ve seen that strange sense of pride that some parents have in their child’s “diagnoses.” Like I said, I don’t think people should be ashamed of mental illness by any means, but it seems like most parents who are truly struggling with their children’s conditions and disabilities don’t have the time for such things.

Is there a “Munchausen by Proxy” message board you could post his mother’s photo on, by any chance? 🙂

Good luck with your stepson. It’s so good to hear that he is getting some talk therapy, it’s so often the missing component!

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