Sunday, February 25, 2007

Pediatric Bipolar. Yeah. Right.

As seen at this blog, a commentary on the tragic case of the death of 4 yr. old Rebecca Riley. See also this entry

Let me be very clear: it is not unlikely a 4 year old has bipolar -- it is absolutely impossible. This is because bipolar disorder is not a specific disease with specific pathology that one can have or not have; it is a description of symptoms that fall together. We decide to call a group of behaviors bipolar disorder-- and meds can help them, for sure-- but this decision is completely dependent on the context of the symptoms. Being four necessarily removes you from the appropriate context, in the same way as having bipolar symptoms during, say, a war, also excludes you from the context. You might still have bipolar, but you can't use those symptoms during the battle as indicative of it. If I transplant you to Brazil, and you can't read Portugese, does that make you an idiot?

I don't mean that 4 year olds can't have psychiatric symptoms. I'm saying you must be more thorough, more attentive to the environment.

As soon as a person-- a kid-- is given a diagnosis, it automatically opens the flood gates for bad practice that is thought to be evidence based. That's what makes the diagnosis so dangerous. Instead of, "should I use Depakote in this kid?" it becomes "It's bipolar, so therefore I can use Depakote." [...]

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