Protecting our most vulnerable

Nov 9, 2018

This is a pretty personal thought... not that my blog is usually clinical and objective... I mentioned a few posts ago that my 4 1/2 year-old was diagnosed with Bipolar disorder and started medication. I'm sure someday she'll be mortified that I have put these thoughts on the internet for eternity. But that's how important I think this discussion is. So here goes.

When I say that my daughter's behavior was tearing our family apart, it is only a slight exaggeration. I was constantly on edge and yelling way more than I wanted to. My wife ended many a day in tears. And, my son, God bless him, was not getting the attention that he needed and had to walk on eggshells in a way that a nine-year-old shouldn't. This had been going on for at least a year. 

But there was no one symptom/behavior that you could point to and say, "that's not right." All kids have tantrums. All kids are unreasonable sometimes. Many kids have sleep issues. Many kids have separation issues with their Moms. Lots of kids struggle with eating real food. Some kids struggle following the rules at school. And, some kids are stubborn and defiant. But when you put all of those things together in one kid....? But what's the deal?

So as part of my continuing education in to ADHD for my career, I attend a three day conference every two years through MGH psychiatric academy called ADHD through the lifespan. The March 2017 conference had tremendous session sessions on ADHD and accompanying conditions. I learned a tremendous amount about dyslexia, tourettes, and bipolar—particularly pediatric bipolar. I had had this presentation in the back of my mind for a year-plus in regards to my daughter. But whenever I mentioned it, which wasn't often, everyone thought I was nuts because she was only 4. But I knew there was something wrong. 

We started out very conservatively. We were in contact with her wonderful pediatrician .We had her evaluated at a the Think Kids program at MGH. We got her a neuropsych. I read most of The Explosive Child. She does therapy once a week at school. And, we tried just about everything we could think of while maintaining a positive parenting mindset. And through the course of a year or so, nothing really worked. I finally decided it was time to take her to see my doctor. It just so happens that I have a world class doctor who I've been seeing for 30 years. Back then he was the one who was aggressive and adept with my medication. He got me the help that I needed when it was perhaps beyond the cutting edge to give a 10 year-old the amount of stimulants that I needed. He is already managing my son's ADHD and anxiety very effectively. 

In advance of our intake I had to fill out the standard questionnaires which amounted to 45 minutes to an hour of filling in computerized bubbles about her behavior. But, I reflected on those bubbles for the many weeks until our appointment date. I just didn't feel like they were asking the right questions to evaluate my daughter. Like I said, it was about the "constellation" of her symptoms/behaviours. It was actually hard to articulate. I just didn't feel like anyone other than my wife and my daughter's teachers really grasped the enormity of her issues. If I didn't have the knowledge that I had from that conference and the determination of a junkyard dog, it would have been easy to believe that I was going crazy or blowing it all out of proportion. Luckily, I'm a persistent son of a gun. So, one night when my wife had the kids at an event that I didn't need to go to, I sat down to write a quick bullet point email to Dr. B. about what I saw as the issues.

1,400 words later I had an email that was so thorough I was actually embarrassed to send it. But I did. To make a long story short, I saw Dr. B. a week or so later for myself and he said that everything I wrote was, "textbook bipolar." This was a tremendous relief to me. Not only did it validate my thinking and pretty much prove that I wasn't crazy; It was an answer! I like answers. I like having a thing that I can attack. Of course everyone else in my life freaked out. My wife cried. My dad swore. My mom consoled me. But I felt better already.

Fast forward to a few months later. My daughter had her intake. She started a liquid form of an atypical antipsychotic med the next day. (Antipsychotic is a scary word. But Abilify is approved to treat several mood disorders.) It is safe, has a low side effect profile, and is pretty effective. And, it works very quickly, unlike, say and SSRI. She was on .5 mg for two weeks and now has been on 1mg for almost a week. Almost immediately she is like a new kids. She generally only has one tantrum a day. She recovers much quicker. She is, all of a sudden, a model kid at school. She randomly tells me that she loves me. She falls asleep at her bed time. And, she is often fun to be around. 

My props to you if you are still reading this. And, I hope you are because this is the point of the whole post. I have two important takeaways from this process. Or maybe they are the same takeaway viewed from different angles. It was not that long ago that the psychiatric community refused acknowledge that pediatric bipolar was even a legitimate diagnosis. It took a real maverick to diagnose a kid at all, let alone a 4-year-old. In fact there aren't actually any studies on Abilify in anyone under six. I am tremendously grateful for the second time in my life to have access to Dr. B. It is a shame that not everyone has access to such talented psychiatric support.

But I think there is a fundamental question that we need to ask ourselves as a society. What are we doing to protect the most vulnerable members among us? The establishment errs on the side of not treating children. Now, I don't necessarily disagree with that approach. We have to be very careful about medicating our kids. We need to be very cautious about how young they are when we address their issues pharmacologically. But, in certain cases, we do more harm by not treating kids just because they are kids. My daughter was in pain. She was wildly out of control. It was affecting her academically, socially, in her family, and in terms of her self esteem. After reading my letter and talking to me and my wife Dr. B. said, "it would be irresponsible of me to tell you to go home and come back in six month." 

I don't know what the answer is. There is no cut and dry way to look at psychiatric treatment of kids. But I know that my daughter needed help and I could not be more grateful to have access to a doctor who understood that and wasn't afraid to act. 



Standard Disclaimer:  In an effort to foil my own perfectionist tendencies, I do not edit my posts much… if at all. Please and typos, mistakes, grammatical errors, or awkward phrasing. I focus on getting my content down. An imperfect post completed is better than a perfect post that goes unposted.



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