You can now watch The Medicated Child online at PBS, an excellent documentary produced by RAIN Media and Frontline describing a critical dilemma facing the child psychiatry community and parents across the world. Over the last ten years there has been a large increase in the diagnoses of childhood mental illnesses of many types including ADHD, depression, autism and anxiety disorders. There has been a particularly large increase in the diagnosis of bipolar disorder (what used to be called manic depression). This is likely due in part to an influential article published in 1996 indicating that 26% of children diagnosed with ADHD also meet the diagnostic criteria for bipolar disorder (a study conducted by Dr. Joseph Biederman). In other words, children that were originally diagnosed or that would have been diagnosed with ADHD are perhaps just as likely to have bipolar disorder instead. Diagnosis of bipolar disorder in children has been controversial, with many child psychiatrists believing it is impossible to diagnose in young children.

While diagnosis of adult bipolar is clearly defined in the DSM-IV (the medical standard for psychiatric diagnoses) by recurring episodes of mania and depression, there is no clear criteria, either in the DSM or in the minds of child psychiatrists for such a diagnosis in children. An apparent divide is set up in the documentary between the diagnostic criteria used by Dr. Joseph Biederman, Chief of the Clinical and Research Programs in Pediatric Psychopharmacology at Massachusetts General Hospital versus the criteria used by other psychiatrists. However, this disagreement is not elaborated throughout the rest of the film. Rather, it appears that all doctors interviewed agree that it is extremely difficult to diagnose bipolar disorder in children, but only Dr. Kiki Chang of Stanford University describes his criteria. Dr. Chang leans towards diagnosing earlier in childhood rather than leaving a potential problem untreated, saying that "when you take irritability to the extent that some of these children exhibit it, and then when you add some of the other manic symptoms in there, decreased need for sleep, decreased goal-directed activity, racing thoughts...you're at least somewhere on the spectrum."

The real controversy with child bipolar disorder is that of drug treatment. Many psychiatric drugs do not appear to work as well in children as in adults. Furthermore since the available bipolar treatments have not been sufficiently tested in children in a concerted scientific manner, we don't know the long-term risks of prescribing these drugs to children. In short, we don't know if these drugs do more harm than good. To emphasize the medical dilemma, and the public controversy the filmmakers show a news report of a young girl that passed away in the night from a fatal mix of prescription psychiatric drugs.

Dr. Chang's goal is to treat symptoms as early as possible saying "perhaps finding the right medication early on can protect the brain so that these children never do progress to full bipolar disorder." One poignant problem with psychiatric studies of any kind is the conflict of interest for scientists and doctors whose research is funded by the major pharmaceutical companies that so often fund large-scale clinical studies. Dr. Chang agrees that "it is an uneasy partnership, but without them where would we be now? We wouldn't have any of these studies."

In an interesting twist, an organization claims to be able to diagnose psychiatric disease by using the technology that scientists generally consider a research tool. The company, called Brain Matters Inc., monitors blood flow in the brain with a legitimate brain scanning method (SPECT), but then makes overly strong claims about what the results mean, including diagnosing a child with a mood disorder after a single brain scan. Dr. John March, Chief of Child Psychiatry at Duke puts it best when he says "we all want a simple, easy solution for these complicated life problems... In my view... if it's too good to be true, it is in fact, unfortunately, too good to be true." There is a reason why you can't simply visit your psychiatrist, receive a brain scan, and walk away with an unequivocal diagnosis of any psychiatric problems from which you may suffer. Science and medicine are performed with significant doubt, as this documentary so effectively demonstrates. As Dr. Chang describes the state of brain scanning technology, "we're at least 5 to 10 years off, if not more from that being a really reliable clinical tool, right now it's strictly a research tool." Nonetheless, this inconclusive brain scanning service is available if you have the $3000 (what Brain matters Inc. charges for one of its scans), and two members of the Brain Matters organization are shown with Dr. Phil touting their service.

Hope comes toward the end of the film when it's suggested that scientists and doctors must pool data and resources to involve children in clinical studies that closely follow these children to observe their response to the medication. In this way, as a community, psychiatrists can determine which medications work, and avoid repeating the same mistakes that may occur with the current system of disorganized experimentation that results from psychiatrists operating in isolation from one another, prescribing medication for bipolar disorder in children. The Frontline website for The Medicated Child has excellent information for parents, and anyone interested in further discussion.

What you can do: If your child has experienced unexpected side effects, take FDA Medwatch Voluntary reporting form 3500 to your doctor, and have him/her fill it out, then send it to the FDA. You can also report side effects yourself by phone at 1-800-FDA-1088, or at Medwatch online. Though you can report independently, having your doctor fill out the form will add weight to the information given to the FDA.