| Diagnosing Children
Question:
My now 7-year-old son has been having trouble since he was about 18
months. It was like seeing two different people in the same body.
Doctors kept telling me I was imagining it and/or wouldn't talk to
me about it until he started kindergarten and the teacher said the same
thing. He was put on ritalin for ADHD. He has been
hospitalized, last year, for acting out in class and being unruly. He
climbed on a desk and started throwing books. He found a wonderful
Dr. at the hospital who has put him on Concerta, Xyprexa, Lithium,
Buspirone, and DDAVP and diagnosed him with ADHD, ODD, and Bi-polar (of
which there is a family history). He has been with this Dr. for over
a year and now the Dr. has "re-diagnosed" him as ADHD and
Intermittent Explosive Disorder, something I have never heard of until
now. What, exactly, is this disorder and why is it apparently so
difficult to diagnose, and why does the Dr. now believe Bryant has this
instead of the ODD and Bi-polar? Thanks, Cindy
Response:
Hello Cindy
Diagnosing children is more difficult and takes time as they are still
developing and forming their personality and hence changing. It is
better to not rush into diagnosing them too fast.
Bipolar Disorder is
characterized by mood swings, from depression to elation or aggression.
Intermittent
Explosive Disorder is a type of Impulse
Control Disorder. This disorder is characterized by frequent and often
unpredictable episodes of extreme anger or physical outbursts. Between
episodes, there is typically no evidence of violence or physical threat.
A pattern might include isolated outbursts of extreme temper with long
periods of reasonably normal functioning, which differs from the more
diffuse and continuous impulsivity of a personality disorder.
In children with Oppositional
Defiant Disorder (ODD), there is an ongoing pattern of uncooperative,
defiant, and hostile behavior toward authority figures that seriously
interferes with the child's day to day functioning.
The difference between the two is that in ODD the child is deliberately
defiant and oppositional to the directions given, whereas in IED it
'happens' in an unpredictable way and not necessarily to oppose the
directions.
Episodes of anger are present in many different types of disorders, and in
working with children it takes time to narrow down their patterns... most
psychiatrists start with a working hypothesis and will keep fine-tuning it
as they become more familiar with the child. Personally, I believe
that it is better to do it this way, as growing children show different
trends and some aspects of the disorder become more clear through
treatment, specially since children cannot explain the process of what is
going on with them (thoughts and feelings) like an adult can. It is
possible that the doctor is noticing some dynamics that do not fit the
earlier diagnosis.
Hope this helps.
Regards
Uzma Mazhar |
