July 13, 2011

If it Looks Like a Duck, and it Quacks Like a Duck - Is it a Duck? Depends on Which Expert You Ask

"If it looks like a duck and it quacks like a duck..." is the perfect question for dealing with children who have a psychiatric diagnosis.

Our neighbor has a daughter who has been diagnosed with autism. The mom has been posting on Facebook that the girl (she's seven, I think) is wreaking havoc all hours of the day and night, staying up for forty hours at a time before she crashes from exhaustion.

When your child acts like this, nobody in the household sleeps, either. It's scary and frustrating and you just want the kid to stop.now. The Boy once stayed up for three days and three nights. I thought I would lose my mind. He ranted and raved, cried and laughed maniacally. He shook five pounds of flour all through the apartment. He made mess after mess and said, "You can't stop me, Mommy." 

He was right, I couldn't stop him. But I could take him to the hospital - and get turned away because he fell asleep in the waiting room. No symptoms, no admission...even though I sobbed as told the doctor all the things he had done (I wondered later if they were considering getting ME a room).

It took his attempt to jump out my bedroom window to get him admitted a few days later. That's when our adventures with bipolar disorder were started.

I asked my neighbor (on FB) if her doctor has ever ruled out the possibility of bipolar disorder because, frankly, the little girl sounds like she's manic.

Her response? 

"She was taken to the XYZ center for autism and had extensive testing and they ruled out bipolar."

I'm sure that's exactly what happened. Now, our story of how that approach may not work so well.

When The Boy was formally diagnosed with bipolar disorder at age six, his psychiatrist thought that all of his behavior problems were due to this condition. Autism wasn't even on the radar screen. His doctor, highly respected in the field of pediatric bipolar disorder, never entertained the thought that another concomitant disorder was a possibility. 

If it looks like bipolar, and talks like bipolar, it must be bipolar...right?

Think of all the therapies The Boy missed in the three-year delay in the diagnosis of Asperger's.

It's been established that several other conditions and disorders often appear concomitantly with autism - among them, ADHD, OCD, bipolar disorder, epilepsy (or a related seizure disorder) and Tourette syndrome.

Even with that knowledge, experts within a specific specialty often miss diagnosing these other disorders. Eager to help, they stay within the confines of their particular psychiatric niche, and continue, business as usual.

This is why it's called 'practicing medicine', in my opinion.

Over the years we've consulted with a psychiatrist, neuropsychologist, neurologist, therapist and behavior specialist - and they've each given their opinions. Then it's my job to get the experts to talk to each other, and come up with a reasonable plan of attacking the issues at hand.

Another tricky part of this puzzle is that a lot of the same medications are used to treat the symptoms of bipolar disorder and autism. It appears that the respective doctors agree only when they pull out their prescription pads.

Real magic can occur when you find a specialist who is willing to entertain the thought that there may be more than one disorder occurring at the same time, just like with The Boy.

By limiting the search to an autism center, the odds are good that autism will remain the only diagnosis. Potential helpful treatment will be denied, opportunities for more rapid improvement of recent problems will be missed.

The child was admitted to the hospital last night. Maybe the doctors and other staff will be able to get to the bottom of her current difficulties. Maybe they'll even suggest more diagnoses to add to the list. Although this in itself is upsetting to a parent, upon reflection, it's good to know the truth. With an accurate diagnosis, there is hope for improvement, and hope for a full night's sleep and a brighter tomorrow.


  1. Wow, what a nightmare for that parent, as well as for you. It's so much for our little babies to deal with, and it's crushing to us parents. But I agree, as heartbreaking as it must be to hospitalize your child, in the long run the hope is that they will be able to diagnose, treat, and stabilize them, for the good of the whole family.

    I don't remember anyone ever telling me that parenthood would be like this. Not once.

  2. Oh my gosh. If your neighbor only would accept all the help you could give her on this subject.

  3. Whew, I'm exhausted just reading this post. Love to you and your neighbor.


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