The Demons of Childhood
Young brains break. Then comes the broken care system
KELLY TROYER SITS IN HER VAN IN the pickup line at the Pelham Road Elementary School, where Alex attends a special class with six other emotionally ill children. While he still clearly struggles--small setbacks can leave him tearful and frustrated--this has been a good year for Alex. After his diagnosis was finally nailed down, Alex began medication that has stabilized his symptoms. Both he and his younger brother, Hudson, are among an estimated 1 million children with bipolar disorder. Hudson, an impish, sparkling 7-year-old, is in a different school. The oldest brother, 12-year-old Brandon, is not only healthy but enrolled in a program for gifted and talented students.
Alex emerges, a typical little boy lugging a giant backpack. He is, as a report from the Medical University of South Carolina states, "well groomed and quiet with very soft speech," but he also has the slightly haunted look of a child whose brain has exacted a terrible price with its unpredictability.
"How are you doing, honey?" asks Troyer. "Did you have a good day at school?"
"I can read now," he announces proudly, as he searches for a book in his backpack.
"We never thought that would be possible," says Troyer as she drives away from the school. "Given everything else we had to deal with."
When Alex was a baby, he didn't sleep more than two hours a night and had problems eating and digesting food. When he was a year and a half, he began to hurt himself and other children at the day-care center, and he was kicked out. Troyer took him to the pediatrician, who "discounted everything I said." Alex, the doctor told her, was a normal kid, just colicky or in the midst of the terrible twos. All that was needed, suggested the pediatrician, was "different parenting skills." Troyer recalls: "I kept saying, you don't understand, this is a child who would rage and not sleep."
Unfair as this appears, and maddening as it is for parents, Troyer's difficulties also reveal the complexities of diagnosing severe mental illness in children, especially when it is manifest at a very early age. The conundrum with mental disorders is linking a clinical presentation--wild and frightening behavior, for example--with a diagnosis and suitable treatment. "We have improving, but not perfect, diagnostic schemes," says James Scully, the chair of the department of neuropsychiatry and behavioral science at the University of South Carolina School of Medicine. Diagnosis is based on observation and clinical experience rather than some measure of underlying physiology or cell pathology, and "there is a huge range of `normal.' We need to figure out if the child is experiencing a developmental process versus a developmental delay versus a real illness."
When Troyer's marriage broke up in 1997, she moved with her three sons into her parents' house in Greenville. Eventually, her mother and the boys' grandmother, Cindy Troyer, quit work as a nurse in order to help Troyer with the children, and Troyer's father, Tom, became a father figure to the boys, playing basketball, teaching them carpentry, and providing essential male ballast to their lives. Alex continued to be impossible to control, and Troyer thought she might finally get help from the family pediatrician in Greenville. The pediatrician recommended the popular antidepressant Prozac. Yet "it made him about 100 times worse," recalls Troyer.
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