Teen's correct diagnosis was exception, not rule

  • Article by: JEREMY OLSON , Star Tribune
  • Updated: December 29, 2011 - 10:13 PM

Bipolar disorder is too often blamed for erratic behavior, doctors say.

Ray Pearson is a sleepy teen whose depressed lows once caused near-daily suicide attempts and whose manic hallucinations had him talking to doorknobs and laundry bags.

Unlike hundreds of other children diagnosed with bipolar disorder, Pearson isn't given to unexpected outbursts. His shifts from depression to mania are as foreseeable as the Titanic -- and just as unstoppable.

Which is why Cindy Spicuzza, a neuropsychologist, found his case so surprising when she examined him last year. Accustomed to batting away bipolar diagnoses that were poor fits for troubled children, Spicuzza reached a rare conclusion after five hours with Pearson.

"This," Pearson's mother recalls her saying, "is the first kid I've seen in a long time that had a correct [bipolar] diagnosis."

The north Minneapolis teenager illustrates a dilemma in the erratic history of pediatric bipolar disorder. It became a fad diagnosis over the past decade, then came under scrutiny because of the number of children who received questionable diagnoses and were placed on psychotropic drugs. But a small number of children and teens genuinely have the disorder -- and they aren't served by either the under-diagnosis of the past, which left them untreated, or the overdiagnosis of today, which marginalizes the disorder and creates confusion about the care they need.

"All of a sudden, people are scared about making this diagnosis at all,'' said Mimi Sa, a psychologist in Cambridge, Minn. "You don't want to underdiagnose or overdiagnose. It's all about accurate evaluation and diagnosis."

For Pearson's mother, Octavia McLaurin, finding the right diagnosis proved elusive at first.

In early 2009, her son seemed depressed after his family's move to Minneapolis from Chicago and the death of a close cousin. Pearson, then 15, shut himself in his room after school.

Pearson had been an angry child, and his mother had been called to school in Chicago when he threw things at teachers and yelled at classmates for taking his pencils. She figured the isolation was just her son getting older. "He was growing into them teenaged years."

Until she found her son in the bathroom, preparing to cut his wrists. He was confined to Abbott Northwestern Hospital for a week, then sent home with a prescription for Prozac, an antidepressant. McLaurin was bewildered. Her son hadn't been referred to any therapist or psychiatrist. Were the pills supposed to be a cure-all?

"I don't know what I'm supposed to do," she thought. "I don't know anything about how to deal with this."

It's a frequent refrain, advocates say. With a national shortage of pediatric mental-health specialists, parents often bring children home from hospital stays with lingering questions.

Reforms in Minnesota have made crisis teams available to more families and streamlined the process of finding hospital beds for them. Advocates have launched more support services. But many parents still feel scared, unprepared and guilty.

"A lot of families feel blamed," said Sue Abderholden, who directs the Minnesota chapter of the National Alliance on Mental Illness.

Bright kid

McLaurin has always held high hopes for her son -- a boy with the smarts to skip fourth grade -- but her focus soon shifted to keeping him alive.

A week after his stay at Abbott, Pearson tried to overdose on Prozac and was hospitalized at the University of Minnesota Medical Center, Fairview. This time, he was put on antipsychotic drugs and scheduled for therapy.

Near-daily suicide attempts followed. Pearson tried to electrocute himself by putting metal in a socket. McLaurin locked all knives and pills in her bedroom and ordered her son to keep bedroom and bathroom doors open at all times.

"I always had to be one step ahead of him," she said.

One night, Pearson snuck into her bedroom closet and found pills. His 5-year-old brother, Marques, saw him swallowing them and told his mother. McLaurin couldn't wake her son. She dialed 911.

Exactly how many American children genuinely have bipolar disorder is a mystery, because many have been diagnosed for symptoms that fall short of the diagnostic criteria. One study set the rate of bipolar disorder, strictly defined, at one youth in every 1,000.

Spicuzza, a neuropsychologist with PrairieCare in Woodbury, said she can count on one hand the number of times she has concurred with a bipolar diagnosis in patients such as Pearson. The disorder is a heavy label for kids whose behaviors and aggression might change as they grow. "Kids are moving targets," she said. "As a clinician, I am über-conservative on making diagnoses on moving targets."

Loud voices

McLaurin now believes her son's symptoms emerged in childhood, but they all rushed out in the summer of 2009: depression, anger and then the voices.

Pearson can't remember the first delusions, but the voices were loud that summer. One time he made baby noises at a laundry bag, thinking it was his little brother. Another time he believed he could walk through walls and bumped into them. On a ride to the hospital, he had a lively talk with an aunt who wasn't there. "Look at those bikes!" he exclaimed to her, as they drove by a store.

Bipolar disorder is characterized by distinct episodes of depression and mania. The increase in youth diagnoses started after top psychiatrists at Harvard University reasoned that mania wasn't distinct in children but appeared as frequent bursts of anger and irritability.

Trouble is, these bursts can mimic a different affliction, attention deficit hyperactivity disorder (ADHD), which is more common in children. In a February report, Dr. Ellen Leibenluft of the National Institutes of Mental Health noted that even a slight misinterpretation of symptoms could result in the misdiagnosis of a substantial number of ADHD children.

While Pearson's mania could lead to delusions, it is something of a relief to McLaurin. When her son is manic, he can be giddy and smiley, willing to clean his room, patch the roof and do other chores. Mostly, his mania is a relief from depression. That's when her son shuts out the world by lifting the hood of his sweatshirt and closing it around his plastic-rimmed glasses. That's when McLaurin worries about her son hurting himself.

Progress

Finally, in the summer of 2009, Pearson's weekly cycle of self-harm and hospitalizations ended with a monthlong stay at the Fairview hospital.

Therapy helped him express his experiences, and doctors arrived at a favorable balance of medications. He stopped plotting suicide, though his mother still found evidence that he'd tried to cut himself.

Pearson was determined to graduate from high school on time and got frustrated when he wasn't getting enough makeup work after his hospitalizations. He struggled to stay awake in class, though, and the stress of schoolwork, classmates and noisy buses made it difficult to hold the voices in check.

More than one teacher told him that college was unrealistic, so he took satisfaction this year in enrolling at Metropolitan Community and Technical College. He will start classes next month, on his 18th birthday, with hopes of merging his love of computers and games into a programming career.

Yet even as McLaurin gained hope for her oldest child, new concerns have emerged. At the dinner table one night, Marques, now 7, yelled, "I wish you'd stop saying that to me!" In fact, no one had said a word. A voice, he later explained, told him he'd die if he ate the food on the table. His sister, Brianna, 11, has started therapy as well.

Bipolar disorder does have genetic traits, but for now McLaurin agrees with a doctor that Marques is too young for the psychotropic drugs that helped his brother.

She is waiting and watching - hoping Pearson stays on a promising path and wondering whether his siblings may follow him.

Jeremy Olson • 612-673-7744

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