We dealt with psychiatrists, psychologists, psychoeducational evaluators, therapists, and counselors from the time our son was 8 until he was 18. He’s had at least 3 psycho-educational evaluations by 3 different professionals in private practice, and two full-scale psychological examinations by two more.

Over the years, he was diagnosed with ADHD, dyslexia, dysgraphia, slow processing speed, generalized anxiety disorder, major depressive disorder, moderate substance use disorder-cannabis, PTSD, and bi-polar disorder. He’s had 3 psychiatrists in private practice and has been evaluated by at least a half a dozen others at hospitals, treatment centers and universities. Just in the 2 years from age 16 to 18 (or as I like to call them, the years from hell), this is a list of the medication prescribed for him: Buspar, Remeron, Vistaril, Gabapentin, Latuda, Concerta, Prozac, Lexapro, Wellbutrin, Mirtazapine, Lamictal, Prazosin, Propranolol, Ranitidine, Ropinirole, Seroquel, Lithium, Trazadone, and Abilify.

I’m Ann Coleman, and this is Speaking of Teens.

You know, our culture is one that puts a lot of trust in professionals – especially healthcare professionals – both medical and mental health. Afterall, they went to school for a long time – they have master’s degrees, doctoral degrees, medical degrees – they’ve all studied for years, made the grades, graduated, passed the boards, gotten their license, and we assume they have the knowledge and experience to do a good job – to properly care for us or a loved one.

When we go to one of these professionals and trust them to make a diagnosis, whether a medical or mental health diagnosis, we don’t know their class rank, their personal biases, observational acuity, their actual interest in getting it right – we don’t know if they’ve argued with their spouse that morning, if they have a kickback arrangement with a particular drug company, a penchant for diagnosing everyone with the same disorder, a racial bias…we just don’t know.

Today, we’re going to pull back the curtain and look at the potential for your teen or tween to be misdiagnosed with a mental disorder and the steps you can take to try and get a correct diagnosis, so your child receives the right treatment.

My son’s story, which I’ll get back to a little later, - it’s a bit of a cautionary tale. Had I listened to every one of these professionals and taken their word as Gospel – no questions asked – my son would definitely not be where he is today. And today, he’s on no prescription medications, he’s a happy, healthy, soon-to-be-22-year-old.

There are so many reasons I want to talk to you about this today. Mainly, because it’s quite likely that at some point you’ll need the help of a professional to diagnose a potential mental disorder (either for yourself or someone in your family, possibly your child).

I recently heard Dr Thomas Insel on the Ezra Klein Show. Dr. Insel is the former head of the National Institutes of Mental Health here in the US, and he was talking about the prevalence of mental health issues in the country today. He mentioned that 1 in 20 of us has a serious mental health disorder that impairs our ability to function; bi-polar disorder, schizophrenia, PTSD, major depression, generalized anxiety (1 in 5 of us if you count things like phobias). He says there are only two types of families; those dealing with mental health issues and those who aren’t dealing with it yet.

And when you look at adolescents specifically, the facts and statistics are nothing short of alarming. So, there’s a good chance you’ll face this issue with your teen or tween at some point. You’ll need to seek help for them from a therapist, a psychologist, a psychiatrist or maybe your pediatrician. You need to be an informed consumer of this assistance. You need to understand the risk of a misdiagnosis - and how to avoid it.

Over the past 10 or 12 years, misdiagnosis of mental disorders has increased 10% in the US overall. At the same time, the increase in misdiagnosis for pediatric mental disorders increased by around 43%. That’s unbelievable. You would think we’d be getting better instead of worse at diagnosing mental disorders. And a misdiagnosis can come in many forms. There are many physical or neurological problems that can mimic psychological issues. So, someone can be diagnosed with a mental disorder when in fact, they have a medical condition instead. Someone can be diagnosed with a medical condition when they have a mental disorder. They can be diagnosed with a mental disorder when their symptoms aren’t really serious enough to warrant it. And they can be diagnosed with a mental disorder, that is in fact, the wrong mental disorder.

Have you ever read the book or seen the movie, Brain on Fire? Susannah Cahalan wrote the book about her month-long nightmare of experiencing a lot of scary and strange symptoms like major paranoia, vivid hallucinations and psychotic behavior, weird movements, seizures, and light sensitivity and eventually, catatonia – just void of emotion and barely speaking. She as only 24 at the time, was working in her dream job as a reporter for the New York Post and had a brand-new boyfriend – these symptoms literally came on suddenly out of nowhere.

Her family and her boyfriend were terrified and doctor after doctor misdiagnosed her. Some told her parents she was probably just partying too much while others diagnosed her with schizoaffective disorder.

Many people would have taken the first answer from a professional and said, okay – I guess that’s it then and started down the road of treatment (medication, therapy, hospitalization). But her mom didn’t. As Susannah herself describes, (quote) “She was a bulldog. I mean she would not take no for an answer, especially in the beginning when they were saying it was alcohol withdrawal and partying. She refused to see that as an answer, and so she did her own research. She asked questions. At home, after a day at the hospital, she’d make a list of all the different terminology they used, and she’d look it up and, you know, not everyone is capable of doing that…I was so lucky to have someone there for me that could do that.”

Susannah was in the hospital for a solid month and remembers nothing from that time other than what family members have told her. She literally had a million dollars’ worth of blood tests and brain scans that turned up nothing. Then a very astute doctor gave her a simple test that showed the right side of her brain was inflamed. You know what that test was? It’s fascinating – I read about these types of experiments when I was studying the brain – he asked her to draw a clock face on a piece of paper – she drew a circle and put all the numbers (1 through 12) on the right side of the circle (between where the 1 and the 6 should go). That’s when he realized she likely had inflammation in the right hemisphere of her brain (which caused spatial neglect on the left field of vision) – because the two hemispheres of our brain control the opposite sides of our body.

Thankfully, Susannah was quickly diagnosed with anti-NMDA receptor encephalitis, received the treatment she needed and made a full recovery. Not everyone is that lucky. Advocating for the correct diagnosis and treatment for yourself or a loved one doesn’t come natural for some – but it’s absolutely necessary.

I want you to get comfortable being the bulldog. Being the mom that doesn’t take the first answer as the absolute and final answer. If you’re not a researcher, you may need to become one. If you’ve never read an academic paper or a scientific study, you may need to learn how. If you’ve never dissected a mental health screening tool or know how to decipher diagnosis criteria in the DSM, you need to be willing to jump in there and know that you can figure it out.

Let’s assume you’ve decided your son or daughter needs to see someone because they’re showing some early warning signs of a mental disorder. And I’ll list all of these in the show notes, but let’s say they seem angry all the time, they’re having frequent major outbursts, their thinking seems illogical, they don’t want to go to school and they’re complaining of physical symptoms like stomach aches, headaches, diarrhea and throwing up.

First, you have to decide where to get help. Who do you take them to see? Do you take them to counseling with a licensed professional counselor? Do you take them to your pediatrician? Where do you go? I touched a little bit on this back in episode 7 – about what to do if you know you’re child needs more than just therapy. But now we’re backing up a little and starting at the beginning. The first signs your child needs help of some kind.

So, let’s talk about the options among professionals you might take your child to and what each can and can’t do. Your first stop might be your pediatrician. You’re comfortable with them, you can get in quickly and you assume they deal with this sort of thing all the time – plus you figure there’s a physical element to it if your child is throwing up and having diarrhea – is it connected?

Sadly, most pediatricians are not trained for, nor do they feel comfortable diagnosing mental health disorders in their patients. For decades, all the experts, surveys, studies, even the faculty at the medical schools agree that med students simply do not receive enough training in mental health – and not much has changed. Unless they go on to specialize in psychiatry, they receive very few hours of mental health education and are simply not well prepared to diagnose in general practice or pediatrics. In 1997 the accreditation counsel did mandate that all pediatric residency programs include a 4-week developmental-behavioral pediatrics rotation. But most agree this is simply not cutting it.

However, because mental health issues effect as many as 1 in 5 kids, and because pediatricians are in the unique position of being on the front line to address these issues, the American Academy of Pediatrics is doing what it can to get medical schools to address certain competencies in their pediatric programs. But they seem to be fighting an uphill battle. I’ve read appeals from various stakeholders in the field going back years.  And surveys of pediatricians confirm that the majority of them still do not feel fully competent to diagnose and treat mental health conditions in their patients. Many will simply refer you to a psychiatrist, psychologist, or a counselor.

But let’s say your child’s pediatrician is just fine diagnosing your child with a mental health disorder and doling out medication. Do you really want that if they have no specialized training? Let’s come back to that question.

Let’s look at another side of it. Let’s say you take your child to the doctor because of the stomach aches, headaches and diarrhea but don’t mention their angry outbursts, illogical thinking and not wanting to go to school (because you don’t see them as connected) and the doctor doesn’t know to ask about psychological symptoms. Perhaps you walk away with a medical diagnosis, or you get a referral to a gastroenterologist or allergist.

I certainly didn’t know that anxiety could cause all these physical issues several years ago. And doctors are generally not trained to look for psychological reasons that someone may be having physical symptoms. But as we saw in Susannah Cahalan’s case, they’re also not well trained in seeing a medical problem when the symptoms appear to be psychological.

The American Academy of Pediatrics does provide a compilation of mental health tools to help pediatricians determine which one to use at the different stages of screening, evaluating and treating patients. These tools (they’re in the show notes) include questionnaires that are either fill out by the patient, a parent or even a teacher or just asked directly of the patient by the physician. They generally take under 5 minutes and screen for things like suicidality, safe environment, substance use, eating disorders…there are 30 pages of links to such assessments. We’ll come back to how pediatricians actually utilize these assessments to diagnose your child in a minute. But if the pediatrician refers you to a mental healthcare provider, or you decide to first go to one, let’s look at the options.

A psychiatrist is a possibility if the pediatrician thinks your child could potentially have an issue that requires medication. Psychiatrists are medical doctors. They go through the 4 years of medical school like other MDs then they go on to a 4-year residency program in psychiatry. Psychiatrists can diagnose mental disorders and write prescriptions for their patients. But for a psychiatrist to be able to properly diagnose and treat an adolescent, they need to have gone through a child and adolescent psychiatry residency program. And unfortunately, there is a major shortage in this country not only in general psychiatry but especially in child and adolescent psychiatry.

Without getting into the statistics – this shortage is dire. In some areas of the country, you might wait up to a year for a new-patient appointment. Three to six months is certainly not uncommon. So, what do you do in the meantime or instead?

Another option is a child and adolescent psychologist. The difference between a psychiatrist and a psychologist is a psychologist doesn’t have a medical degree – they did not go to medical school and therefore, can’t write prescriptions. But we call them doctor because they received either a Doctor of Philosophy degree (a PhD) in psychology – which tends to focus more on learning how to do scientific research or they have a Doctor of Psychology (a Psy.D.) which focuses more on practical application and actually working with clients.

These psychologists also go on to do a special training in child and adolescent psychology to earn that designation – at least one or two years extra. So, these guys are hard to come by as well. Out of the over 100,000 psychologists in the US, only around 4,000 are child and adolescent psychologists. So, you’re likely going to have a wait to see them as well.

What about licensed professional counselors (“LPCs”)? Can they diagnose and treat mental disorders? The short answer is that it depends on the state. Even what this type of clinician is called often varies from state to state. About half the states call them something else, like “licensed mental health provider” or “clinical mental health counselor.” But to be licensed in most states, they generally need a master’s or doctoral degree in counseling, pass a national exam, and have a certain number of hours of supervised clinical experience.

But just like their title, laws vary from state to state as to whether or not LPCs are allowed to diagnose. Over half the states allow it, some states don’t say whether they can or can’t and at least 2 (Indiana and Main) specifically exclude LPCs from being able to diagnose mental disorders. Even in a state where an LPC can diagnose, they cannot prescribe medication so if medication is required, there’s still that extra step involved of getting in to see a psychiatrist or perhaps a pediatrician.

Let’s look further at how each of these clinicians pinpoint symptoms to ultimately diagnose a mental health disorder. Unfortunately, there’s no blood test, no biological marker for a mental health disorder. While there may be a neurobiological basis for some disorders and others appear to be genetic, there’s still no mental health lab test. That leaves diagnosing mental health disorders somewhat of an art based on science, which means you’re at the mercy of the training, knowledge and experience of the clinician making the diagnosis. Which is why you need to be a wise consumer of these services and know who you’re dealing with.

As we said, a pediatrician, though generally under-qualified to diagnose, can if they want to, without any additional specialized training. They may or may not use one of the assessments available to them (which as I said, takes usually under 5 minutes to administer) – so they either use a tool like that or simply ask their own questions to pinpoint symptoms or diagnostic criteria - they pick a diagnosis and more likely than not, prescribe medication.

Let me skip to the psychologist before coming back to the psychiatrist. A psychologist is well trained in the use of standardized assessments or tests and other psychological exams at their disposal, and they use them. Testing, depending on the clinician and the situation, can take several hours to complete – and may be spread out over multiple appointments. They will likely have parents and teachers also fill out forms and answer questions. Then they take all the data collected, interpret it, pinpoint symptoms, or diagnostic criteria, make a diagnosis, and draft a written report to review with you and maybe your child. Then they’ll refer you to a psychiatrist or your pediatrician for medication (if needed) because they can’t do that.

A psychiatrist doesn’t use these standardized assessments used by psychologists. Depending on the clinician, they may use one or more general assessments for you, your child, and even their teachers, they’ll ask questions of you and your child, discuss thoughts, feelings, and behavior, and then based on all of the data collected and, on their expertise, they pinpoint symptoms, or diagnostic criteria, make a diagnosis, and prescribe medication.

What about an LPC making a diagnosis? As I said, they are allowed to do so in many states, and they might choose to do it in states where it’s not specifically addressed by statute. LPCs do have a master’s degree and work about 2 years under a supervisory LPC (about 3,000 hours) before they’re licensed. However, many psychiatrists and perhaps even pediatricians want any diagnosis that comes from someone other than themselves, to be from a psychologist who’s conducted standardized testing. LPCs do not perform these tests – although they may use assessments to try and gather accurate data before making a diagnosis.

So how do these different types of clinicians actually take the symptoms they uncover and make a diagnoses? How do they interpret the symptoms?

The tool they’re supposed to use is the DSM, which stands for Diagnostic and Statistical Manual of Mental Disorders. People even refer to it as psychiatry’s bible. It was first published by the American Psychiatric Association in 1952 and is currently in its 5^th edition with a new text revision published in March of 2022. So, it’s currently called the DSM-5-TR. The DSM has basically codified psychiatry - internationally. This 1,000-page book describes a multitude mental disorders in different categories and lists the symptoms and specific criteria for diagnosing each one – the diagnostic criteria.

Now, just to be very clear, the DSM is for diagnosing only – there is nothing in the manual about how to treat the disorder – nothing about which kind of therapy, medication, or anything else – that’s a whole other topic altogether. For example, one of the criteria listed for generalized anxiety disorder is “The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least six months and is clearly excessive.” That’s just one of three criteria and a list of several symptoms like difficulty sleeping, irritability, increased muscle aches or soreness.

Just looking at the DSM alone, there are many clinicians, researchers and academics that have all sorts of objections to it and feel it can easily cause misdiagnosis. Some argue that the DSM is a vain attempt to simplify human nature into lists of symptoms. And others say the symptoms are too broad and inclusive and that’s why an estimated 1 in 20 people have a serious mental disorder. If you go look at the DSM yourself, you could probably easily diagnose yourself with something. Some experts don’t like how the mental disorders are organized or categorized, or upon what basis it’s been modified over the years and who makes the decisions to modify it. They say that various revisions of the DSM may have been based on science, but others have simply been based on opinion or on changes in societal norms. For example, up until about 50 years ago, homosexuality was listed as a mental disorder.

And in 2013, when the DSM-5 was published, 15 new disorders had been added since the DSM-IV. Symptoms were also added to currently listed disorders and merged with others under another disorder. And many point to these issues for the 10% increase in misdiagnosis of mental disorders overall and the near 43% in pediatric misdiagnoses over the last 10 or 12 years. This is what Allen Frances, former chairman of the DSM-IV’s Task Force said in a 2013 article as the DSM-5 was published, “The elastic boundaries of psychiatry have been steadily expanding, because there is no bright line separating the worried well from the mildly mentally disordered. The DSMs have introduced many new diagnoses that were no more than severe variants of normal behavior. Drug companies then flexed their powerful marketing muscle to sell psychiatric diagnoses by convincing potential patients and prescribers that expectable life problems were really mental disorders caused by a chemical imbalance and easily curable with an expensive pill.”

Many experts and laypeople feel this way. The list of psychiatric “disorders” get longer all the time, symptoms that are just part of everyday life – the nature of being a human, get thrown into a list with other symptoms and BAM – a new disorder is formed, for which big Pharma has a pill!

And what this has done is basically watered down (for lack of a better term) all psychiatric diagnoses. It makes it hard for some people to take a diagnosis seriously, and that’s terrible for our kids. These ideas get stuck in a teacher or an administrators head, and it can really be devastating for an entire school population. Comments like, “who doesn’t have a psychiatric illness these days” or “who isn’t on psychiatric medication” or “we all have ADHD to some extent”. All of this is because so many of us could get a diagnosis of a mental health disorder if we go by the current DSM. Now I will say, because I did read this, there are declarations that anyone on the steering committee for the DSM is not associated or being paid by a drug company to broaden those symptoms – so there’s that at least. But they certainly do take advantage of being able to market directly to the patient – the drug companies do.

 

Side Note – I remember vividly when the FDA relaxed its rules for big pharma ads. The television commercials that run constantly today, didn’t start airing until 1997- According to Statista, in 2020 ads by big pharma accounted for 75% of the total television industry ad spend.

So, you might agree that the DSM is anything but a perfect diagnostic tool, but it’s what we have. Plus, it must be pretty difficult for some clinicians to even use the DSM. There certainly are lots of books, flip charts and guides out there that attempt to simplify it: “The DSM-5-TR Insanely simplified”, the “DSM-5 Made Easy - the clinicians guide to diagnosis”.

But then again, how many pediatricians and mental health practitioners even refer to the DSM to diagnose their patients? How many would you think? Would you maybe hope? One recent global survey reports only about 57% use it on a regular basis to diagnose patients. Maybe that means the rest have it memorized, but I kind of doubt it.

And those who do consult the DSM, they may use it as just a guide or a starting point rather than trying to adhere to it to the letter. Who knows? So, obviously, the DSM isn’t perfect and not everyone even uses it - or uses it as intended.

All along the process, with any of these different types of clinicians, so many mistakes can be made before they even get to the point of consulting the DSM. Your son or daughter may be having an off day when they show up at the psychologist’s office for testing. Maybe they were just dumped by a boyfriend or girlfriend and answer the questions where it skews towards depression. Or maybe they’re in a really great mood and have forgotten for the moment about how they feel on “off” days.

One thing many critics of the DSM point out is that clinicians use the symptoms for adult mental disorders and apply them to kids and adolescents. There are lots of researchers and clinicians that feel an entirely different set of symptoms should be listed in the DSM for different age groups and that special attention should be paid when evaluating gifted kids. Kids and adolescent’s brain are in flux. They’re thoughts, emotions and behavior are not on a straight trajectory. Their self-control, focus, decision-making abilities (all the executive functions) depend on a prefrontal cortex that is not yet fully online. Their amygdala and reward system are in hyperdrive. They do not think, feel, or act like adults and their symptoms cannot be compared to those of adults – those types of assumptions can easily lead to misdiagnosis. This is one reason ADHD and bipolar disorder, and other behavioral disorders misdiagnosis is extremely high in kids and adolescents. And gifted kids are often misdiagnosed with these and other disorders because their thinking process tends to differ from other kids their age.

Another big problem with evaluating adolescents is their ability to accurately relay their symptoms – their thoughts and feelings. They’re not as aware and not as articulate as it might be assumed by the clinician. And when parents speak for them (like in the questionnaires we have to answer about them) we make assumptions as well.

The questionnaires parents, kids and teachers fill out are so hard to answer accurately. I remember agonizing over answers in person and in writing over the years. I remember looking at answers I gave, compared to those my son gave and then compared to the teachers and wondered if we were all talking about the same person. These things are so very subjective.

Not only that but many symptoms of mental disorders come and go, they aren’t static, or they vary in intensity so one could be literally forgotten about by the time an appointment rolls around or a questionnaire filled out.

Race can also figure into a misdiagnosis. It’s been shown that African American boys are diagnosed with oppositional defiance disorder when white boys with the same symptoms are diagnosed with ADHD. Clinicians can make a misdiagnosis based on a lack of cultural sensitivity and objectivity – or just flat out based on their own personal biases.

And many symptoms of mental disorders overlap – they’re included in the list of symptoms for more than one disorder – just like Allen Frances mentioned in his article referring to the changes between the DSM-IV and the DSM-5. For example, auditory hallucinations are symptoms of schizophrenia, bipolar disorder, major depression with psychotic features, intense anxiety, and PTSD.

It's common for anxiety, OCD, PTSD or even other learning issues in kids and teens to be misdiagnosed as ADHD. Bipolar disorder is something else that is very often misdiagnosed in children because the symptoms are just not the same as they are in adults. It can often be misdiagnosed as depression if the teen is in a depressed state when the evaluation is taken. And if they’re in a manic state, it can be misdiagnosed as ADHD. The possibilities for misdiagnosis are endless.

Additionally, as we said at the beginning, many symptoms of mental disorders are also symptoms of non-psychiatric disorders. Using auditory hallucinations again as an example, it can be a symptom of temporal lobe epilepsy, dementia, and various brain infections or tumors. It can also be associated with being high on certain drugs or withdrawal from certain drugs. And if you’ve ever watched reruns of House, you know it could quite possibly be an environmental issue – some sort of chemical exposure. So, one of the most obvious ways to misdiagnose a mental disorder is to overlook a careful medical and neurological examination and rule out all other issues. I’ve even read of kids being diagnosed with ADHD because they had hearing loss or their eyesight wasn’t up to par, so you might add that to the list as well.

I probably don’t have to tell you that a misdiagnosis can lead to some major issues. For one, you end up not treating the real problem. And if you give a kid a medication to treat a mental disorder that they do not have can make matters so much worse than they were to begin with. And the problem is, it’s hard to know if that’s the original disorder causing the problem, a medication side effect or it’s not the problem you thought it was. It’s just an impossible situation.

And if a therapist is told it’s one problem when it’s another, they will probably tailor their treatment to fit that disorder, which may not help the real disorder, if in fact there is a disorder because it might be a medical issue if misdiagnosed. And unfortunately, once someone is diagnosed with something, there can be a bias towards that diagnosis sticking even if it’s incorrect. The emotional distress, not just for your child, but the whole family, is immeasurable.

So, what can you do when you’re not a doctor, a psychiatrist, a psychologist or licensed therapist and you need to ensure that your teen or tween is diagnosed properly?

I think one of the most important things we can do as parents to insure that you eventually get a proper diagnosis is to be skeptical. You now know there are plenty of reasons to be skeptical – so look at any diagnosis through that lens. Become the expert on that mental disorder. Read the DSM criteria and see of you think it makes sense. Read the best book you can find that discusses the symptoms and compare it to your child’s. Read articles – go to Google Scholar search engine and type in adolescence and whatever the disorder is and read all you can about it. Then type in adolescence and the disorder and misdiagnosis and see what they say. Be sure to look at the dates on the articles and studies and read the latest ones.

This is probably a good place to tell you what happened with my son. I mentioned it briefly in another episode but it’s worth mentioning again, I think. When he was 17 – weeks away from turning 18, we had put him in a residential treatment program (you can go back and listen to episode 10 to hear the full story). Anyway, this place was in Southern California, best of the best - top of the line help for mental disorders that lead to substance use disorders (thank God for health insurance). We already knew he had anxiety, and his behavior was just off the rails. So, there he is in California and at the time we were still living in South Carolina. The kids see a therapist a couple of times a week, we all met with a family therapist I think it was a couple of times a week too – I can’t remember, and they had group therapy and yoga and other therapeutic experiences all day every day.

The staff psychiatrist called me maybe a week into his stay and maybe after having met with him twice for a few minutes each time and she told me she’d diagnosed him as bipolar. This was a shock for me. He’d been evaluated for mental disorders by an adolescent psychologist and had been seen by 2 private adolescent psychiatrists and one in an adolescent psychiatric hospital before going to this residential treatment center and had never been diagnosed bi-polar and as far as I knew no one had ever even suspected he was bi-polar. So, I was a bit skeptical, and I questioned her as much as she allowed me to. But she insisted and then proceeded to tell me she was putting him on some really strong medication.

Now, I’m naturally skeptical and very curious and if you’re not, you need to work those muscles when presented with a mental diagnosis for your kid. My first stop as I recall was the book store, I believe I bought the only book they had on adolescent bipolar disorder, The Bipolar Teen, and I read it in like one sitting with some colored pens in hand as I always do. And I can remember reading it very carefully and thinking, I don’t know, maybe, maybe he is.

So, I got online started digging into the research – the scientific studies on adolescent bipolar disorder. And realized that the author of the book I’d read had co-authored many of the studies and articles I was reading David J. Miklowitz, PhD. So, I Googled him and realized he’d actually published over 200 research articles and book chapters on bipolar disorder and schizophrenia and had written 5 other books. The book I’d read had been translated in 8 languages and he’d lectured on the topic all over the world.

As soon as I saw that he was a Professor of Psychiatry in the Division of Child and Adolescent Psychiatry at the UCLA Semel Institute, I thought, hmmm, that’s about an hour from the residential treatment center. You know professor’s phone numbers are published right there on the university website. So, I called him and he answered the phone. And yes, he was accepting new patients. So, then I had to beg him to get my son in within the next few weeks because he was about to turn 18 and we couldn’t even force him to stay at the residential treatment center after that. I wanted to pick him up at the RTC, end his stay there and drive him up to UCLA to meet with Dr. Miklowitz. He was very accommodating and agreed. So, he said they would do the evaluation over a period of 5 weeks, one day a week. I then had to explain to sweet Dr. Miklowitz that we lived on the other side of the country and that flying back and forth or staying in a hotel or Air B&B in the heart of LA for 5 weeks was simply not financially feasible for us and immediately asked him for a second favor – I asked if he could possibly change his entire program for my son and see him on consecutive days, (and by the way could we condense it down to 3 days in person and 2 over the phone so I could avoid a couple of days in LA?). And I will be forever grateful that he agreed. Again, thank God for health insurance.

To make a long story short, my son did not have bipolar disorder (nor did he have PTSD or major depressive disorder). And when he went off all the medications he’d been on for everything, he lost the 30 pounds he’d gained on them and as I’ve said before, things got better and better the more I learned how to manage my own emotions and communicate with him about his emotions.

I tell you this story because I want you to realize you don’t have to be intimidated by any of this. If you can read, you can do what I did. I’m not going to lie, it wasn’t easy and I was a nervous wreck the whole time this was going on but we do it, right? We do what’s best for our kid. We call whoever we need to call. We finagle and wrangle our way in. We state our case, or we cry and beg and plead – whatever it takes.

In addition to being skeptical about the exact mental disorder diagnosis, we should also be skeptical about it being a mental disorder at all. Get the medical examinations, the eye exams the hearing tests, whatever it takes to rule out medical conditions that could mimic symptoms of a mental disorder. When my son was little and was complaining about not feeling good and saying it was in his “tummy throat”, I took him to his pediatrician, an allergist, a gastroenterologist, (maybe others) until we finally settled on anxiety. Insist on the exams, go to specialists, just because they went to medical school doesn’t mean you should be intimidated by them – if one doesn’t listen go to another one.

Be careful where you start. And I know you may not have a choice. Where I currently live, I think there is one psychiatrist, but I don’t think there are any psychologists and no child and adolescent specialists. So, I understand lack of access. If it’s possible, go out of town – the closest city. And treat choosing a clinician the same as any other service provider. Check them thoroughly and interview them just as you would anyone else. Remember that pediatricians are easy access but not necessarily the best person to diagnose a mental health disorder. Especially if they aren’t called on to do it a lot. Now, if you want to rule out medical causes for symptoms, that’s a really good place to start and then get referrals to other specialists.

Something else you can do is keep a journal about your teen’s moods and behavior as best as you can. As soon as you start noticing something’s going on, start writing. Be as detailed as you can about what time of day or night it happens, what else is happening at the same time, what foods they’re eating, what happened the hour before, what’s going on at school, how are they sleeping, any physical illness they’ve had, what medications do they take and when, and on and on. And, if you can get them to, have them do the same and ask them to write down as detailed as they can what they’re thinking and feeling. This way, if it’s weeks or months before you can see someone, you’ll have a good record of what’s been happening. Because I can tell you, before I started doing that, it was impossible to remember everything that you think you can.

Before you do meet with someone, let your teen know that whomever you’re meeting with is not judging them as they ask questions – that they’re asking these questions to get to the bottom of why they’re not feeling quite right. Tell them they may have to really stop and think about and that it’s very important that they be 1000% honest in their answers. The clinician should tell them that but that doesn’t always happen. This is one of the places mistakes or misinterpretation happens. A teenager is just not great at digging deep and being aware of their feelings so it’s very hard for them.

This isn’t a cake walk for sure. Any time you see your kid struggling or acting out it’s scary. If something is going on, check the warning signs I’ve linked to in the show notes. And in an emergency, take them to the ER or call 911. You can also call 988 now for the suicide and crisis lifeline for help or direction. Don’t put it off. The longer you wait, the worse it can become. Half of all mental disorders start by age 14 and 75% by age 24. The sooner you know, the more help they’ll receive.

So, again, what you can do to try and prevent a misdiagnosis:

Be skeptical and do your own research, get a second opinion if possible.

Have them checked out medically to rule out other issues.

Be careful where you start. A child and adolescent psychologists or psychiatrist should be at the top of the list.

Start writing everything down the minute you notice there may be a problem, and let your teen know how important it is to try to answer any clinician as openly and honestly as they can.

Speaking of Teens is the official podcast of neurogility.com.

Go to neurogility.com/herewego to find all our free parenting guides and e-books to help you learn more about your teen and how to parent them in a way that increases their emotional well-being and keeps them safe.

You can go to neurogility.com/29 for this episode’s show notes and transcript.

Thank you for listening to this really long Episode – I really hope you got something out of it – and if you know someone else who may be struggling with this issue, go ahead and share it with them!

If you want to reach out, you can email me at acoleman@neurogility.com – I love your emails.

Just as a reminder, we won’t have a new episode for you on December 6^th, but I’ll be back on the 13^th – Until then – Happy Holidays!!!