#42 What to do with a psychotic 6 year old

Over the last several months, three different families with psychotic six year olds have consulted with me. Technically, none of the children was formally diagnosed with psychosis though I can guarantee behind their backs this is exactly what teachers and parents of other kids at the school were calling them. Instead, the long list of specialists seeing the terrifying trio used euphemisms such as mood regulation problems, anger management issues, oppositional defiant and bipolar disorder to describe their behaviors. One mother sent me a psychiatrist’s report so full of convoluted niceties to label outrageous behavior that poor mom was reduced to tears. “I don’t understand. Why can’t anyone tell me what is wrong with my child?” she wailed. I sympathized with both the doctors and the parents. After all, between the three of them they had sent a preschooler to the hospital, threatened to jump off a balcony, reduced an older brother to hysterical tears on a daily basis, bit a teacher in addition to large daily outputs of kicking, screaming, hitting and smashing up stuff. Two of the three had long pre-school rap sheets while the third mostly held the punching in until he got home. Their combined prescription drug use could secure them a slot on Celebrity Rehab (the Kindergarten addition). Yet until the parents sought out a nutritionist, not a single specialist asked them about the main chemicals they were ingesting. That is, food. Notably, two ate a sugared, dye-laced cereal for both breakfast and lunch. I now think of these cereals as magically malicious. The specific brand is less of concern then the high levels of sugar and artificial colors and low levels of important nutrients. One boy’s daily snack was a popular glow in the dark candy. As far as I am concerned, he had eaten no food, only irritants until dinner unless you count the few ounces of milk he poured on his cereal. I felt myself growing meaner just imagining eating his diet. The third tyke only ate white food. His diet was mostly pancakes with syrup, bagels with cream cheese with an occasional cracker with peanut butter thrown in when he was in the mood. After thirty years of clinical practice, I am still surprised when smart, caring parents end up in this situation. What is equally stunning is how much money they can spend on smart, well-respected professionals and the diet is never considered as a possible culprit. I told all three parents the children had to be taken off their drugs and I was not referring to Risperdal. This is when you see just how addicting sugar cereal and white carbs can be. The parents all told me this was not possible as the boys would starve rather than eat something else. Further, they were at the end of their figurative ropes and could not handle the screaming should a preferred drug-food not be available. “He will throw a thirty minute tantrum and disrupt the whole family,” one mother insisted. “He will not eat all day (believe me I have tried) and then really fall apart,” echoed another. I plowed on, identifying one real food item each child was willing to eat. (Peanut butter for one and pizza for the other two.) Throw away the cereal and pancakes, I instructed and provide peanut butter or pizza three times a day if they refused regular meals. At least the children would have real food three times a day. This small change would improve their diets dramatically though I will not be winning any nutrition awards for the new pizza diet. To close the gap between what the little rascals were willing to eat and what their brains needed to function, I threw in a few nutrient supplements. Finally, I warned the parents there could be a withdrawal period so they better get the cereal and candy out of the house. That way the six year olds could not brow beat mom or dad into submission in a weak moment. Since all three had been enormously successful in the browbeating department, this step was critical. The first child was 80% better on an all pizza diet after three days of “hell”, according to his mother. Not bad for a child who liked to play with matches and had threatened to burn the house down. I expect similar results from the other two if the parents can stick to the plan. A number of years ago I saw a similar case where the father was a psychologist of some renown. The poor youngster was so perniciously negative; it was hard to be in the room with him. Other kids agreed and he had no friends. He also ate an atrocious diet of bread, pasta and colored sports drinks. After several weeks the father reported back that making diet changes was just too hard. “Maybe down the road when things are less stressful,” he added lamely. Sadly, he chose the road more often traveled and gave the child a handful of medication rather than address the diet. Fast-forward three years and the situation has not significantly improved and dad still is not ready to take on the diet. It is sad when people have the skills but not the motivation to act. Where is Robert Frost when you need him? ‘Two roads diverged in a wood, and I I took the one less traveled by, And that has made all the difference.’ (http://www.bartleby.com/119/1.html)