Asked by Elizabeth Rooks, Seymour, Indiana
My 7-year-old son has lost touch with reality, I think. He says he feels like he's in a dream and nothing is real. He sees things and hears voices telling him to do bad things. He is bipolar, has autism, anxiety disorder, ADHD, ODD and OCD. He has tried many medications that either don't help or make things worse. He says the voices are telling him to kill himself. What should I do? I'm so scared for him.
Mental Health Expert
Dr. Charles Raison
Emory University Medical School
Your son's situation is obviously a psychiatric emergency, and I am truly sorry to hear of his very serious problems. The fact that he has been given so many diagnoses points to two things: first, how common it is for psychiatric conditions to co-occur; and second, how difficult it can be to diagnose children.
Of the problem you list, the two I worry about most as a psychiatrist are the suicidal thoughts and the psychotic symptoms (i.e. hearing voices). It is unusual for children to kill themselves, but not unheard of, and children are so guileless that if they tell you they are thinking about killing themselves, they need to be taken with utmost seriousness. So job one is to make sure your son is safe. I realize this is easier said than done, but I want to highlight that first and foremost.
It is also very unusual for children to develop clear-cut psychotic symptoms. Psychosis usually develops after puberty, but there are plenty of cases of childhood psychosis. Again, like the suicidal thoughts, psychosis in childhood is extremely serious and often but not always indicates the presence of especially severe mental illness.
Let me tell you the most practical thing I can about your son's treatment. Despite the failures you've experienced, the most important thing you can do is not give up.
I've seen thousands of patients over the years, and I can assure you that the most powerful factor in good outcomes for people with serious mental illness is the commitment of family members to keep on trying.
Plenty of people who failed multiple treatments are now doing remarkably well because they hung in there and found a combination of interventions -- usually built around medicine and therapy/social support -- that worked.
So here is the take-home message. Just because treatment has not been effective so far does not mean that there is no hope or that treatment won't work. Failed treatment should lead not to discouragement, but to a deepened commitment to searching for interventions that will help your child.
When you do feel discouraged, try to imagine all the patients I have treated, or advised on, who had their lives turned around for the better when the right treatment for that particular patient was finally found and instituted.
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