Too Young to be on Anti-Psychotics?

PHOTO Cole Evaold was diagnosed with ADHD and a mood disorder when he was just three and a half years old.PlayCourtesy Jennifer Evavold
WATCH Medicating Your Child

When Chris and Jennifer Evavold adopted their son Cole as a newborn, they knew he would change their lives, but not this way. The last seven years have been a nightmare.

Every morning Cole springs from bed screaming, flailing and sometimes punching anyone near him in the family's home in Buffalo, Minn. Just getting him fed and dressed is a feat.

The seven-year-old Cole isn't just rambunctious. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and a mood disorder at just three-and-a-half, and was prescribed medication to regulate his behavior. Since then he has been on an ever-changing cocktail of pills. His impulsiveness and violent language and behavior continue.

"It's so hard to get anyone to relate to you," his mother said. "They just can't even fathom how out of control things are. And if you tell him one behavior that he did one day, they'll say, 'My kid did that.' But it's not the one behavior. It's the compounding of all of these things."

Evavold said problems with Cole started at a very early age.

"The very first daycare he was in -- he was six weeks old -- the woman says he's high maintenance. And I thought, 'He is an infant! He's young!' What does high maintenance mean when it was a baby?"

Being first-time parents, the Evavolds just thought Cole was just a little fussy, but it was more than that. By the time he was two-and-a-half, Cole was on his fourth daycare. When he destroyed a caregiver's bedroom, his parents decided to have him observed.

"He pulled the drawers out of her dresser and took them out. He broke a picture on the wall, pulled her curtains down, and just turned the whole room upside down," Evavold said.

She and her husband were horrified but not surprised. He'd had similar rages at home. "He [was] flat-out, an hour straight, flailing, spitting, drooling, hitting, just a little animal, just out of control."

But Cole was also becoming violent. He had hit and bitten other children in daycare, but his most frequent target was his little sister Brynn, now five.

His father, Chris, said Cole once tried to kill her. "I am sitting in the house and I heard the hit. He hit her over the head with the shovel and I walk over there. 'What are you doing?' 'Oh, I am trying to kill her.'"

Cole's Parents Search for Answers

The couple had some clues to their son's frightening behavior. They had been told that Cole's birth father was bipolar, had taken medication to treat the condition and had even attempted suicide.

The Evavolds knew Cole might inherit it, but since bipolar disorder isn't generally diagnosed until the late teens or early twenties, they thought they had plenty of time. They also said they thought giving him a loving home might help improve his chances, but no amount of love was helping.

Cole's family history and erratic behavior led his pediatrician, Dr. Ernest Swihart, to the mood disorder diagnosis.

"Cole really cycles. It goes from very busy, very irritable to pretty depressed and down," he said.

Swihart would likely diagnose Cole as bipolar, but there are no official criteria for that diagnosis in children.

"I would call him severely mood disregulated," he said. "That's as far as I want to go with it."

To treat Cole's outbursts, Swihart prescribed a mix of psychiatric drugs, including Lithium, Adderall to treat his ADHD, and Seroquel to stabilize his mood. It was a very controversial move since Cole was just three-and-a-half at the time.

Swihart also admitted that some of the drugs Cole now takes are largely untested in children and it's not clear how they could affect his developing brain. Initially, his father was horrified.

"Obviously, I said, 'Heck no, my kid will never go on medicine,'" Evavold said.

"I was scared too," his wife added. "Every medicine we give him, there is always a death warning...but we really didn't have the luxury of time. We have another child in the house and he hits her in the head with a shovel and even with our friends' children, he took a croquet mallet to one of our friend's kid's head and luckily she missed it she got out of the way but you know we're thinking we have to control it."

Dr. Swihart and the Evavolds both agreed it wasn't an easy decision to medicate Cole, but they felt it was their only choice. The lack of a diagnosis for juvenile bipolar disorder and the issue of medicating children as young as Cole are greatly debated in the psychiatric community.

Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University, urged caution.

"It's important to emphasize that most of these children, almost all of these children, are getting the medications for things that haven't been studied so we don't know how effective they are, we don't know how safe they are," he said. "On the other hand, there are rare cases, extreme situations where there may be few other alternatives."

Cole takes medication in the morning before school and in the evening before dinner. His behavior has improved, particularly since he was prescribed Lithium at age six-and-a-half, but he still can be highly irritable and still has violent outbursts.

"He gets better with Lithium," his mother said. "If he has the rages now they are much more subdued."

For Cole and his family, the future is unclear. His mother thinks her son is now as stable as he can be. "We can't go any higher in these doses without things falling out of whack."

The prospect of Cole having a "normal" life and being able to support himself are slim. The Evavolds say they are prepared to care for him forever if that's what it takes.