Do the Right Thing

Spirit, science, and health

Children with Bipolar Disorder? Really?

Why are so many young children diagnosed with bipolar disorder today?

Is bipolar the new diagnosis du jour? A few weeks ago I asked the question in this post. Since then you may have read the Newsweek article by noted psychiatrist and PT blogger, Stuart Kaplan, M.D. If you haven't, you really should!

There has been a 400% increase in the diagnosis of bipolar disorder in young children and a 40 times increase between 1995 to 2003 alone according to Dr. Kaplan (among others). He states that bipolar in young children is likely due to other perhaps more mundane diagnoses like ADHD, ODD, PDD, and so forth. 

Do children, even very young preschool children, really have bipolar disorder? Even if they did, how could you tell since the symptoms of bipolar in children seem to overlap with so many more common issues that might contribute to these troubles (e.g., attention deficit, hyperactivity, oppositional defiant, and conduct disorders, learning disabilities, the influence of child abuse and neglect, poor parenting). Today, young children are receiving a very serious psychiatric disorder label at alarming rates. They are also offered serious mood stabilizing medications that may not have adequate research support to use with young children. In my earlier blog post I mentioned a recent article in the Archives of General Psychiatry stating that the rates of bipolar disorder in the United States are at least twice (and often more) found outside of the United States.

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So, what's up with bipolar in children all of a sudden?

Might this remarkable new development in the field of child psychiatry reflect the true discovery of a previously undiagnosed psychiatric disorder in now almost 5% of all American children? Or might this trend reflect something else? A fad perhaps? A way for the pharmaceutical industry to sell more of their products to more people? A way for child psychiatrists to make more money or develop a new and exciting career (treatment or research) specialty? All of the above?  

So, what's the right thing to do for our children in this regard?

Perhaps only time (and future research and clinical best practices) will really tell. Of course I am referring to research conducted and clinical trails that do not have conflicts of interest. In the meantime, if my child were offered a diagnosis of bipolar disorder and encouraged to take medication for it, I would want a second (and perhaps a third and fourth) opinion if possible. I would also want a professional opinion from someone who doesn't have a financial or career development conflict of interest in making the diagnosis. I would also want a child development specialist to take a look as well (such as an appropriately trained child psychologist). Until this controversial issue is better resolved, this seems to be the right thing to do for our children.

What do you think? 

Thomas Plante, PhD, ABPP, is the Augustin Cardinal Bea, SJ University Professor at Santa Clara University and Adjunct Clinical Professor of Psychiatry at Stanford University.

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