Is irritability diagnostic of bipolar disorder in autistic children? Read More
I am commenting because professionals like you who invalidate and deny correct diagnosis of children with bipolar disorder have directly caused me, my cousins and my children a great deal of harm and grief including diagnosis delayed by decades in some cases. The consequence of improper diagnosis is improper or no treatment for childhood or teen onset of mood disorders. I do agree that irritibility is not enough to diagnose a mood disorder, but it is also important not to rule it out and in treatment and services provided, assume that there is a higher risk for a mood and or psychotic disorder and a very high risk if a mood disorder is developing and is mistreated, under-diagnosed and under or untreated. I happen to have bipolar disorder. In my 50's now I know of no experts who would disagree based on my history. All my cousins have have been treated for a mood disorder, on one side of my family 100% have a bipolar diagnosis. I'm the youngest, yet I was the first diagnosed, at age 30. Most of my cousins were diagnosed in their 40's. There were decades of unnecessary suffering. I knew I had it when I was 16. I used to argue with psychiatrists and psychologists to no avail. So I did not get the medication that I needed until I was 30. I also gave up on seeking treatment in my 20's because I was not listened to by people who were your colleagues at Penn. When I saw my older children, now in their 20's, develop symptoms of bipolar disorder as children, people like you caused me a depth of pain an anguish by denying the obvious. Thankfully, I found a board certified Child and Adolescent Psychiatrist who has been President of the NJ AACAP and has been awared recognition by the National Alliance for Mental Illness, who treated them. They are doing great now. I also have a 10 year old. He may be that one in forty thousand children who present first in the Autism Spectrum, develop psychosis before the age of 12 and mood symptoms. He responded amazingly well to lithium. Although he has been given a bipolar diagnosis by his board certified, Child and Adolescent Psychiatrist, I don't think he definitly has bipolar disorder. I think we should treat the symptoms of Autism, Psychosis and Moods agressively with a full array of multi-modal treatments and services. I think he has the potential to develop Schizoaffective Disorder, but the diagnosis is an ongoing process. That is because he experiences Psychosis (paranoia and hearing voices) even when he is not exibiting mood symptoms. His mood symptoms are much clearer than just irritibility. He shows signs of brief manic like moods lasting less than 4 days but no depression, unless the irritibility is depression. If your book was "Your Child Might or Might Not Have Bipolar Disorder" that would be different. I don't expect you to listen to a word I say. Thank goodness I've had enough therapy and recovery to deal with the invalidating nonsense people like you perpetuate. I'm writing this for my own mental health. Also, as an advocate, I hope someone else reads this before they listen to your invalidating message. I've met the author of "The Bipolar Child" in person. He is a very brave doctor and author who went out on a limb to help families like mine. You may be an expert, but I'm the expert on myself, and on my child. My older children are the experts on themselves now. If you are truely a responsible person, you should take responsibility for the harm you cause by influencing people to delay or not treat mood and psychotic disorders in children. First do no harm.
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Stuart L. Kaplan, M.D., is a clinical professor of psychiatry at the Penn State College of Medicine.
It can take a radical reboot to get past old hurts and injustices.