Pediatric Bipolar Diagnoses Increasing
> 4/9/2007 11:46:05 AM

Bipolar disorder is one of the most dramatic and difficult mental afflictions, often entailing a lifelong struggle with the competing forces of severe depression and mania. Physicians noted its brutal effects in action well before approving lithium as treatment and officially classifying the disorder as "manic depressive illness" in the mid-20th century. Patients suffering from severe BP were among the most unpredictable and difficult to treat. As we've come to understand the disease, treatment has grown more effective, but in the last ten years the mental health community has been confronted by a previously unforeseen challenge: bipolar diagnoses assigned to adolescents and children too young to have even begun kindergarten. While there is evidence of very young people suffering from some of the same symptoms that occur in older patients, and we've reported on the importance of early intervention for bipolar disorder where it exists, we should also be very careful to avoid overzealous diagnosis or treatment of BP as a convenient explanation for the difficulties experienced by problem children.

A bit of the current media spotlight stems from a tragic case involving the pharmaceutically-induced death of a four-year-old girl who'd been diagnosed with ADHD and bipolar disoder when she was only two. While the child's parents have been charged in her death, the professionals in this case also displayed fatal irresponsibility: mental illness is extremely difficult to define in a two-year old child due to an undeveloped brain and difficulties with communication. Only fifteen years ago, such a diagnosis would have been seen as extremely abnormal, but in the decade between 1990 and 2000, the percentage of bipolar patients under the age of eighteen increased fourfold. Perhaps the most visible sign of this epidemic's peak was the popularity of the 1999 book "The Bipolar Child," written by a New York City psychiatrist and his wife. The book has sold almost one-quarter of a million copies to date. It lists possible combined symptoms of the disease and has led many parents to their doctors, convinced that their children are suffering from bipolar disorder. When reviewing some of the given symptoms, it's easy to understand the confusion, as many are behaviors common in some form to almost all children. 

A recent New Yorker feature illustrates that, despite the National Institute of Mental Health's 2001 assertion that "bipolar disorder...can be diagnosed in prepubertal children," doctors are still very much divided on how to treat it in these cases (if it exists at all). This is not to dismiss the growing concern about bipolar children and adolescents. If a child can, in fact, be demonstrably proven to suffer from the disorder and benefit from select medications, immediate treatment may work to prevent the years of suffering that would precede an adult diagnosis. But, much like the previous decade's ADHD crisis, the huge upswing in patients labeled bipolar certainly owes a good bit of its identity to paranoia and the endless search for a chemical cure. Parents enduring long-term frustration with the behavior of their children are expected to look for an explanation, preferably clinical. But bipolar disorder is a largely genetic condition affecting between one and four percent of the American population, and it is almost certainly not an explanation for the misbehavior of a small child.

As we've seen, misdiagnosis and the drugs that come with it can cause profound physical or social changes in a child that are not exclusively positive. A parent who believes that his or her child suffers from the disorder or has heard the term used by acquaintances and general practictioners should first consider all other options, especially if there is no family history of the condition. While the few children legitimately suffering from bipolar disorder should get the treatment they need as soon as possible, the diagnosis and the steps made to address it should not in any way be taken lightly, and parents need to understand that the difficulties of childhood are sometimes just that.

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