Del.icio.us
Digg
Reddit
Facebook
StumbleUpon
TwitThisA decade ago, it was assumed that manic-depressive illness was limited to adults, except in the rarest circumstances. More recently, there has been an unprecedented surge in the number of clinicians who diagnose and treat the disorder in youth, even in very young children. Diagnosis in children and adolescents has more than doubled, according to Eric Youngstrom, PhD, of the University of North Carolina at Chapel Hill, and it is the now the most common diagnosis in children under 12, hospitalized for psychiatric disorder. This spike followed the publication of The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder, by Demitri Papolos, MD, and and Janice Papolos in 1999 (viewed as a bible by parents and now in its third edition), media attention on the national TV show 20/20 in 2000, and a Time magazine cover story headlined "Young and Bipolar" in 2002.
An estimate in a Harvard Medical School newsletter said that about 1 in 200 youngsters is affected, but the diagnosis remains mired in controversy. Depending on whom you ask, the real numbers may be substantially higher or lower. The American Psychiatric Association Diagnostic and Statistical Manual (DSM-IV TR) uses the same criteria to diagnose children as it does for adults, even though research suggests that children and adolescents with bipolar disorder are not just smaller adults. For example, children are more likely to have rapid mood shifts many times a day rather than over weeks or months.
Because of the overlap in symptoms between bipolar disorder and other childhood mental disorders (such as attention deficit hyperactivity disorder (ADHD), depression, oppositional defiant disorder (ODD), obsessive compulsive disorder (ICD), and separation anxiety disorder), many experts believe that it is underdiagnosed. Often its symptoms are inadvertently dismissed as normal emotions and behaviors of children and adolescents.
Since data on the efficacy and safety of mood stabilizing medications in youth is very limited, current treatments are based largely on experience with adults. An outspoken critic, David Healy, MD, a psychiatrist with Cardiff University College of Medicine in Wales, UK, goes so far as to suggest that the disorder is being overzealously diagnosed because of direct-marketing to consumers by the pharmaceutical industry.
A recent New Yorker article by Jerome Groopman, MD, highlights the difficulty of making a definitive diagnosis and quotes Steven Hyman, MD, the former director of NIMH, “There is something very real about the kids with devastating and disruptive symptoms, but the question is still the boundaries. You can do more harm than good if you treat the wrong kid with the wrong medication.”
Sadly, the stakes of not treating are equally worrisome. Left misdiagnosed or untreated, the disorder significantly impairs functioning in school, with peers and at home. Overall, bipolar disorder affects children and adolescents more severely than adults. A recent study funded by NIH found that adults who first developed bipolar disorder as children suffered worse symptoms than those who developed the disorder later in life. “The earlier you intervene, the better the prognosis,” says Dr. Papolos.
Advertisement 
