Most treatment professionals working with children and adolescents are acutely conscious of the rise in the rate of which children and adolescents, but many significantly pre-pubescent children, are increasingly being identified as having Bipolar Disorder. While estimates vary from article to article, it’s interesting to notice several recently reported statistics. The New York Times, in an article released in September of 2007, noted that in the 10 year span from 1993 to 2003, there clearly was a forty-fold upsurge in the rate of which this population was being identified as having Bipolar Disorder, while a more scholarly article (Youngstrom, 2005) noted that marked increases had been found in the rate of diagnosing in children of these involved with Child Protective Services in Illinois. Other writers have pointed to the sharp upsurge in the rate, some positively (NYT, 2007, Papalos and Papalos, 2006), even saying that there must be much more of an increase. Others, however, have expressed alarm at this sharp increase, and have pleaded with professionals to have a more conservative method of diagnosing this in pre-adults. There is much debate in the field, hotly opinioned views, and contention in the field attributable to the huge gulf between the absolute most liberal, and the absolute most conservative, when it comes to this diagnosis. To some degree, this divide is evident between Psychiatrists and Psychologists, and indeed, the previously noted NY Times article remarked that 90% of the diagnosing of Bipolar Disorder in children was being done by psychiatrists. However, there are many other mental health professionals, including psychologists and other non-psychiatric folk in the field, who take the liberal approach shared by many psychiatrists.
What Drives us to Diagnose Bipolar Disorder in Children and Adolescents?
For folks who advocate earlier diagnosing, one of the most commonly quoted reasons is prevention: prevention of a poor childhood, prevention of academic difficulties, prevention of social failure, prevention of kindling, etc. The chance, proponents of earlier diagnosing opine, is that failure to do something is an injustice to the child, and to those involved in the child’s life. This has been the stated reason driving such professionals as Dr. Dimitri Papalos and his wife, Janice Papalos, and of others, and indeed, any professional with any modicum of empathy has most certainly considered this when reflecting on an incident of possible Bipolar Disorder in a young child or adolescent. For, if indeed, allowing a young child to feed their childhood without appropriate treatment sentences them to a substandard future, who in our midst would hesitate to do something callcriteria? The issue is that it is not entirely clear that we have gotten this right, and it’s most certainly not yet determined that what seems to be Bipolar Disorder in children will follow the child into adulthood.
What is this animal we call Childhood Bipolar Disorder?
In adulthood, it’s well-accepted that Bipolar Disorder involves discrete periods of Mania, and discrete periods of Depression. Obviously, you can find the murkier cases involving Mixed episodes, although it is well-accepted that such cases do indeed occur in adulthood. However, even as we descend retrospectively into childhood, the waters become murkier and murkier. What does Bipolar Disorder appear to be in early adolescence? Think about late prepubescence? And how about the very young? Analysis the literature (Papalos and Papalos, 2006, Youngstrom, 2005, Danner-Ogston, et al, in press, Geller, 1997, etc.) reveals opinions that span the spectrum from the very conservative (let’s keep things while they were), to the very liberal (let’s diagnose in infancy). Each opinion is justified in some kind of logical argument or another, but above all, there’s no consensus, and strong evidence supporting a necessitate caution.