Child bipolar diagnosis is a poor fit for many

Over the last decade, more children with behavior and emotional troubles have received a diagnosis of bipolar disorder. This is a condition in which moods swing dramatically between depression and mania. Traditionally, bipolar was diagnosed only in adults.

A fierce debate has raged in recent years over diagnosing children with bipolar illness because the symptoms vary so much in children compared with adults, and because the medications used to treat the disorder carry some serious side effects. The American Psychiatric Assn. has proposed changes to how the diagnosis is made in children for the next edition of its diagnosing guide, the Diagnostic and Statistical Manual, or DSM-5. An expert panel has suggested two new diagnoses to account for the symptoms seen in children: "severe mood dysregulation" and "temper dysregulation disorder with dysphoria."

There appears to be growing support for backing away from the child bipolar diagnosis. In a paper published this week in the journal Child and Adolescent Psychiatry and Mental Health, experts from the Hastings Center summarized findings from a series of workshops on the issue and concluded that it may be better to avoid giving a child a diagnosis of bipolar disorder. The authors say the label simply does not fit many children who have been given it over the last decade. Moreover, there is still too much debate and confusion over what the children's symptoms represent. For example, it's unclear what mania really looks like in children compared with a much more precise concept of mania in adults.

"Using new labels such as SMD or TDD reflects that physicians do not yet know exactly what is wrong with these children or how to treat it," Josephine Johnston, a co-author of the study, said in a news release. "Facing up to this uncertainty could lead to better treatment recommendations and more accurate long-term prognosis."

This is not to say that these children and their families don't need help, the authors state. The concept of treating troubled children and their families without pinning a firm label on the behavior is a good idea. Unfortunately, health insurers often demand such labels in order to provide coverage for care. I wonder if insurers will cover care for "severe mood dysregulation" in the same way they would for "child bipolar disorder."

-- Shari Roan

Photo credit: Susan Tibbles  /  For The Times

Comments

[Love astrology]

thanks for the nice info..

[Michael Cheng]

Many of these children and youth may have Sensory Processing Disorder (aka Regulatory-Sensory Processing Disorder). Though not officially in the DSM, it is a condition whereby children/youth have troubles with sensory processing, which can lead them to be overwhelmed by sensory input (e.g. sound, touch, smells, and other input), thus leading to mood lability such as temper, tantrums, and rages. Classic examples would include the child with autistic disorder who rages at loud noises, or being touched unexpectedly. But more research shows that even 'neurotypical' kids may have this, including those with other diagnoses such as ADHD, learning disabilities and even 'bipolar disorder'. The good news? Professionals such as occupational therapists can assess and help treat sensory processing disorders. For more information, contact the Sensory Processing Disorder Network (www.spdnetwork.org).

[Lucy Jane Miller]

We appreciate the reference to Sensory Modulation Disorder (SMD) in Shari Roan’s article today on bipolar disorder. The Sensory Processing Disorder (SPD) Foundation has been researching SPD and its subtypes (one of which is SMD) since 1973, full time since 1995. We have convened a Scientific Work Group with scientists from Harvard, Yale, Duke, MIT, and ~ 10 other institutions. We collaboratively decided to first focus our joint research efforts on SMD. Children with SMD have outbursts and tantrums lasting minutes to hours, and aggressive and withdrawn (fight or flight) behaviors that often cycles with bouts of emotional immaturity/silliness. These shifts of unmodulated behavior cause intense ups and downs often within an hour. Poor sleep and feeding patterns are common.

Our group’s research suggests this is due in part to unregulated arousal (studies on sympathetic nervous system). Genetic factors are implicated and a rigorous epidemiologic study suggests more than 5 percent of children have SMD. Ms. Roan is quite right in citing that no one knows exactly what is wrong or how to treat it. However, we have had excellent results using a non-drug intervention provided intensively (3 to 5 days a week) but short term (2-3 months). The treatment is occupational therapy with a sensory and relationship based approach geared to: 1) helping children self- regulate and be less reactive to unanticipated environmental stimuli and 2) assisting caretakers to reframe children's issues as physiological not behavioral. Parent priorities, education and support are crucial to success. SPD, particularly sensory over and under- responsivity, is also under consideration for inclusion in the DSM-V. We believe this diagnosis is more appropriate at early ages, less likely to receive pharmacological intervention as a first initiative, and less likely to create expectancy effects and fears in families.

Lucy Jane Miller, Ph.D.

Executive Director, Sensory Processing Disorder Foundation

[GreenLantern2]

Who SAYS the symptoms of bipolar disease in children are different than those of adults? Where is the PROOF? Antipsychotic drugs have horrific side effects and have not been tested in children or adolescents. I strongly suspect that pharmaceutical companies are behind the "brand extension" of pushing bipolar diagnoses into children and teens to expand their market base.

My younger daughter was (and still is) extremely difficult to live with. She had daily, hour-long, screaming tantrums from age 3 until she was about 11. She was irritable, disorganized, and had rapid mood swings. But she wasn't--and ISN'T bipolar. She's in college today and doing well, and her tantrums turned out to have been anxiety attacks--she has suffered from severe anxiety disorder since she was 3. SSRI's (FAR more benign than antipsychotics) helped when she could tolerate them, and there still may be one that will do the trick without causing side-effects she can't handle.

How many "bipolar" children are misdiagnosed--and who benefits from it? Certainly not those children, who are turned into zombified adults unable to function independently.

[hank]

This is what is wrong with psychiatry. They come up with a diagnosis and spend years harming people before finally backing off of their claims. Meanwhile millions are hurt. This is no "developing science," it is junk science.

[Becky]

As a person with Bipolar Disorder, I'm happy to see that the trend of diagnosing kids with Bipolar Disorder is changing as the medication is so heavy for adults to withstand as it is. http://manicdepressivetalk.com/news/should-kids-be-medicated-bipolar-disorder

[tao_psychology student]

For many people, it may seem as though a diagnosis of bipolar has become the new trend in children’s psychological disorders. However, bipolar disorder is a real diagnosis that is classified under the mood disorder section of the DSM-IV-TR, which has its own characteristic symptoms and treatment. Symptoms that are characteristic of bipolar disorder in children, include mania.

Even though bipolar disorder is a “label” placed upon the child, there are many benefits that may result from such a diagnosis. One benefit is that a sense of understanding or relief may be granted as a diagnosis may “explain” some of the child’s behavior. Another benefit is that with a diagnosis the proper treatment may be constructed among a multidisciplinary team of psychologists, psychiatrist, school staff, and family. With a treatment plan and understanding, the treatment can be implemented to help the child.

With a diagnosis of bipolar in children, there is often a need for psychiatrists and psychologists to rule out or differentiate between the diagnosis of other disorders with similar presentations. For example, a child who is experiencing symptoms of bipolar with mania, may seem the same as a child with ADHD. Such over lapping symptoms include impulsivity, distractibility, and disruptive behavior. It is the clinician’s job to rule out other possible diagnosis and confirm that the child is suffering from bipolar disorder before a diagnosis is given to the child.

Another point needs to be recognized about the recent surge in bipolar diagnosis in children. It is that with the increase in knowledge and awareness, has come a better understanding of the disorder, its symptoms, and treatments. With this information, clinicians are more informed and aware, which therefore may increase the prevalence of diagnosis in children.