Diagnosis of Bipolar Disorder Rises in US Children
September 4, 2007 by Kristina Chew, PhD
Filed under Health
From 1994-2003, the number of children in the US being treated for bipolar disorder increased by 40%, as reported in the September 4th New York Times. Researchers from New York, Maryland, and Madrid analyzed a National Center for Health Statistics survey of office visits to doctors in group practices or in private practices. The number of visits in which a doctor recorded a diagnosis of bipolar disorder increased from 20,000 in 1994 to 800,000 in 2003:
Many experts theorize that the jump reflects that doctors are more aggressively applying the diagnosis to children, and not that the incidence of the disorder has increased.
But the magnitude of the increase surprises many psychiatrists. They say it is likely to intensify the debate over the validity of the diagnosis, which has shaken child psychiatry.
Bipolar disorder is characterized by extreme mood swings. Until relatively recently, it was thought to emerge almost exclusively in adulthood. But in the 1990s, psychiatrists began looking more closely for symptoms in younger patients.
Some experts say greater awareness, reflected in the increasing diagnoses, is letting youngsters with the disorder obtain the treatment they need.
Other experts say bipolar disorder is overdiagnosed. The term, the critics say, has become a catchall applied to almost any explosive, aggressive child.
After children are classified, the experts add, they are treated with powerful psychiatric drugs [antipsychotic drugs like Risperdal and Seroquel; mood stabilizers like Depakote] that have few proven benefits in children and potentially serious side effects like rapid weight gain.
The study is published in the September issue of The Archives of General Psychiatry.
A February 2007 article in Archives of Pediatrics & Adolescent Medicine (2007:161:193-198) reported a rise in child psychiatric disorders (in autism, hyperkinetic disorder and Tourette syndrome). One hears “greater awareness” as one reason for the rising prevalence of autism (now 1 in 150, according to statistics released in February by the Centers for Disease Control); one also hears speculation that autism, like bipolar disorder, is being overdiagnosed. Statistics and prevalence rates aside, I also noted the article because of friends and family member who have bipolar disorder. We have a few friends have children who have been diagnosed with both Asperger’s and bipolar. My friend Kevin started a bipolar blog a few months ago and has especially shared his experiences with bipolar disorder while an adolescent (and I thank him much for his generosity in doing so, and his honesty.) And, my mother-in-law has bipolar disorder and has received treatment inconsistently over the course of her life. It is true that I have wondered if bipolar is something to look out for, too, in Charlie—who can have very sudden changes in his mood, from very happy to extremely anxious in the space of a moment—-and certainly to be aware of, and informed about.
(If the “1994-2003″ time period sounds familiar to you, it is from 1994-2003 that the administrative prevalence of autism grew, from 0.6 to 3.1 per 1000 from 1994 to 2003; see this 2006 study by Paul Shattuck.)
Maybe the change is just another example of the chronological and geographic cultural shift in DSM Criteria and not better awareness. How long should it take for professionals using the DSM to be able to correctly use the most recent up to date criteria? Thirteen years seems to be rather excessive for professionals to become “more aware”.
It certainly is interesting to see how much more medical attention is being given to psychiatric/development issues in children these days.
BTW, I think you meant to say 4000% (40 fold).
All of these diagnoses, including ADHD and ASD, require a diagnosis by a qualified professional (that’s what they recommend anyway). You can’t just look at a child and say, hey, that child is bipolar. It doesn’t work that way. Not even a pediatrician can do that. Also, there’s overlap in psychiatric diagnoses. It’s not surprising then that there are shifts and fads in what gets diagnosed and what doesn’t.
BTW, the Rescue Post is reporting it as a 40-fold increase. (I got a screenshot).
Does anyone else think it possible that the number of bipolar people has gone up because of the huge drop in infant/fetal mortality? Over the twentieth century there was a drop in infant mortality from about 100 per 1000 live births in the beginning of the century to about 7 per 1000 in 2000. Some researchers have found bipolar disorder linked to problems in being born (such as in “Pre- and perinatal complications and risk for bipolar disorder: a retrospective study” Journal of Affective Disorders 50:117-224). That could mean more babies born and surviving that go on to have bipolar disorder. I’ve been looking at the numbers primarily thinking of autism, and wrote it up in my amateur way (http://homepage.mac.com/dgstevenson/mortality/) but the argument is the same for bipolar disorder.
I attended a workshop on Child and Adolescent Psychiatric Disorders a couple of years ago. When I started teaching (only 13 years ago!) I never dreamed of the myriad diagnoses I’d encounter in the classroom.
“When I started teaching (only 13 years ago!) I never dreamed of the myriad diagnoses I’d encounter in the classroom.”
This is just a naive observation and not a criticism: I recently joined a list specific to disruptive behaviors and even as a mom long familiar with autism, I was somewhat staggered with the lists of diagnoses attached to some of the children and the accompanying medications. I did not know that a single child could be diagnosed with ADHD and bipolar and OCD and ODD concurrently. The example is the most extreme but many of the kids had two concurrent diagnoses; autism and ADHD, autism and OCD, bipolar and ODD, etc. It was a new experience for me, and I wondered how common this is? Does anyone have an opinion if these are all real pathologies or social reactions to circumstantial outliers of child behavior?
Don’t you understand that this is all a fraud perpetrated by the drug companies…the market to sell drugs to a population that is largely healthy (KIDS!!). What a disgrace. How on earth did the human race manage this last 100,000 years without bi-polar meds for our kids??? Insane. None of your kool-aid for my kids, thanks.
I have Bipolar 1. At first They thought it was ADHD, (attention deficite hiperactive disorder) and all that medication did was make me worse. So, I’d say Bipolar is either overdiagnosed, missdiagnosed, ignored completely, or just isn’t imortant enough to study thuroughly anymore.
Diagnosig bipolar disorder is quick and easy and pasy well. It is the most commonly misdiagnosix in the youths I see as a child psychiatrist. When a youth tells me he has bipolar disorder my first thought is the psychiatirst who last saw him was either stupid, lazy, or both. But this bipolar fad, just like the mpd/did-satanic-cults-are-eating-babies-recovered-memory-syndrome/hystria/mothers cause all mental ills fads, will also pass.
Diagnosig bipolar disorder is quick and easy and pasy well. It is the most common misdiagnosis in the youths I see as a child psychiatrist. When a youth tells me he has bipolar disorder my first thought is the psychiatirst who last saw him was either stupid, lazy, or both. But this bipolar fad, just like the mpd/did-satanic-cults-are-eating-babies-recovered-memory-syndrome (1980’s)/hystria (late 1800’s)/mothers cause all mental ills (1950’s) fads, shall also pass.
“How on earth did the human race manage this last 100,000 years without bi-polar meds for our kids”…We managed just perfectly well, those little kids who were never treated for psychiatric disorders grew up to become tremendously productive individuals, such as Nero and Hitler.
I wasn’t treated for bipolar for the first 18 years of my life, because my parents thought it was a fraud- they blamed my agressive behavioral problems on a ‘cry for attention’, now after being diagnosed two years ago and receiving meds and therapy, I’m finally happy and healthy. I realize how much pain those ‘evil’ ones had to endure.
I am the mother of a child with BPD, ADHD, and Overanxious Disorder (the pediatric version of Generalized Anxiety Disorder). I can tell you that correct diagnoses are a long time coming, and you should not accept a quick diagnosis without question. I can also tell skeptics and naysayers that until they’ve had a child with inexplicable disturbing behaviors (if it were simply poor parenting, theoretically all three of my children would behave this way, or at least similarly), they need to take the time to do a little listening and researching before they take the time to criticize. Unless and until you have had a child who hears voices, experiences regular night terrors, instantaneous rage in unremarkable situations, or has to be physically restrained to keep himself or others from harm, you don’t know. I can tell you that vitamins, or better diet, or “better” parenting are not always the answer.