Q: It seems there is a higher incidence of young children and adolescents being diagnosed with bipolar disorder – why is this?
A: There is more frequent diagnosis of Pediatric Bipolar Disorder in the United States today and the diagnosis is made more frequently here than in most countries which have studied the disorder. There may be cultural and/or environmental reasons for this. For example in Europe similar symptoms are often classiﬁed as ADHD with combined language and developmental disorders or the child might be diagnosed with Conduct Disorder or Major Personality Disorder. There may be a reluctance on the part of some European diagnosticians to give such a grave diagnosis to young children and teens. American clinicians may have become more comfortable with the diagnosis. Bipolar disorder is hereditary and lifelong. Often children present with symptoms that are different from those of the adult. For example adult symptomatology includes periods of depression alternating with periods of mania. On the other hand in children often the presenting symptoms are severe irritability, explosiveness and hyperactivity. Parents of these children are desperate for answers and hope of resolution. Frequently then children are given powerful psychotropic medications that may mask the real problem or actually make the situation worse. Doctors are reluctant to prescribe antidepressants to a child who may be bipolar for fear of inducing a manic episode. So if the reason for the child’s irritability is depression they will not be getting proper treatment. Few studies have been performed in the US or anywhere else which followup previously diagnosed bipolar children to see if they still have bipolar symptoms as adults. Regardless of the diagnostic label these children and their families need help usually in the form of a combination of psychotherapy and medication. More research is obviously needed to clarify the diagnosis and the effectiveness of treatment.