Child bipolar diagnosis is a poor fit for many


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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