Diagnosing Bipolar Disorder in PediatricPopulations: Fact or FictionKyle R.
KendallUniversity of Massachusetts, Amherst Diagnosing bipolar disorder in pediatricpopulations poses a special challenge as it is clinical accepted that thepresentation of bipolar is significantly differs from that of adults. However,under the constraints of the DSM-V the criteria for diagnosing bipolar disease isprimarily based on research and studies conducted on adults thus leaving alarge margin of error when it comes to diagnosing a pediatric patient using thiscriterion. I believe that in factbipolar along with several other mental disorders begin to manifest during theadolescence years, but they present themselves differently than that of aclassical presentation of an adult, largely in part due to the fact that theadolescent is still developing and is heavily influenced by the living and socialenvironment they live in and spend most of their time in.
According to Singh,(2008) It is estimated that if one parent has bipolar disorder “the risk of thechild being diagnosed is 15-30% which increase to 50-75% if both parents havebipolar”I would say the largest issued in this topic isthat the DSM fails to provide a comprehensive evaluation to allow a clinicianto come to a definitive diagnosis whether that be pediatric bipolar disorder orsomething along the lines of Pre-pubertal onsetmanic depressive disorder. An example of what this might look like would be theFIND assessment paired with both the YRMS and P-YMRS which would give you a three-sidedevaluation of the patient and provide a clinician with more information to makea better destination as to the severity of the disorder. Singh, (2008) alsoremarks that to a large extend the child’s environment plays a huge role,meaning that a child may not have bipolar but due to a high stress environmentwith several influencing factors may mimic symptoms of the disorder andtherefore be misdiagnosed. Using a tool such as the one aforementioned wouldsignificantly reduce misdiagnosis as well as cut down on the number of pharmaceuticalsbeing prescribed to pediatric patients.
I come from a family with a history of depression, growing up Iwas exposed to it almost constantly and my behavior began to show signs ofbipolar, (i.e drastic changes in mood) I began to mimic behavior that I wasseeing around me. My father acted as my advocate with my doctors as they lookedto the DSM as some sort of “cookie cutter overlay” and because I presented withthe criteria for pediatric bipolar disorder they wanted to start me on an aggressivetreatment of mood stabilizers as well as antidepressants. Had my father not stepped in I can only beginto imagine where and what my life would be like today.
Studies have shown thatby simply removing the child from their everyday living environment for a smallamount of time (as little as 72 hours) that a child’s behavior who does notactually meet criteria for a bipolar diagnosis will begin to normalize. (Martin,2017)In conclusion, I feel that bipolar disorder should be diagnosedas early on as possible, with the notion to ensure all aspects of the child’sdaily life being taken into consideration as well as an extensive interviewwith the child’s caregivers and parents prior to any clinical diagnosis ortreatment. Singh, (2008) reports that it can take on average up to 10 years toproperly diagnosis and treat a patient with bipolar, so why not try to getahead of the curve.
Once a diagnosis is reached the treatment should rely aslittle on pharmaceuticals as possible and the dosage and medication should bereevaluated at each visit to the clinician. There is a reason that doctors “practice”medicine because there is no clear cut diagnosis and treatment plan for allpatients that present with a certain condition, the same cannot be more true inthe field of psychology. Given the proper time and tools to evaluate a pediatricpatient I feel that a conclusiveclinical diagnosis of bipolar can be achieved amongst the pediatric agedpopulation. During the process all aspects of abnormal psychology need to beevaluated to ensure that thereis not a single reason as for the child’s behavior and actionsother than that of a clinical diagnosis of bipolar.
References Parry, Peter I., and Edmund C. Levin. (2012)”Pediatric Bipolar Disorder in an Era of “Mindless”Psychiatry”.” Journalof Trauma and Dissociation” 51-68. Singh, T. (2008). “Pediatric Bipolar Disorder: DiagnosticChallenges in Identifying Symptoms and Course of Illness.
” “Psychiatry” (Edgmont), 5(6), 34–42. Stringaris, A., Baroni, A., Haimm, C., Brotman, M.
, Lowe, C.H., Myers, F. … and Leibenluft, E. ((2010). “Pediatric bipolar disorder versus severe mood dysregulation:Risk for manic episodes on follow-up”. “Journal of the American Academy of Child and AdolescentPsychiatry” 49: 397–405.
Martin, A., Bloch, M., and Volkmar. F. (2017)”Lewis’sChild and Adolescent Psychiatry”(5th ed.
). Lippincott Williams (LWW)