Pediatric bipolar disorder is potentially one of the mostcontroversial areas in abnormal psychology.
Many of the symptoms found inpediatric bipolar disorder can also overlap with symptoms from ADHD and otherdisorders which have their onset emergences in childhood and adolescence. It iscrucial for clinicians to catch the early onset of bipolar disorder in thepediatric population because this diagnosis could greatly affect the outcome ofthe child’s future. However, it is important to consider the dangers ofmisdiagnosing a patient, especially a child. Furthermore, clinicians should neverfollow what is written in the DSM-V like a cookbook and should always use theirown clinical judgment before diagnosing a patient. Instead of rushing todiagnose a child with bipolar disorder, the clinician should first consider thechild’s medical history, family history, and look for any unique symptoms that differfrom adult bipolar disorder.
Should the results be uncertain, it would bebetter for the child to be placed on a “watch list” than misdiagnosing, labelingthe child as one with a mental illness, and providing potentially risky treatments.Despite the dangers of misdiagnosing a child with bipolar disorder, it is stillmore important to continue attempting to diagnose children who could be at riskfor bipolar disorder than putting a complete halt to it. Accordingto Singh (2008), in the general population, there is a one percent risk of anindividual developing the full blown bipolar disorder. When in the process ofdiagnosing a child with bipolar disorder, the clinician must also take intoaccount the child’s family history. Should one parent has bipolar disorder, therisk to each of the parents’ children is 15 to 30 percent. If both parents havebipolar disorder, the risk of the child increases to 50 to 75 percent. Fromthis, if the clinician took into account the child’s family history, he or shewould be able to realize that the child would be more at risk than the averagechild for bipolar disorder if at least one of the child’s parents has bipolardisorder.
The reason why there is much controversysurrounding pediatric bipolar disorder, according to Parens (2010), is because thedrugs used to treat bipolar disorder include mood stabilizers andantipsychotics, which put the children at risk of significant side effects. Therise of the bipolar disorder diagnosis in children and its treatment withmedications whose risk/benefit profiles are not accurately and securelyestablished create much talk in the medical community. Furthermore, in a recentstudy mentioned in Singh (2008), it found that there was an increase of 40-foldin the number of young people diagnosed with the bipolar disorder in the UnitedStates. The increase of diagnoses in childrenwith bipolar disorder can either suggest that clinicians may have missed casesof bipolar disorder due to poor understanding, or that bipolar disorder inchildren is vaguely defined, leading to misdiagnosis and inappropriatetreatment.
However, it is clear that children who have the bipolar disorder andfail to receive treatment puts them at greater risk of school failure,rejection by peers, physical injury, substance abuse, families may be tornapart, and possibly even suicide, according to Parens (2010). Therefore, it isimportant to still try to attempt to diagnose children with bipolar disorder,but to do so with great caution and being sure not to skip over any details whendiagnosing them. Although itis dangerous to misdiagnose children with the bipolar disorder, it is alsodangerous to refuse diagnosis of a child who potentially has this disorder.
From the article by Singh (2008), for every year of untreated illness, there isa 10 percent lower likelihood of recovery for bipolar youth. Developmentally speaking,it is already difficult to diagnose children since they have not yet achievedemotional, neurocognitive, and physical maturity. Furthermore, in childrenyounger than 10 years old, it is difficult for them to verbalize their emotionsand the symptoms they have will have different meanings based on whichdevelopmental stage the child is at. In the article by Parens (2010), in themid-1990s, Joseph Biederman and Barbara Geller helped redefine the syndrome ofmania which was key to any bipolar diagnosis. As a result, for Geller, childrenwho had mainly rapidly cycling elevated/expansive and/or grandiose mood, or forBiederman, who had mainly chronic irritable mood, received the diagnosis ofbipolar disorder. From the process of forming these definitions for thedisorder plus other social and clinical factors have significantly increased thenumber of children who were diagnosed and treated for bipolar disorder.
Bytrying to further understand what the bipolar disorder is like in children andwhat the differences are versus adults will greatly help with properlydiagnosing children with the disorder. To furtherhelp with diagnostic validity, Singh (2008) states that longitudinal studies ofan illness is key to helping affirm the validity of the diagnosis made byclinicians. The prospective longitudinal studies mentioned in Singh’s (2008)article, which were carried out over a span of two to four years, seem to helpaffirm that youths who were diagnosed with the bipolar disorder showed acontinuum of bipolar symptom which had frequent fluctuations of mood symptoms.These results helped provide validation of diagnosis for the pediatric bipolardisorder. As statedbefore, increasing the knowledge of pediatric bipolar disorder will helpprevent clinicians from misdiagnosing children who may otherwise have ADHD.From the article written by Insel (2010), the use of functional brain imagingstudies is discovering circuitry differences between disorders that haveseemingly overlapping symptoms.
Some similar disorders to the bipolar disorderare ADHD and severe mood dysregulation (SMD). In a recent fMRI study in thearticle by Insel (2010), children were asked to rate their subjectivefearfulness of neutral faces. The amygdala was over-activated in ADHD,under-activated in SMD, and activated normally in the bipolar disorder. Otherstudies demonstrated similar results to these when using over techniques formeasuring brain circuits, one of them being the magnetoencephalography (MEG).The results of these studies suggest that there may be tools of clinicalneuroscience to help clinicians provide children with the correct health care andprevent misdiagnosing. Overall, itis important to continue trying to properly diagnose children who have bipolardisorder and provide the proper treatment. Besides the biological perspectivesof pharmacological treatments, clinicians could first try alternative treatmentssuch as the psychosocial treatment before moving onto pharmacologicaltreatments as those carry significant risks such as extreme restlessness,uncontrollable speech, and involuntary movements, according to Parens (2010). Itis also important to consider the risks of putting a stop in diagnosingchildren who could potentially have bipolar disorder as it will lower their chancesof recovery every year, and could completely disrupt their daily life andfamily life.
Clearly, there are risks to diagnosing children with bipolardisorder. However, as clinicians become more familiar with the unique symptoms thatcome from pediatric bipolar disorder, they will be able to more accurately diagnoseand treat pediatric patients, once again reiterating the importance of diagnosingbipolar disorder in the pediatric population.