Is Bipolar Disorder Overly Diagnosed in Children?

Lucy Daniels Center mental health clinicians have long felt that Bipolar Disorder is overly diagnosed in children, and it now seems that most experts in our field have come to agree with us.

Many people who develop Bipolar illness—which usually appears in late adolescence or later—have had difficulties earlier in their life, such as with their mood or with controlling their anger and impulses. The problem has been that, in most situations, we cannot identify ahead of time which children who have trouble with their mood and impulses will develop Bipolar Disorder. We are now learning that most children who have such problems do not actually develop Bipolar Disorder with its deep states of depression and/or mania. It’s very possible that many children have been unnecessarily maintained on powerful medications with potential significant side effects.

Every so often, the American Psychiatric Association reviews and changes its diagnostic categories, and it is currently revising how it describes these children who cannot regulate their temper and are excessively unhappy (“dysphoria”) but for whom it would be premature to say have Bipolar Disorder. The revision proposes a new category called, “Temper Dysregulation Disorder with Dysphoria (TDD).” A recent commentary in the prestigious New England Journal of Medicine has applauded this change but is concerned that we have just created another category that will soon be thought of—without sufficient evidence—as a biological illness requiring medication.

At the Lucy Daniels Center, every year we work with scores of children who could be described as having Temper Dysregulation Disorder with Dysphoria. No one reason explains why they have these challenges, nor does one solution work for every child. Some children will benefit from medication, but most— if not all—need help to build their emotional capacities. These children’s parents often need assistance so that they can best parent their child.

In our opinion, medication is reasonable to consider if it can provide a benefit for a period of time and the potential for benefit outweighs the risks. But in our clinical view, treatment plans that provide medication without providing the help to strengthen the child’s capacities is an inadequate treatment approach.

 

– Mental Health Matters! is written by the Lucy Daniels Center for Early Childhood and posted on the Carolina Parent Magazine's website, the Triangle's family resource - in print for over 21 years!  And online at www.carolinaparent.com.