Dr. Haupt: Controversy still surrounds the diagnosis of bipolar disorder in children and adolescents. Nevertheless, ongoing research increasingly supports the idea that bipolar disorder can begin in childhood. This research is driving increased recognition of symptoms in children and adolescents that likely represent bipolar disorder.
During my career, I have been on both sides of this debate. As a resident doing my child psychiatry rotation, I had the privilege of working with Barbara Geller, MD, an expert on childhood bipolar disorder. However, I began the rotation extremely skeptical that bipolar disorder occurred in children. I changed my mind after diagnosing a 6 year old who was so severely affected that he was contemplating suicide with the same deliberation one sees in adults. After one month of treatment we saw him again, and he proclaimed, “Now I know what it’s like to be normal.” I was happy for him, and continued to be impressed by the maturity and insight that suffering with his symptoms had brought to him.
Your question about diagnostic reliability is a key issue in this debate. Investigators continue to examine how the criteria used for diagnosis of bipolar disorder in adults may or may not be useful for identifying bipolar disorder in children. Similar to other psychiatric diagnoses, there are clear-cut cases of bipolar disorder that any child psychiatrist would diagnose, but there are other milder cases, including symptoms that extend all the way into normal human behavior (especially for a young person). How to diagnose and treat one of these less obvious cases is a difficult problem for psychiatrists and families.
The most reliable diagnoses are occurring in the setting of National Institute of Mental Health sponsored studies. Currently, the Treatment of Early Age Mania (TEAM) study is being run by Drs. Geller and Luby at Washington University in St. Louis, with additional study sites at Children’s National Medical Center in DC, Johns Hopkins Medical Center in Baltimore, the Western Psychiatric Institute and Clinics at the University of Pittsburgh, and at the University of Texas, Galveston. The TEAM study provides an ideal way to make or confirm a diagnosis of bipolar disorder while providing your child with careful follow up and treatment monitoring.
Another good option for obtaining a careful diagnosis is from a psychiatrist that is board certified in child psychiatry.
As many readers with bipolar disorder can attest to, psychiatric diagnoses can be difficult to pin down, and the “right” diagnosis may change over time as additional symptoms become apparent. The need to revisit a diagnosis is even more important in children and adolescents, since their diagnoses may become clearer (or hopefully disappear) as they mature.