1 Decade, 40 Times More Bipolar Kids
Child Bipolar Explosion -- or Rampant Misdiagnosis?
Sept. 4, 2007 -- Today's children and teens are 40 times more likely to have
bipolar disorder than were the children of 10 years ago.
That's 20 times faster than the growth in diagnoses of adult bipolar
disorder over the same decade. Are we only now discovering a huge reservoir of
untreated psychiatric illness? Or is there an epidemic not of disease, but of
misdiagnosis and overtreatment?
The study that provides this alarming data doesn't answer this crucial
question, says study researcher Mark Olfson, MD, MPH, professor of clinical
psychiatry at Columbia University Medical Center and New York State Psychiatric
"We found a striking national increase in the treatment of young people
for bipolar disorder: from 20,000 youths in 1994 to 800,000 youths in
2003," Olfson tells WebMD. "The study does not tell us why so many more
kids are being diagnosed and treated for bipolar disorder. But it gives us
- Bipolar disorder is often a lifelong condition. More bipolar disorder in
children should mean a corresponding increase in adults with bipolar disorder.
Olfson says that isn't happening. This means we're either discovering
previously unrecognized bipolar disorder in children, or that we're
- Youths diagnosed with bipolar disorder are more likely than adults to also
be diagnosed with ADHD (attention deficit hyperactivity disorder).
- Most adults diagnosed with bipolar disorder are female. Most children and
teens diagnosed with bipolar disorder are male. "It is my sense that most
of these people are boys around age 12, and many have ADHD or at least are
treated for that with stimulants," Olfson says.
- During the 10 years covered by the study, the diagnostic criteria for
bipolar disorder have broadened. "Many adults and young people who would
not have been considered to have bipolar disorder now are," Olfson
Definition of Childhood Bipolar Disorder Controversial
What, exactly, is childhood bipolar disorder? It's controversial. Bipolar
disorder used to be called manic depression because it is characterized by
bouts of depression and bouts of mania.
Mania in adults is characterized by euphoria, grandiosity, irritability,
racing thoughts, and frenetic activity. While some experts argue that childhood
mania must also exhibit signs of euphoria and grandiose behavior, others say
irritability may be the only sign.
"In children, the symptoms of bipolar disorder are very different from
the symptoms in adults," Julio Licinio, MD, chairman of the department of
psychiatry at the University of Miami, tells WebMD.
In January 2007, the American Academy of Child and Adolescent Psychiatry
(AACAP) set out a "practice parameter" acknowledging the controversy.
The AACAP's expert panel noted that for both children and adults, doctors are
much more often diagnosing bipolar disorder based on individual symptoms rather
than characteristic patterns of symptoms.
The AACAP panel noted that there's also debate over whether bipolar disorder
in children is even the same illness as bipolar disease in adults. What is
agreed on is that bipolar disorder is an increasingly common diagnosis in
children -- including preschool children.
"There was a real underdiagnosis of bipolar disorder in children. We've
gone to the other situation now," Licinio says. "Some of these children
are just irritable and cranky and negative. They get more brittle than manic.
And people can mistake juvenile delinquency for bipolar disorder. So there is a
potential for this to be really missed."