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1 Decade, 40 Times More Bipolar Kids

Child Bipolar Explosion -- or Rampant Misdiagnosis?

Treatment of Children With Bipolar Disorder

Olfson and colleagues used data collected annually by the National Center for Health Statistics. The data come from questionnaires given to office-based doctors who directly treat patients. The study compared reports on treatment of bipolar disorder in adults with reports of bipolar disorder treatment of children/teens aged 0 to 19 years.

The Olfson team's report, in the September issue of Archives of General Psychiatry, shows that doctors treat bipolar disorder in youths the same way they treat it in adults: with powerful psychiatric drugs.

In two-thirds of visits, youths diagnosed with bipolar disorder receive mood stabilizers -- most often anticonvulsants such as Depakote. Children are just as likely as adults to be treated with antipsychotic drugs, although children are more likely to receive the newer "atypical" antipsychotics. In six out of 10 visits, patients regardless of age receive a combination of at least two drugs.

"The types of medications they receive resemble those received by adults," Olfson says. "There are real risks associated with misdiagnosis of children with bipolar disorder. These drugs have powerful side effects and their long-term safety has not been established for children."

Worrisome as they are, drug side effects are not the only problem facing children diagnosed with bipolar disorder. There's also the stigmatization of having a serious, possibly lifelong mental illness.

"School personnel may treat the child differently, the options for things like after-school programs and summer camp may be limited, and there may be problems with getting health insurance," Olfson says. "And the children may give up on themselves if they think they have a brain disorder that has no cure. So there is the potential for serious risks."

So what should parents do if their doctor suspects their child has bipolar disorder?

"It can be a devastating thing for a parent to hear," Olfson says. "Rather than overreact, parents should ask how the diagnosis was made. Did the provider talk with the child's teachers? Did the psychiatrist or another doctor look at the child over time? How much information went into this decision?"

Before deciding on treatment, Olfson recommends that parents consult an expert in child and adolescent psychiatry.

Licinio says that while there may be a trend to overdiagnose bipolar disorder in children, there are still many children who would benefit from having their bipolar disorder recognized and treated.


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