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1 Decade, 40 Times More Bipolar Kids

Child Bipolar Explosion -- or Rampant Misdiagnosis?
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Definition of Childhood Bipolar Disorder Controversial continued...

"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."

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."

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