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Children's Health

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New Treatment Guidelines for Bipolar Children

Careful Diagnosis, Psychiatric Drugs, and Therapy Can Help, Report Shows

More Pediatric Bipolar Diagnoses continued...

McClellan, a member of the psychiatry department at Seattle's University of Washington, did not work on the guidelines. In his editorial, he calls the project "laudable" given the "considerable controversy" about pediatric bipolar disorder.

The guidelines only apply to children aged 6 and older. That's commendable, says McClellan's editorial. "There is no valid justification for diagnosing bipolar disorder in preschoolers," he writes. "Labelling severe tantrums in toddlers as major mental illness lacks face validity and undermines credibility in our profession."

How to Distinguish Misbehavior From Mental Illness

The guidelines call for careful diagnosis to separate normal childhood antics and misbehavior from true bipolar disorder, in which patients experience bouts of mania and depression. The child and at least one parent are needed to assess the child's mental health.

Frequency, intensity, number, and duration of symptoms -- "FIND," for short -- are important.

They say that for example, a child who becomes silly and giggly to a noticeable or bothersome degree for 30 minutes twice per week has some unusual behavior, but the frequency, intensity, number of episodes, and duration may not qualify for a bipolar disorder diagnosis.

It's also important to note the context of the behavior. "Hot, hungry, stressed, and/or tired children without psychopathology may become irritable," write the authors.

Likewise, grandiose statements (such as "I am Superman") might not signal mental illness, depending on the child's age, say the authors in the journal.

When children are diagnosed with bipolar disorder, it's vital that they get proper care. Medications known as mood-stabilizing drugs, such as lithium, can help control bipolar disorder. In addition therapy can help, and family involvement is important, write the authors.

"It is often necessary to use several medications in combination because these kids are very ill, often suicidal, or too manic and depressed to attend school," says Kowatch, in a news release. "Stabilizing their moods and allowing them to return to school as soon as possible is critical if they are to lead normal lives."

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