Examining the Diagnosis of Bipolar Disorder in Children

A new study from the Hastings Center suggests that children who exhibit signs of bipolar disorder may fare better with an emerging diagnostic approach, under which children may be diagnosed with new conditions like Severe Mood Dysregulation (SMD) or Temper Dysregulation Disorder with Dysphoria (TDD).

Hastings Center researchers Erik Parens and Josephine Johnston, who also published the study in Child and Adolescent Psychiatry and Mental Health, examined the evolution of the diagnosis of bipolar disorder and the “vigorous debate in pediatric psychiatry about whether symptoms in children accurately reflect the criteria for bipolar disorder, particularly for mania.” The researchers also examined the significant increase in the diagnosis of the disorder since the mid 1990s, which “has led to concerns about accurately defining psychiatric disorders in children as well as the safety and efficacy of resulting pharmacological treatment,” according to Parens and Johnston.

The research study involved a series of interdisciplinary workshops, from which a series of conclusions were drawn:

“1. The bipolar label may fit poorly many of the children who have received it over the last decade.

2. There is debate about what children’s symptoms represent. For example, what is characterized as mania in children is very different from its features in adults. Mania is a hallmark feature of bipolar disorder, formerly known as manic-depressive disorder.

3. The bipolar label, which has a strong genetic component, can distract from addressing the family or social context.

4. Physicians must be forthcoming with families about uncertainties and complexities in the diagnosis and treatment of bipolar disorder in children.

5. Current training practices and reimbursement policies may leave some psychiatrists and pediatricians unable to deliver the comprehensive care that these children need.”

According to Johnston, changing the diagnosis of children who exhibit bipolar-like symptoms would eventually lead to improvements in both recognition of psychiatric conditions in children and the resulting treatment.

“Using new labels such as SMD or TDD reflects that physicians do not yet know exactly what is wrong with these children or how to treat them," she said. "Facing up to this uncertainty could lead to better treatment recommendations and more accurate long-term prognosis.”