Over the last 10 to 15 years, doctors have increasingly diagnosed bipolar disorder in children troubled by rapid mood swings and hyperactivity.
But recent evidence suggests that in many cases, those diagnoses were incorrect. As a result, thousands of kids may have inappropriately been prescribed drugs whose risks and benefits in children aren’t well understood.
Childhood bipolar disorder is often treated with the same mood stabilizers and antipsychotics used to treat the disease in adults. However, these drugs haven’t been well studied in children, there are no FDA-approved medications for bipolar disorder in children under age 10, and studies of the drugs in teenagers have been short-term, shedding no light on their long-term safety or efficacy.
That’s why it’s especially concerning that in 2007, the National Institute of Mental Health reported that doctors were diagnosing childhood and adolescent bipolar disorder 40 times more often than a decade earlier.
As an epidemiologist, whenever I see such a marked increase, I ask, “is this real? Or have doctors changed something about the way they diagnose this condition?”
In the case of childhood bipolar disorder, the second possibility is more likely, based on study results published last year.
Researchers at Case Western Reserve University evaluated more than 700 children aged 6 to 12 years who had been referred for mental health treatment. Almost 90 percent of those children’s parents described them as having rapid mood swings and high energy levels, common symptoms of bipolar disorder.
But the researchers diagnosed bipolar disorder in only 11 percent of those children, and in only 6 percent of children who didn’t have hyperactivity or rapid mood swings. So why had doctors elsewhere apparently misdiagnosed so many kids?
One explanation: children with other disorders, like ADHD, can also exhibit hyperactivity and irritability. So providers can’t rely on those symptoms when diagnosing bipolar disorder. Instead, they need to ask about the symptoms of mania that are specific to bipolar disorder — such as needing only a few hours of sleep a night, thinking you have superhuman powers, or constantly jumping between conversation topics.
Another possibility, wrote McGill University psychiatrists Ioana Iordache and Nancy Low in the Journal of Psychiatry and Neuroscience, is simply that increased awareness of bipolar disorder led doctors to consider it more frequently as a diagnosis.
Children and teenagers with profound mood and behavioral disturbances often have more than one mental health problem, which can further complicate diagnosis. These children need careful evaluation by a provider who specializes in childhood or adolescent mental illness. Even then, finding the right diagnosis and treatment plan takes time.
A Mayo Clinic expert discusses bipolar disorder in children.
An excellent article in the Minneapolis Star Tribune explores other possible causes for mood swings, hyperactivity and behavior problems in children and teenagers — including trauma, chronic overstimulation from media exposure and illicit drug use.