Did you have a chance to read the Sunday Magazine of the New York Times this weekend? I realize that some of you are saying to yourselves, "of course not! I was caring for my 1,2,3 children and doing laundry, running errands…etc and had no time to read the paper." I’m with you. Except I was able to read half of the Sunday Magazine as I was rocking back and forth on my feet, desperately trying to get Willow to stop wailing tonight. And, as I said I didn’t have a chance to finish the article so my impressions are just that. Those of you who did, I would be really curious to know your  thoughts…or even if you haven’t read it but have an opinion about all of this, I would like to hear what you think too….

The feature article was on the diagnoses of bipolar disorder in children: how they are being diagnosed, how often or how little (depending on which camp you are in).

Though I have heard how more children are being diagnosed as bipolar now, I had no idea really how many.  A study last fall measured a fortyfold increase in the number of
doctor visits between 1994 and 2003 by children and adolescents said to
have bipolar disorder, and the number has likely risen further. 

An adult with a bipolar disorder typically displays episodes of depression and episodes of mania (delusions of grandeur, euphoric feelings, etc).  What struck me was the discussion between psychiatricts that believe that too many kids that are mainly irritable (aggression and explosive rage) or depressed are being diagnosed with bipolar when they are really ADHD or  have Oppositional Defiant Disorder (ODD) and other psychiatricts believe that those colleagues are wrong, wrong, wrong. Instead, they believe that these kids do have a bipolar disorder.  They believe that kids that mainly exhibit irritability can be bipolar. They argue that though the kids do not have the manic swings (delusions of grandeur, euphoria, etc) of bipolar, they could be bipolar nonetheless.  That perhaps bipolar looks different in kids than adults. They argue that perhaps kids develop the manic swings only later in life or that mania looks different in kids- and is an irritable mood instead of an elevated one. Or could it be that bipolar is truly rare in kids and is being overly diagnosed?

I found this passage from the New York Times article fascinating,

In an influential 1995 paper that began the paradigm shift
toward bipolar disorder within child psychiatry, Janet Wozniak — the
director of the pediatric bipolar-disorder program at Massachusetts General Hospital
and co-author of “Is Your Child Bipolar?” — working with the chief of
pediatric psychopharmacology, Joseph Biederman, revealed that 16
percent of the children who came to the clinic met the D.S.M. criteria
for mania. This was shocking news; it was widely believed until then
that mania in children was extremely rare. Wozniak reported that the
children’s mania most often took the form of an irritable mood
rather than an elevated one, and that the mood was often chronic: the
norm, rather than the exception. All but one of the manic children in
the study also suffered from A.D.H.D.

Wozniak told me that the
discovery of mania in so many of the kids she was treating came as a
shock to her too. “It was like I opened up my eyes: Oh, my goodness,
these children have bipolar disorder,” she said. “And I realized that
what I’d been treating them for hadn’t been working well. I was often
treating them for bad A.D.H.D., using different stimulant medicines or
higher doses. I was often treating them for their depression and not
getting anywhere. In those days, the teaching was that we had a group
of medicines that could be used for ‘aggression’ in children. What’s
interesting is that these were the anti-manic agents; they were lithium
and antiseizure medicines.” In other words, many of the children in
Wozniak’s clinic went unrecognized as bipolar, but they were
inadvertently being treated for bipolar.

I’m curious what the rest of the article will reveal about this highly controversial current diagnosis and what it means for our children and society.

Photo Illustration by Gerald Slota for The New York Times

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