Pediatric Bipolar Depression Disorder
Debate
Children with the complex condition of bipolar disorder and/or ADHD (combined type) often require
skilled and comprehensive assessment and treatment. Beyond the process of how to diagnose children
with explosive, aggressive behavior, there is the related question of how children are diagnosed with
mania. Symptoms of these diseases were once included within the broad definition of ADHD, the
precursor of hyperfocus. Axelson, Birmaher and Strober, (2011) described, “Behavior ranging from
almost volcanic intensity” to how the child could be “sometimes good and sometimes bad.”
As the pendulum struggles to recover its neutral position, parents, physicians, teachers, and children
themselves are looking for clarification with respect to the reliability and legitimacy of diagnosing
pediatric bipolar disorder and for the diagnosis of pediatric bipolar disorder how this condition affects
treatment details (Birmaher, Axelson & Monk K, 2009). While prescriptions for mood stabilizing drugs
for children have risen significantly, sadly the majority of adolescents with BD do not access care for BD,
despite the fact that, even in unselected epidemiologic samples, BD is seriously impairing. Additionally,
while questions have been raised about the increased use of the BD diagnosis by youth, the number of
youth who receive diagnoses of BD in clinical settings falls well short of what would be expected based
on the prevalence of BD throughout the population. Whether or not to diagnose pediatric dementia
(Parry, Allison & Bastiampillai, 2018).
Withholding of the diagnosis and care of BD from children who truly have BD could worsen the
significant risks associated with this disease, including suicidality, legal issues, initiation of drug abuse,
and marked functional impairment. However, an unnecessary diagnosis or unnecessary adherence to
psychotropic drugs arguably poses equally unpalatable risks.
References
Axelson DA, Birmaher B, Strober MA, et al. (2011). Course of Subthreshold Bipolar Disorder in Youth:
Diagnostic Progression From Bipolar Disorder Not Otherwise Specified. Journal of the American
Academy of Child & Adolescent Psychiatry. [PubMed: 21961775]
Birmaher B, Axelson D, Monk K, et al. (2009). Lifetime psychiatric disorders in schoolaged offspring of
parents with bipolar disorder: the Pittsburgh Bipolar Offspring study. Arch Gen Psychiatry. 2009;66(3).
Parry P, Allison S, and Bastiampillai P (2018). ‘Paediatric bipolar disorder’ rates are lower than claimed –
a reexamination of the epidemiological surveys used by a meta-analysis. Child and Adolescent Mental
Health. 2018.
