Concerned parents often ask me, “Does my child have bipolar disorder?” Over the past 11 years, since the publication of the first edition of The Bipolar Child in 1999, this question has become more and more prevalent. Parents who struggle with this question face a serious dilemma – they are reluctant to have their children labeled “bipolar,” yet, they want an explanation of what is going on and a treatment plan that helps their children be as successful and happy as possible.
Mental health professionals, including psychiatrists and psychologists, also struggle with this question. Because we have no definitive biological test for bipolar, we must rely on diagnostic guidelines – those published in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and on the insights of leading researchers in this area.
Unfortunately, as the diagnostic criteria set forth in DSM-IV are the same criteria used to diagnose adults, the usefulness of DSM-IV in establishing a diagnosis in children has been problematic.
Promising developments are in the works to provide mental health professionals with clearer and more precise guidelines for diagnosing troubled children and teenagers. After a great deal of research and deep reflection, the DSM-5 Task Force recently released its proposed revision of the Diagnostic and Statistical Manual of Mental Disorders – DSM-5. This new edition, scheduled to be published in May, 2013, includes a new diagnostic entity under the category of “Disorder Usually First Diagnosed in Infancy, Childhood, and Adolescence.” The new diagnostic entity I refer to is “Temper Dysregulation Disorder with Dysphoria,” which provides more precise diagnostic guidelines specifically for children and teens.
Although DSM-5 will no doubt help publicize these diagnostic criteria, and I welcome the addition of these new guidelines, they are not exactly groundbreaking. I have been using this concept in my practice for the past years since the publication of “Defining clinical phenotypes of juvenile mania,” by Leibenluft E, Charney DS, Towbin KE, Bhangoo RK, and Pine DS, in the American Journal of Psychiatry, 2003 March;160(3):430-7. In their study, the authors “suggest criteria for a range of narrow to broad phenotypes of bipolar disorder in children, differentiated according to the characteristics of the manic or hypomanic episodes, and present methods for validation of the criteria.” In other words, the authors open the possibility of not just one diagnosis of “Childhood Bipolar” but any of several different childhood bipolar diagnoses each of which has its own unique set of presenting symptoms. The broad phenotype in their description is very close to the currently proposed DSM-5 diagnosis of Temper Dysregulation Disorder with Dysphoria.
I have found the concept of mood/temper dysregulation in children and adolescents very useful in performing an advanced differential diagnosis and critical in developing an effective treatment plan and accurate prognosis for each patient. So the answer to the question “Does my child have bipolar disorder?” is more involved than a simple “Yes” or “No.” An advanced differential diagnosis, performed by a qualified professional, is essential in arriving at a precise diagnosis and delivering the most effective treatment.