Mommy Am I Really Bipolar?

Article excerpt

Hundreds of thousands of children in the U.S. have been wrongly diagnosed with the trendy disorder, argues a noted psychiatrist. And the results can be tragic.

In the autumn of 1994, a novel idea was afoot in my profession. At the annual conference of the American Academy of Child and Adolescent Psychiatry, I attended a workshop on bipolar disorder in children. About 10 of us attended the meeting, held in a small, poorly lit room. Only one or two doctors reported having actually seen a child with bipolar disorder, but we all agreed to keep our eyes open for other sightings.

Three years later I attended another session about bipolar disorder in children at the academy's annual meeting. In a large ballroom beneath a gleaming chandelier, several hundred child psychiatrists buzzed with excitement. As a mainstream concept, the diagnosis had arrived.

I have been a child psychiatrist for nearly five decades and have seen diagnostic fads come and go. But I have never witnessed anything like the tidal wave of unwarranted enthusiasm for the diagnosis of bipolar disorder in children that now engulfs the public and the profession. Before 1995, bipolar disorder, once known as manic-depressive illness, was rarely diagnosed in children; today nearly one third of all children and adolescents discharged from child psychiatric hospitals are diagnosed with the disorder and medicated accordingly. The rise of outpatient office visits for children and adolescents with bipolar disorder increased 40-fold from 20,000 in 1994-95 to 800,000 in 2002-03. A Harvard child-psychiatry group led by Dr. Joseph Biederman, a prominent supporter of the diagnosis, recently insisted, "Juvenile bipolar disorder is a serious illness that is estimated to affect approximately 1 percent to 4 percent of children."

I believe, to the contrary, that there is no scientific evidence to support the belief that bipolar disorder surfaces in childhood. In fact, the opposite seems to be the case: the evidence against the existence of pediatric bipolar disorder is so strong that it's difficult to imagine how it has gained the endorsement of anyone in the scientific community. And the effect of this trendy thinking can have devastating consequences. Such children are regularly prescribed medications that are not effective in kids and have unwelcome side effects.

The case of Rebecca Riley, a Boston toddler, vividly summarizes some of the inherent risks. Her psychiatrist first identified Rebecca as suffering from pediatric bipolar disorder at the age of 2. (The psychiatrist concluded that Rebecca's two siblings were bipolar as well.) In addition to diverting the psychiatrist from the very real problem in Rebecca's family--a well-chronicled history of child abuse--the diagnosis led to the prescription of a common cocktail of medications. Rebecca's parents misused one of these medications--clonidine, prescribed to treat high blood pressure in adults but also given to children because of its sedative effects--to quiet their child. Forever. "There was no waking her up," Rebecca's mother stated on 60 Minutes. (The psychiatrist later settled a malpractice suit for $2.5 million.)

In adults, bipolar disorder is characterized by cycles in which a patient rotates between two extremes, or poles, of feeling: depression and mania. The cycles may vary in length and intensity, but the adult diagnosis depends on clear-cut episodes of behavior that is distinctively different from normal: severe overexcitement or highs that last for weeks, and crushing, painful periods of deep depression that also last for weeks or months. The description of childhood bipolar disorder by its advocates is dramatically different. Where adult bipolar disorder expresses itself in episodic, out-of-character behavior, a child diagnosed with bipolar disorder will have symptoms that characterize the child's typical behavior. In this telling, an elementary-school-age child with the disorder may be chronically enraged and have several tantrums per day. …