The current paper will discuss the case for the diagnosis of the bipolar depressive disorder in children in light of the current controversy concerning the issue. The controversy surrounding this diagnosis will be outlined and the consequences of failing to diagnose this childhood disorder will also be discussed. Bipolar Depressive Disorder in Pediatrics
The Bipolar Diagnosis Controversy
Since the early 2000s, there has been a general divide among psychiatrists about the pediatric bipolar disorder (Birmaher, 2013). This was following a discovery of a forty-fold increase in the diagnosis of the disorder from the mid-1900s to 2002 (Wakefield, 2013). This was due to the views of mania in children and what exactly mania entailed in children.
The diagnostic criteria for bipolar divided the disorder into bipolar I, bipolar II, cyclothymic disorder and bipolar not otherwise specified (American Psychiatric Association, 2013). Bipolar I represent the classic manic-depressive disorder and needs to fulfill the criteria for mania followed by an episode of major depression or hypomania.
The redefinition of mania by APA led to the controversial diagnosis divide. According to APA, (2013), the seven criteria A symptoms of mania include inflated self-esteem, more talkative than normal, racing thoughts, less need for sleep, overinvolvement in activities with potential for harm, easily distracted and psychomotor agitation. Mania is present if the patient presents with elevated or expansive mood with at least three of the seven symptoms or irritability with at least four of the seven symptoms.
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The debate states that mania in a child is hard to diagnose (Birmaher, 2013). The symptoms of irritability coincide with other childhood disorders including ADHD and severe mood dysregulation (SMD) (Lee, 2016). Critics are worried that pediatric bipolar may be nothing more than a misdiagnosed case of other milder childhood mood dysregulation or a response to social stressors such as in reactive attachment disorder (Zeanah, Chesher, & Boris, 2016). Bipolar Depressive Disorder in Pediatrics
A case for diagnosing pediatric bipolar disorder
Pediatric bipolar is an established childhood disorder worthy of a diagnosis (Sadock, Sadock, & Ruiz, 2014). Bipolar disorder does affect children and the rise in diagnoses of the case only represent an awareness of the disorder (Lee, 2016). In the past clinicians did not diagnose it more often because they did not understand the pediatric presentation as it can be different from adult cases.
Bipolar is a mood disorder. Children have been known to suffer from other mood disorders for centuries including major depression and other adult conditions, for example, anxiety, why not bipolar (Frías, Palma, & Farriols, 2015). It would be illogical to accept these other conditions and exclude bipolar from the pediatric population based on unclear grounds.
Consequences of not diagnosing this disorder include a delay in treatment and the unfavorable outcomes of untreated bipolar. The manic-depressive cycles in bipolar predispose the child to school failure, injury to self and others, peer rejection, suicide and substance abuse (Frías, Palma, & Farriols, 2015). They are prone to reckless and harmful behavior. A diagnosis and treatment of this disorder are needed to avoid such outcomes.
A diagnosis of the bipolar depressive disorder in children is possible. Just like depression and anxiety, mood disorder does occur in children and a missed diagnosis predisposes the child to an array of consequences. The presentation may be a bit different from the adult case but it should not hinder assessment and diagnosis. Bipolar Depressive Disorder in Pediatrics
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Birmaher, B. (2013). Bipolar disorder in children and adolescents. Child and adolescent mental health, 18(3), 140-148.
Frías, Á., Palma, C., & Farriols, N. (2015). Comorbidity in pediatric bipolar disorder: prevalence, clinical impact, etiology, and treatment. Journal of affective disorders, 174, 378-389.Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Lee, T. (2016). Pediatric Bipolar Disorder. Pediatric annals, 45(10), e362-e366.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
Wakefield, J. C. (2013). DSM-5: An overview of changes and controversies. Clinical Social Work Journal, 41(2), 139-154.
Zeanah, C. H., Chesher, T., & Boris, N. W. (2016). Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 990–103. Retrieved from http://www.jaacap.com/article/S0890-8567(16)31183-2/pdf
Bipolar Depressive Disorder in Pediatrics
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