My book, Your Child Does Not Have Bipolar Disorder: How Bad Science and Good Public Relations Created the Diagnosis, describes the failures of organized psychiatry, the pharmaceutical industry and the media that led to the adoption and frequent diagnosis of a rare or nonexistent disorder. Making the diagnosis of bipolar disorder in youth proved harmful to the health of children and the reputation of psychiatry as a science. An important measure of the extent of the problem is found in the statistics of changes in diagnosis rates. Between 1994 and 2003 the percentages of mental health office visits for bipolar disorder in youth increased from less than half a percent (0.42%) to more than six and a half percent (6.67%), and between 1996 and 2004 the percent of youth leaving psychiatric hospitals with a diagnosis of bipolar disorder went up 400%!
In this blog I want to go beyond what is in the book to extend my critique of the disorder to current developments in child psychiatry about bipolar disorder in children and adolescents. One of the rewards of writing about pediatric bipolar disorder in youth is that it is topical; there is a constant stream of studies and reports on the disorder that merit the attention of parents and professionals who are concerned with this diagnosis. I will be considering some of these reports from my perspective as a highly experienced child psychiatrist clinician and academic researcher.
The authoritative foundation for the classification of psychiatric diagnosis in the United States and many other countries is the DSM System (Diagnosis and Statistical Manual of Mental Disorders) of the American Psychiatric Association. The current edition of this system, the DSM IV, has been under revision for several years. The DSM V Committee on Children and Adolescents has been highly critical of the diagnosis of bipolar disorder in children and has unwittingly provided public vindication for many of the views expressed in my book. The DSM V Committee on Children and Adolescents serves as a final authority on what psychiatric diagnoses are acceptable. The judgments of the committee are closely heeded by insurance companies, lawyers, clinicians, researchers and governmental agencies. The committee has relied on a number of new studies over the recent past to support its recommendations. These studies will be critically reviewed in this space and the reports of this DSM V committee about bipolar disorder will be discussed.
Another reward of writing about the bipolar disorder diagnosis in childhood is that a consideration of this topic cuts across many issues in child psychiatry of interest to the general public. These issues include Attention Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, Major Depressive Disorder, medications, clinical trials, psychotherapy, and research methodology. All of these are addressed at some length in my book and will be continue to be addressed in this blog.
For parents, a better understanding of this diagnosis is intended to be of immediate benefit to themselves and their children. An enhanced understanding of the disorder will assist parents in discussing their children’s diagnosis with their physicians. The blog will discuss topics such as medication and behavior management for parents whose children have been given the diagnosis of bipolar disorder.
My own position about many of the issues facing contemporary child psychiatry and child mental health resists easy categorization. I am not anti or pro drug treatment of pediatric psychiatric disorders. I strongly endorse good drug treatment: use of medications that are safe, effective, and backed by good scientific evidence for those children who need them. Similarly, I strongly endorse psychotherapy approaches that are proven effective. I am always on the side of science-based approaches to understanding and treating children with mental health problems.
One of the many painful aspects of the study of bipolar disorder in children and adolescents is that it contaminated the evidence base of child psychiatry. A good portion of the studies of pediatric bipolar disorder reported in the scientific journals of psychiatry are seriously flawed. This charge is documented in my book, and I will continue to develop it in this blog.