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.

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6 Responses to Welcome

  1. glenn bogue says:

    I am the author of a 5 book series. my book on disease delves into the nutritional research of Henry Bieler, M.D. Honorary Chair in Nutrition, Columbia’s Goldwater Hospital. Dr. Bieler asserted that the subatomic structure of proteins is altered by heat into hydrophobic matter which putrefies in the intestines and leads to leaky gut condition. These “toxins” then can enter the bloodstream and become lodged in the spine and the brain, leading to ADD or MS or Parkinson’s. In the Pottenger cat study, group #1 was fed raw proteins and had no disease. Group II was fed the same proteins only cooked. That group developed brain/spinal disorders in the third generation.
    Is this not where we are today in the 3rd generation of cooked proteins?

    Glenn Bogue M.A., esq.
    The Books of Isis

  2. Rose Jones says:

    As an adult who suffers with bipolar disorder – which has been well treated with medications, I read this with great interest. I also have 2 kids with some kind of “issue.” The deal is – the medications that treat bipolar disorder are no joke. I am on Depakote, and struggle with my weight, and wonder about the long-term liver problems. I believe that kids are much too medicated – and I had placed one of my sons on medication, although he is off of it now. I do wonder if my life had been easier if I had been diagnosed and treated earlier, although when I had my manic episodes there was no doubt that something significant was happening. By the way, I hope that at some time you or one of your colleagues takes a deeper look into the diagnosis of bipolar disorder in relation to post-partum psychosis as I experienced this and it was horrible. I appreciate your honest inquiry into this field, and hope that you are able to get your point across. We want to do whatever we can to help kids, without hurting them more.

  3. As a parent of an almost 7-year old daughter, who has been through so much over the past 6 years, this article intrigues me. If most of these children are being misdiagnosed…what do they have? We had our first child and everything seemed quite normal for the 1st 9 months. Other than the fact that she was born with her hands wide open, and never liked people touching them, everything was great. And then…the tantrums, sleep problems, low muscle tone. All milestones were met on time – except walking – which didn’t happen until 19 months. This led to early intervention and PT started. When the therapist recognized some sensory issues, she said testing for OT was needed. My daughter qualified easily and sensory and fine motor issues were addressed. Then we dealt with sleep issues and problems with separation anxiety. This led us to a psychologist who did the full battery of testing. An IEP was established and upon entering kindergarten we had a child psychiatrist on board (outside of school) with OT, PT, social worker, and special education (at school). Along with a low dose of Risperidone! Things got better, but Reverse SAD reared it’s head and we discovered that May is not a good time. The psychiatrist recommended periodic tests to see if my daughters “mood” problem was under control enough to tolerate ritalin. It wasn’t…
    Now, we’ve finished 1st grade and have been tolerating ritalin for the past 3 months. My daughter has qualified out of all but OT 1x week (for next year). Other than math she is at an average-above average level at school. Problem is, she is great as long as I am not present. Perseveration, ODD, hyperactivity, and irritability are my life. Have I steered her in the wrong direction???? Her brother who is 2 years younger has none of these issues. Help!!! Mom

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  6. Chelsea Martinez says:

    I can’t thank you enough for writing this book and being brave enough to be honest!
    I’ve been through hell and back, and am still fighting misdiagnoses from my childhood. When I was 5 I was diagnosed ADHD and put on Ritalin. I was distracted in school and didn’t like to sit still mainly because I was bored. I learned to read when I was 3 and was reading Anne Rice and Stephen King novels by the first grade, when science got boring in second grade I picked up my mom’s college Chemistry book and learned the Periodic Table, and just found school boring (though I got excellent grades).
    The Ritalin just made me feel out of it and I was so irritable I would just lash out at anyone. There were alot of familial issues at the time as well; my dad was on crack and in and out all the time, my mom was/is an alcoholic and she started an extramarital affair with a man I still can’t stomach, and I was really sick with UTI’s/kidney infections due to a urinary reflux. I was hospitalized again and again for the psychiatric “issues” and by the time I was 14 I had been diagnosed; ADHD, Bipolar Affective Disorder, ODD, PTSD, BPD, NPD/HPD traits, MDD, and suffering from COA issues/institutionalized thinking trauma. I had been hospitalized from days to 9 month stays from the age of 6 onward (psychiatric inpatient), and restrained, taught how to slit my wrists (though I never did) with hospital wristbands and how to manipulate the medications in my throat to spit them up later by the older residents. Not to mention being physically attacked and verbally assaulted by them.
    The medications and counseling/psychotherapy were the worst though; Ritalin, Zoloft, Adderall, Adderall XR, Clonidine, Lithium, Depakote, Seroquel… just to name the ones I remember. And everytime I would tell these counselors and psychologists and psychiatrists that I wasn’t bipolar, that I just wanted to get off of these medications, they were hurting me… I was shot down with patronizing statements of understanding, reviewing the symptoms of the disorders and asked things like, “Now that sounds like what happened the other day doesn’t it?”, or simply ignored with, “We’ll get you the help you need.” when I couldn’t take it anymore and just cried for someone to help me. When I was 14 and locked up for 9 months for running away from my foster home, the clinician actually wrote that I had a strong knowledge of the DSM-IV diagnostic criteria, but my judgement was limited with impulsivity and my insight was likely limited as well and it was her impression that much of what I had told her “had strains of truth in it, but is likely laced with exaggerations due to her fairly dramatic presentation of her history.”. This was after I sat down with her and told her that I wasn’t bipolar and more accurately fit the diagnosis of PTSD, which she then agreed with, and negated the bipolar diagnosis/ammended it to PTSD chronic with institutionalized thinking trauma.
    The problems I’ve faced as an adult have been a restriction of opportunities (I can’t become a nurse or join the military etc), being involuntarily committed by my ex-boyfriend for “threatening suicide” when I went to buy melatonin to help me sleep (he told them the pharmacy I would be at and that I was buying “sleeping pills” to kill myself), and then his family tried to take me to court for custody of my children over the “suicide attempt”… thankfully that worked out in our children’s favor with both of us being granted joint-custody. I guess the conclusion here is that people, parents, teachers, psychologists, don’t understand the long-term repercussions and problems a childhood psychiatric diagnosis or misdiagnosis can cause. I struggle everyday from PTSD and I’m afraid of psychologists/psychiatry in general!
    Thank you again for writing this book!

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