Sherry Roberts
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Should Bipolar Disorder Be Diagnosed in Children/Adolescents?
According to the Diagnostic and statistical manual of mental disorders (DSM)-5, a diagnosis of mania requires distinct episodes of “abnormally elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy”, on seven consecutive days for mania and 4 days for hypomania, and three (four if the mood is only irritable) so-called B symptoms, such as inflated self-esteem, decreased need for sleep, increased goal-directed or psychomotor activity, pressured speech, flight of ideas and increased distractibility. In addition, high-risk behavior, sexual disinhibition or psychotic symptoms may occur. To enhance the accuracy of diagnosis, an emphasis on the changes in activity and energy as well as mood was included in DSM-5. The diagnosis of bipolarity now requires, as entry criterion A, not only the presence of an elated and irritable mood, but also the association of these symptoms with increased energy/activity (for full criteria see DSM-5 (Grimmer, Hohmann, & Poustka, 2014, p. 111). It would be premature to tag children and adolescents with a bipolar diagnosis. Children with symptoms associated with Bipolar should be diagnosed DMDD. Disruptive mood dysregulation disorder (DMDD) is a condition in which a child is chronically irritable and experiences frequent, severe temper outbursts that seem out of proportion to the situation at hand. Children diagnosed with DMDD struggle to regulate their emotions in an age-appropriate way. In between outbursts they are irritable most of the time (“Child Mind Institute,” 2020). DMDD was introduced as a diagnosis to address what psychiatrists considered to be the overdiagnosis of pediatric bipolar disorder. While the key feature of DMDD is irritability, the hallmark of bipolar disorder is the presence of manic or hypomanic episodes. ADHD can present with mood dysregulation as well. This disorder may be misdiagnosed as bipolar disorder, especially in adolescents and children. Many symptoms overlap with the symptoms of mania, such as rapid speech, racing thoughts, distractibility, and less need for sleep. The “double counting” of symptoms toward both ADHD and bipolar disorder can be avoided if the clinician clarifies whether the symptom(s) represents a distinct episode (Psychiatry online, 2020).
The bottom line is that Bipolar can be diagnosed in children but it has been overly diagnosed and misdiagnosed often when it is simply ADHD, DMDD and ODD. The factor that sets them apart would be mania. Evidently, there is a considerable symptomatic overlap of bipolar symptoms, such as distractibility, excessive talking and reduced social inhibition with other disorders, in particular ADHD.
References
Disruptive Mood Dysregulation Disorder Basics. (2020). Retrieved from https://childmind.org/guide/guide-to-disruptive-mood-dysregulation-disorder/
Grimmer, Y., Hohmann, S., & Poustka, L. (2014, December 1, 2014). Is bipolar always bipolar? Understanding the controversy on bipolar disorder in children. US National Library of Medicine, 6, 111. https://doi.org/ doi: 10.12703/P6-111
Psychiatry online. (2020). Bipolar. Retrieved from https://dsm-psychiatryonlineorg.ezp.waldenulibrary.org/doi/full/10.1176/appi.books.9780890425596.dsm16
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