Is Childhood Bipolar Disorder Overdiagnosed?

Doctor Ellen Leibenluft discusses the question of over-diagnosis in childhood bipolar disorder, which may be caused by a gap in diagnostic ctiteria.

I wouldn’t use the term over-diagnosis here in this particular instance because over-diagnosis implies that you are taking a healthy child and giving them a label, giving them a diagnosis, and that clearly is not what’s going on. The question is more whether it’s the correct diagnosis that they’re getting. It appears that one of the problems is that they may not fit very well into the current diagnostic system. There isn’t a good home for them in the current diagnostic system. The current diagnostic system is called the DSM IV. In that system, these very, very irritable children tend to also have ADHD (attention-deficit/hyperactivity disorder) so they’d get that diagnosis, they oppositional-defiant disorder. If you recruit them, and we’ve recruited about 100 of them, they have very high rates of anxiety disorder, about a quarter of them have had an episode of depression by the time that they are 12. So they meet criteria for a lot of different diagnoses but there is no one diagnosis which really captures what they have. One could in a sense say that they’re being mis-diagnosed but that also isn’t really fair because it’s not like there is a clear diagnosis for them. The issue really is that there are these children out there that are very impaired, psychiatrically are having a great deal of difficulty but there isn’t a diagnosis which captures very well exactly what’s happening with them. Well we don’t know exactly what’s going to happen with these children in DSM V, and the process is really just beginning and people are talking about it. Certainly it is clear that there’s a problem here; that these very, very irritable children are not well served by the current diagnostic system in the DSM IV. Everyone is very aware of that, is talking about it and wants to do something to improve it; exactly what that will look like, people really need to talk about it more and review the data more before we can really come to any firm conclusions.