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What’s Normal? The difficulty of diagnosing bipolar disorder in children.
Jerome Groopman, is a physician Harvard Medical School and a staff writer at the New Yorker.
The full article is available in the April 9, 2007 New Yorker. The May 7 issue contains three letters from physicians in response. Two physicians at Harvard Medical School, cited in Groopman's article, argue that
- as potent as the side effects of treatment can be, psychiatry's greater appreciation of the occurrence of bipolar disorder in childhood has led to remarkable advances in diagnosis and treatment which we feel far outweigh these drawbacks.
Demitri Papolos, a physician at the Albert Einstein College of Medicine and author of a book cited by Groopman, argues that
- [W]hen children are not diagnosed and treated appropriately, aggressive behavior, psychosis, and even suicide are not uncommon results, often accompanied by secondary effects, including enormous family upheaval.
I guess this shows that if schools adopted a medical model, teachers would be allowed to have differing opinions.
by Jerome Groopman
Abstract
MEDICAL DISPATCH about bipolar disorder in children. In April 2000, Steven Hyman, a psychiatrist who was at that time the director of the National Institute of Mental Health (N.I.M.H.), convened a meeting of 19 prominent psychiatrists to discuss bipolar disorder in children. The disorder has long been recognized in adults, and, in the late 1990s, there was an increase in awareness of the disease in children, first in medical journals and then in places like BPParents. Many parents who contacted Hyman about their children cited a book called The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder, by Demitri and Janice Papolos. The Papoloses argued that bipolar disease was often overlooked in children, and they cited research based on questionnaires they distributed through BPParents. At the N.I.M.H. meeting, the psychiatrists argued about whether bipolar disorder actually existed in children and whether an accurate diagnosis could be made. Mentions psychiatrists Barbara Geller, Joseph Biederman, and Janet Wozniak. Meanwhile, articles inspired by the Papoloses’ book began cropping up in the media. Mentions Time magazine’s 2002 cover story. The number of children under 13 who have been diagnosed with bipolar disorder has increased 600% in the past 10 years. Many doctors fear that the media has exaggerated its prevalence in children. The situation has similarities to the overdiagnosis of attention-deficit hyperactivity disorder (A.D.H.D.) in children. The consequences of a misdiagnosis of bipolar can be dire. Describes the history of the medical treatment of bipolar disorder. Geller first encountered a child she believed exhibited bipolar disorder in the early 1990s. She found that the manner in which symptoms appeared in children was significantly different from that of adults. Describes a study she did in 1995. Lists the disagreements among physicians over bipolar diagnoses. The need to establish diagnostic criteria is critical because many of the drugs given to bipolar children haven’t been tested extensively. Mentions the drug Risperdal. In January, 2007, the American Academy of Child and Adolescent Psychiatry published a paper to guide clinicians in their assessment and treatment of pediatric bipolar disorder. Biederman and Wozniak have affixed the diagnosis to preschool children, but Geller contends that bipolar disorder can’t be accurately diagnosed in a child younger than six. In the early 1990s, Geller, responding to fears about incorrect diagnosis, established a second-opinion clinic for bipolar disorder at Washington University. Child psychologist April Prewitt spends a good deal of time “undiagnosing” children who’ve been told they’re bipolar. Psychotherapist Phillip Bloomberg believes that drug-company advertising has influenced the public’s view of bipolar disorder.
— Jerome Groopman
New Yorker
2007-04-09
INDEX OF NEWS ITEMS
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