CHILDREN SUFFER BIPOLAR DISORDER TOO

Diagnosis In professional classifications such as the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) or the World Health Organization's International Classification of Diseases (ICD)[2] bipolar disorder is classified with adult onset disorders. However, as far back as the 1920s, Kraepelin [3] showed in a retrospective study of 900 manic-depressive adults that 0.4% had onset of symptoms before the age of ten. In a cohort of bipolar disordered adults, Loranger and Levine [4] retrospectively evaluated 200 adult bipolar patients and found that 0.5% had onset between the ages of five and nine. In a study of 898 adults with bipolar disorder, Goodwin and Jamison [5] found that 0.3% had onset before age 10. This literature supported the existence of childhood onset mania, but also indicated that it may be rare. This idea was supported by a review of 28 papers by Anthony and Scott [6], which suggested that childhood bipolar disorder was uncommon. In these papers, only three of 60 cases (5%) of purported childhood bipolar disorder met their criteria for bipolar disorder. However, Anthony and Scott’s criteria differed from those currently in use, so the applicability of this work to current views of bipolar disorder is uncertain. Population and community studies using DSM criteria show that about 1% of youth may have bipolar disorder [7][8]. Studies in clinics using these criteria show that up to 20% of youth referred to psychiatric clinics have bipolar disorder [9][10][11]. Many of these children required hospitalization due to the severity of their disorder [12][13]. Because of these dignostic uncertainties, the validity of an early-onset form of bipolar disorder had been debated in the late 20th century. However, since that time, systematic reviews of diagnostic, genetic, neurobiological, treatment and longitudinal research studies [14][15][16][17] have concluded that this disorder can be validly diagnosed in children and adolescents. This consensus of the scientific community is also seen in the appearance of practice parameters for the disorder from the American Academy of Child and Adolescent Psychiatry[18] Findings indicate that the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, and continues to increase. The data suggest that doctors had been more aggressively applying the diagnosis to children, rather than that the incidence of the disorder has increased. The study calculated the number of psychiatric visits increased from 20,000 in 1994 to 800,000 in 2003, or 1% of the population under age 20.[19] The reasons for this increase in diagnosis are unclear. On the one hand, the recent consensus from the scientific community (see above) will have educated clinicians about the nature of the disorder and the methods for diagnosis and treatment in children. That, in turn, should increase the rate of diagnosis. On the other hand, assumptions regarding behavior, particularly in regard to the differential diagnosis of bipolar disorder, ADHD, and conduct disorder in children and adolescents, may also play a role. information obtain from wikipedia

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