Is Bipolar Disorder in Children Overdiagnosed?
The 40-fold increase in children who receive a diagnosis of bipolar disorder has generated great concern. Some believe it represents an over-diagnosis of a serious condition whose boundaries have become fuzzy and thereby confers upon children unnecessary, inappropriate, and harmful labels and medication. To the degree that this occurs, it is indeed a serious problem that warrants correction.
While we certainly wish that NO children would experience the very difficult symptoms associated with bipolar disorder, citing the increase of diagnoses as 40-fold may be an alarmist way to think of the situation.
According to a study conducted in 2007 by Moreno et al.[1] , the estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100,000 population. While this does represent a 40-fold increase, and is the statistic which continues to draw attention, there is a practical reason for it. The illness in children has only recently been acknowledged and diagnosed with any regularity. Understandably, any increase from zero will seem to be disproportionately large. What is not frequently pointed out is that the prevalence cited in 2002-2003 is consistent with lifetime prevalence rates of strict DSM BD I and II and well within lifetime prevalence rates of the bipolar spectrum [2].
In 2011, a thorough review of the literature on the prevalence of bipolar disorder in children was conducted [3] . That metanalysis looked at 12 studies which presented data on the presence of mania or hypomania, as reported in community epidemiological samples, from 1985 to 2007. Together the studies accounted for 16,222 children between the ages of 6 and 17. Half of them took place in the United States while the other half were from other countries around the world.
The metanalysis determined that the overall rate of bipolar disorder in children was 1.8%, higher than commonly acknowledged. But it also determined that there was no evidence of an increase in rates of bipolar disorder in the community over time nor were there significant differences between the US samples and the non-US samples. However, individual studies of the US rates were more variable than the others. The studies with the highest rates correlated to the use of the broadest definitions of the disorder; another example of the effect of un-validated boundaries. ( Click here to read “Why Does My Child Have So Many Diagnoses?)
According to the above metanalysis, there does not seem to be a recent over-diagnosis of bipolar disorder in children. There is no doubt that some children who do not have bipolar disorder are being diagnosed as such. Many studies show however that under-diagnosis is far more prevalent than over-diagnosis in the adult community. We believe it is likely to be the same for children. Given the severity of the illness, any number of children who suffer from it is too many.
___________________________________________________________
[1] Moreno C, Laje, G, Blanco, C, Jiang, H, Schmidt, A.B, & Olfson, M: (2007). National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry, 64:1032–1039 [2] Angst J: (1998). The emerging epidemiology of hypomania and bipolar II disorder. J of Affective Disorders, 50:143-151 [3] Van Meter AR, Moreira AL, Younstrum EA: (2011). Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. Sep;72(9):1250-6. Epub 2011 May 31
