There was a 40-fold increase in diagnosis of children with bipolar between 1994 and 2004, while the diagnosis of bipolar in adults doubled.
Could this be explained by simply an increase in awareness? No and here’s why: let’s treat the increase in the adult population as a measure of the increase in level of awareness. Given this, the rate in children should also have doubled. Instead, what it suggests is that there is a massive amount of misdiagnosis in children.
The problem is that many of the symptoms of bipolar, including rages, rapid talking, and flights of ideas and fantasy, are actually within the bounds of “normal” behaviour for children. They are not normal for adults, which is why they contribute to a diagnosis of a disorder.
There is a grave danger in applying criteria that were developed for adults to children. Children frequently will throw tantrums for example. This behaviour needs to be managed, and it is certainly not acceptable, but we do expect children to experiment with tantrums at some point. We don’t consider them to be mentally ill.
But if an adult throws a child-like tantrum, by screaming, stamping, and throwing objects, then a diagnosis of mental illness makes more sense.
Another sign of illness in an adult is detachment from reality. For example, bipolar adults often experience what’s known as “delusions of grandeur.” They might also experience fantasies about their talents, relationships with powerful people and other delusions.
But for children, fantasy is normal. In fact, it is a sign of an intelligent, creative mind. For adults such fantasies are a sign of sickness, but for children, the opposite is true: they are a sign of health.
Until the medical community carefully and intentionally develops guidelines for assessing the possibility of bipolar in children, we should be skeptical of doctors who apply diagnostic criteria to people outside the population for which they were designed.
If the rate of increase for adults is used as a baseline, then the forty-fold increase in childhood diagnosis should have been a two-fold increase. If true, then this would mean that 95 percent of child bipolar diagnoses would be wrong.
Behavioural problems are common in children. A doctor with limited experience of children but who is well-schooled in mental illness might understandably mistake normal childhood bad behaviour as symptoms of a disease.
Misdiagnosis is always serious, but it is especially dangerous for children, for three reasons.
First, if the child is incorrectly diagnosed as having bipolar, then the true problems will not be identified and will go untreated.
Second, the drugs that are given for bipolar are, to put it bluntly, extreme. They have nasty side-effects, they cause lethargy and weight gain and can induce an array of health problems. They affect concentration, tax the liver, can rob a child of any opportunity for a normal, natural childhood.
Third, the child will be stuck with a label that will persist throughout school and into adulthood, colouring interactions with adults and affecting every aspect of life. Teachers will learn of the diagnosis and treat them differently. Doctors will take it into account with every visit. If there are problems at school such as fights with other students or disputes with teachers, the child – known to be “bipolar” – will always be assumed to be in the wrong. They will be marginalised and stigmatised. A heavy price for a physician’s naive mistake.
The best course of action for the parent of a child who is bipolar is to take them to a child psychologist (not psychiatrist). Such a professional is likely to look for behavioral problems first and grown-up disorders second. This gives the child a chance to be treated as a normal, if badly behaved, boy or girl.
It is the responsibility of any parent in this situation to make sure that the child has not been misdiagnosed. The price of being wrong is too high.