Support for the diagnosis of bipolar in children
The controversy surrounding the diagnosis of bipolar disorder has been ongoing for decades. It is particularly of interest in the US because, since the adoption of the APA DSM diagnostic criteria in the late 1990s, the prevalence has increased. In contrast, it has mostly remained the same in other countries. From a subjective point of view, no would want to diagnose children bipolar; however, evidence supports the diagnosis of bipolar in children from an objective perspective.
The controversy of diagnosing mental disorders in children has always been a controversy, particularly because symptoms do not present as in adults; hence, it is assumed it does not exist, or the cases are very low warrant diagnosis, the stakes for the wrong diagnosis are high, and pose potential risks. A similar position was held for the diagnosis of depression, but it is now accepted and demonstrated that despite the atypical symptoms, depression is a significant cause of morbidity and mortality in children above the age of ten years; the same holds for bipolar (Goldstein, Post, & Birmaher, 2019)
Using advanced imaging of the hippocampus, Cao et al. (2017) compared changes in the brain in bipolar, depression, and healthy individuals. The hippocampus is essential in mood and emotional regulation, some of the features that are severely affected by bipolar. The authors of the study concluded that the hippocampus’s subdivisions are significantly reduced in size in bipolar compared to depression and healthy persons. Arguably, children have brains too; it would be naïve to suggest that bipolar cannot affect children but can affect adults. Opposing the diagnosis of bipolar in the face of such evidence ignores basic biology; children have brains.
Bipolar is a complex and multifactorial disorder comprising of the interaction of genetic and environmental factors. Current research has found an association between a single nucleotide polymorphism to bipolar, and these findings are under investigation for predictive testing and genetic counseling. Additionally, twin studies have demonstrated a 60% to 80% concordance inheritability of bipolar. The evidence for genetic risk in bipolar is convincing, despite being in its early stages of research (Kerner, 2014). The point here is that there a genetic component for bipolar, whether you chose to acknowledge it in childhood or adulthood depends on the level of objectivity you want to apply. Empirically, the genetic risk of bipolar begins at conception.
From another perspective, it has been argued that bipolar diagnosis symptoms are similar to other disorders, such as ADHD. However, according to Biederman, the intensity, frequency of irritability, and out–of–control behavior is quantitatively distinct in bipolar. A well-trained psychiatrist can distinguish them from other disorders, similar to a neurologist capacity to distinguish between petit ma seizure from temporal lobe epilepsy. Arguably denying diagnosis based on skill deficiency is not a solid ground to stand on at this point (Parens & Johnston, 2010).
In conclusion, it is a shared acknowledgment that children who present with “bipolar symptoms” need help regardless of the final label. However, refuting the current evidence for bipolar disorder in children is disregard for the very science that drives medical practice, and choosing to wait until adulthood is not empirically supported.