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Going to Extremes

Experts Question Rise in Pediatric Diagnosis of Bipolar Illness, a Serious Mood Disorder

By Sandra G. Boodman
Washington Post Staff Writer
Tuesday, February 15, 2005; Page HE01

From the time her son was born, Jennifer DeWeese said, she suspected something was wrong. As an infant he cried inconsolably and slept mostly in hour-long snatches. At 3, he was always irritable and had prolonged tantrums triggered by the slightest change in his routine. A therapist told his mother he was emotionally disturbed and suggested she read a popular book about childhood bipolar disorder. A year later a child psychiatrist in Virginia Beach made the diagnosis: the 4 1/2 -year-old was manic-depressive.

A few months later, when his even-tempered sister grew moody and volatile, DeWeese took her to the same psychiatrist. They sat down with DeWeese's well-thumbed book about bipolar children and went through its symptom checklist. Based largely on those results and the family's history -- DeWeese said she learned during her divorce that the children's father had been diagnosed as bipolar in high school -- the psychiatrist told DeWeese her 5 1/2-year-old daughter was bipolar, too.


Experts are questioning the rise in pediatric diagnosis of bipolar illness. (Randy Mays For The Washington Post)

_____Live Discussion_____
Kids and Bipolar Disorder: Dr. Jon McClellan discussed the growing number of pre-adolescent children diagnosed with bipolar disorder.
_____From the Post_____
Telling Bipolar Disorder From Something Else (The Washington Post, Feb 15, 2005)

"I feel relieved to know there is something causing their symptoms and something we can do about it," said DeWeese, 34. She is convinced, she said, that her children's problems are inherited, not a reaction to their father's permanent departure, a bitter divorce marked by allegations of spousal abuse, a bankruptcy that resulted in the loss of the family's house and car, DeWeese's frequent hospitalizations for kidney disease and the arrival of a new stepfather.

Now 6 and 8, DeWeese's son and daughter exemplify a trend that is roiling mental heath: the burgeoning number of children diagnosed with bipolar illness, also known as manic depression, which affects about 2.3 million Americans.

The illness, which is usually diagnosed in adolescence or early adulthood, is a serious and disabling mood disorder that, if untreated, carries an elevated risk of suicide. Sufferers typically cycle between manic highs, in which they can go for days without sleep in the grip of grandiose delusions, and depressive lows, marked by a preoccupation with death and feelings of worthlessness.

There is no test for bipolar illness, which is believed to result from a poorly understood interplay between genetics and environment. Although the disease runs in families, according to the National Institute of Mental Health (NIMH), most children with one bipolar parent won't develop the illness. Their risk is about 10 to 15 percent compared with 1 percent among the general population. NIMH officials say there are no reliable statistics on the risk posed by having two bipolar parents.

Statistics documenting the increase in pediatric bipolar diagnoses are elusive, but a dozen psychiatrists and child psychologists in the Washington area and elsewhere interviewed for this story say there have been sharp increases in the past decade. Before that, the illness was rarely diagnosed before adolescence.

Although definitive answers about the disorder in children await the results of several NIMH-funded studies currently underway, many doctors aren't waiting. Proponents of early intervention say that aggressive treatment can limit the damage of untreated mental illness.

As a result, some preschoolers barely out of diapers are being treated for bipolar disorder with powerful drugs, few of which have been tested in children.

At Dominion Hospital in Falls Church, which houses the Washington area's largest inpatient psychiatric unit for children, psychiatrist Gary Spivack said patients as young as 4 have been hospitalized, sometimes for a few weeks at a time. "They're just so out of control that almost nothing else has the power to do it," Spivack said, who adds that many were being raised in highly dysfunctional homes.

But some experts say the surge in diagnoses is a dangerous fad -- one critic called it "psychiatry's flavor of the month" -- a decision too often based on skimpy evidence, cursory evaluations and incorrect assumptions about genetic risk.


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