These children are troubled, critics say, but most don't meet psychiatry's official diagnostic criteria for the lifelong psychotic disorder.
"Labeling severe tantrums in toddlers as a major mental illness lacks . . . validity and undermines credibility in our profession," warns Jon McClellan, associate professor of psychiatry at the University of Washington, in a forthcoming article in the Journal of the American Academy of Child and Adolescent Psychiatry. "The illness has become a cultural phenomenon, adorning the cover of Time magazine and headlining national news broadcasts."
Experts are questioning the rise in pediatric diagnosis of bipolar illness.
(Randy Mays For The Washington Post)
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Kids and Bipolar Disorder: Dr. Jon McClellan discussed the growing number of pre-adolescent children diagnosed with bipolar disorder.
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It has also spawned numerous Web sites and more than a dozen books mostly aimed at parents. Two of them are written for children, including "Matt: The Moody Hermit Crab," whose main character winds up in a mental hospital after he tries to stab his family with a kitchen knife.
'Very Disturbed Children'
Joseph Biederman, a professor of psychiatry at Harvard and one of the most forceful advocates of the aggressive treatment of preschoolers, thinks bipolar disorder has been "severely under-diagnosed" in children.
He likens the criticism he has encountered to the outrage that greeted Galileo's challenge to the notion that the Earth was flat.
"The diagnosis is controversial only because it has been assumed not to exist," said Biederman, chief of pediatric psychopharmacology at Massachusetts General Hospital.
In his view there are clear-cut symptoms that distinguish bipolar disorder from attention-deficit hyperactivity disorder (ADHD), with which it is often confused, or other problems. He said studies have found that bipolar children are severely agitated and aggressive, grandiose (they tell the teacher how to run the class or think they have the same authority as a parent), hypersexual (one report cites children who imitate sexy rock stars or use explicit language) and experience very rapid mood swings, sometimes several times an hour, during which they can become explosively angry.
"These are very disturbed children that are a nightmare to treat," said Biederman, who estimates he has seen nearly 100 of them: 3-year-olds so assaultive their parents feared for their safety; 5-year-olds who downloaded pornography from the Internet; and preschoolers who literally tore apart his office during a consultation.
"These symptoms are not subtle," he said.
Maybe not, said Washington psychiatrist and lawyer Wayne Blackmon, but they are also suggestive of a host of other problems: depression, anxiety, abuse, ADHD or a behavioral problem such as conduct, explosive or oppositional defiant disorder.
"With kids, especially little kids, all disorders pretty much look alike," added Blackmon, a former president of the Medical Society of the District of Columbia. "Kids tend to behave by lashing out and acting out."
