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A Diagnosis Emerges? Pediatric Bipolar

Posted Aug 14 2008 4:13pm


Does pediatric disorder exist? Who decides what the criteria are?

Furious seasons has a fact-filled post today on exactly this topic. What is most curious about this possibly emerging diagnosis is that it does not yet appear in the DSM. Yet officials at the FDA are claiming it is a diagnosis, by virtue of the fact that medications have been approved for treating it. Pretty circular logic. As problematic as the DSM is, it at least has the supposed backing of research (which actually turns out to be flimsy in many cases…) But this is an unusual case of a diagnosis being created outside the DSM.

Here are several paragraphs from the post :

More pointedly, McClellan told me earlier this year that the kids and teens he was seeing (he sees some very intense kids and teens at two Seattle-area hospitals) who had been diagnosed with bipolar were in fact kids with oppositional defiance disorder and conduct disorder who were largely the product of extreme, and extremely dysfunctional, environments. The leader of the Harvard group, Joe Biederman, has said kids are born this way.

McClellan is far from the only one flying red flags around the bipolar child business. Steven Hyman, a Harvard psychiatrist and former NIMH head, has publicly expressed his concerns about the meds these kids are given: “We don’t know the first thing about safety and efficacy of these drugs even by themselves in these young ages, let alone when they are mixed together.”

In 2006, Thomas Insel, NIMH director, also pointed to the meds being given bipolar kiddos as being a concern, telling the New York Times , “There are not any good scientific data to support the widespread use of these medicines in children, particularly in young children where the scientific data are even more scarce.”

In an op-ed, Larry Diller of UCSF noted : “Biederman shocked the child psychiatric world in 1996 by announcing that nearly a quarter of the children he was treating for attention deficit hyperactivity disorder also met his criteria for bipolar disorder. Up until then bipolar disorder was rarely diagnosed in teenagers and unheard of in prepubertal children. Biederman could justify his findings by simply broadening the semantic definitions of a previously more circumscribed condition contained within American psychiatry’s bible — the ‘Diagnostic and Statistical Manual of Mental Disorders’.”

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