car in the upper giLike most professionals, states require psychologists to keep up with current research through continuing education. Yesterday, I attended a lecture on the differential diagnosis of ADHD and or Bipolar disorder in kids. Not surprisingly, the water is muddied by the similarity of some of the symptoms and the fact that most kids with Bipolar Disorder have other problems such as ADHD, Learning Disabilities, Opposition Defiant Disorder, among others.

Another problem the presenters mentioned was that today there are 40 times more kids diagnosed as bipolar than in the mid-1990’s. Thus, the presenters raised the questions as to whether we are seeing more kids with bipolar, are we better at spotting this diagnosis, or are we over-diagnosing kids with bipolar disorder? Additionally there are troubling concerns that only a few research teams are responsible for most of the research on this topic.

In particular, one Harvard psychiatrist has been implicated in two related controversies. First, he allegedly failed to report about one and a half million dollars he received in consulting fees from pharmaceutical companies. The problem lies in the fact that his studies have consistently supported the value of using medications produced by those companies for the treatment of bipolar disorder in kids. The second problem is that he allegedly promoted the use of powerful anti-psychotic medications in preschool children prior to even conducting a study to verify the value and safety of their use with kids in this age group.

Furthermore, research validating safety of powerful drugs in young kids would be inordinately expensive because you would have to follow the children for a decade or more to know for sure whether the medications eventually culminate in harmful changes in brain function. And such a study would also need a large pool of children whose parents would allow them to receive these drugs for a prolonged period of time.

Partially out of concern that the diagnosis of Bipolar Disorder in children may have become far too popular among psychiatrists, it has now been proposed that a new diagnosis known as Temper Dysregulation Disorder (TDD) come into play. This diagnosis will be given when a child has severe temper tantrums in response to small stressors. For example, a child is told to eat her green beans and she throws her plate against the wall and wails. These outbursts must occur three or more times each week and, in general, the child shows signs of anger, irritability, or sadness. Apparently, some professionals have been labeling such kids with the bipolar disorder diagnosis.

Leaving the conference, I was struck by the realization that the role of learning, parenting, and the environment were never raised as contributing factors by any of the presenters in regard to either disorder. It sounded as though kids simply “catch” these disorders and the emphasis was decidedly biological. This emphasis lets everyone off the hook and it leads to a single, focused treatment strategy that will utilize drugs for both disorders. Worrisome? I think so.

Photo by Toca Boca, available under a Creative Commons attribution license.