New Treatment Guidelines for Bipolar Children
Careful Diagnosis, Psychiatric Drugs, and Therapy Can Help, Report Shows
New guidelines have been issued for treating bipolar disorders in
"Clinicians who treat children and adolescents with bipolar disorder
desperately need current treatment guidelines," write the guidelines'
authors, who included Robert Kowatch, MD, of the psychiatry department at
Cincinnati Children's Hospital.
Kowatch and colleagues don't claim to have all the answers. Their report
says the guidelines aren't intended as an "absolute standard," and they
call for more studies on bipolar disorders -- and their treatments -- in
The guidelines appear in the March edition of the Journal of the
American Academy of Child & Adolescent Psychiatry. The guidelines were
drafted by a team of doctors, clinicians, and members of the Child and
Adolescent Bipolar Foundation (CABF).
The CABF is a national nonprofit advocacy group for families raising
children diagnosed with or at risk for bipolar disorder.
The guidelines focus on diagnosis, therapy, and the use of mood-stabilizing
drugs. The authors also say they don't know how bipolar children will fare as
adults. "No one can say for sure what these children will look like when
they grow up," they write.
"However, it is clear that they manifest a serious disorder and that
early diagnosis and aggressive treatment are necessary for these patients to
function successfully within their families, peer groups, and schools. There is
also the hope that early recognition and treatment of pediatric bipolar
disorders will reduce or eliminate the many negative outcomes associated with
More Pediatric Bipolar Diagnoses
"Once considered rare in children, pediatric bipolar disorder is now
widely diagnosed in the United States," says Jon McClellan, MD, in a
Bipolar disorder is more likely to affect children of parents who have the
condition, according to the National Institute of Mental Health. Adults with
the disorder have clearly defined periods of mania and depression yet children
and teens have very fast episodes of mood swings. They can suffer episodes of
depression and mania many times a day. They tend to be more irritable and
destructive rather than overly happy. It can also be difficult to tell the
difference between normal behavior and other problems seen during this age
McClellan, a member of the psychiatry department at Seattle's University of
Washington, did not work on the guidelines. In his editorial, he calls the
project "laudable" given the "considerable controversy" about
pediatric bipolar disorder.
The guidelines only apply to children aged 6 and older. That's commendable,
says McClellan's editorial. "There is no valid justification for diagnosing
bipolar disorder in preschoolers," he writes. "Labelling severe
tantrums in toddlers as major mental illness lacks face validity and undermines
credibility in our profession."
How to Distinguish Misbehavior From Mental Illness
The guidelines call for careful diagnosis to separate normal childhood
antics and misbehavior from true bipolar disorder, in which patients experience
bouts of mania and depression. The child and at least one parent are needed to
assess the child's mental health.