Working On A Chain Gang

Pediatric Bipolar Disorder: Underdiagnosed or Fiction?

Ethical Human Psychology and Psychiatry, 2009 by Sahling, Daniel L

Diagnoses of children with pediatric bipolar disorder (PBD) have surged in recent years. This article explores three alternative explanations for the increase in these diagnoses: (a) PBD had previously been unrecognized and underdiagnosed by clinicians; (b) the symptoms of PBD are largely a result of iatrogenic effects and side effects of psychostimulant medications, for example, Ritalin and Adderall; and (c) changes to the diagnostic system now classify previously normal behaviors of childhood as symptoms of PBD. After reviewing the evidence, this article concludes that the increase in diagnoses is primarily due to the iatrogenic effects of psychostimulant medications and to the changes to the diagnostic system, and is not a previously unrecognized or underdiagnosed illness of unknown origin.

Keywords: pediatric bipolar disorder; adverse drug reactions; iatrogenic; stimulants; mood disorders

Currently, there is a great deal of controversy surrounding the increased diagnoses of bipolar disorder among children. Between 1994 and 2003, there was a 40-fold increase in diagnosing bipolar disorder in children (Moreno, Laje, Blanco, Jiang, Schmidt, & Olfson, 2007), and the trend has continued to escalate since then (Carey, 2007). After carefully reviewing the available evidence, this article proposes that diagnosing children with bipolar disorder has less to do with science than it does with finding new markets for the drug companies. Furthermore, other factors and long-standing theoretical explanations need to be considered to better understand the symptoms that surround this disorder and why it is being diagnosed more frequently. This article will examine three alternative explanations for the possible causes of pediatric bipolar disorder (PBD).

1. Many instances of PBD had previously gone unrecognized and been undiagnosed, as claimed by some researchers.

2. Stimulant medications and their side effects are the main causes of the symptoms-the iatrogenic explanation.

3. Changes in the current diagnostic system for PBD contribute to classifying previously normal childhood behaviors as maladaptive.

Other sections will explore the biomedical theories that are claimed to cause or predispose an individual for these disorders. The last part of the discussion will focus around methods of treatment for children diagnosed as bipolar.

PRESCRIPTION DRUGS

Children diagnosed as having PBD have often also been previously diagnosed as having attention-deficit/hyperactive disorder (ADHD). Children diagnosed with ADHD are often prescribed a psychostimulant medication such as Ritalin (Gadow, 1991; Maalouf, Ziegler, Schlozman, & Prince, 2006; Seitler, 2006)
adderall side effects

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