Is Bipolar Disorder Overdiagnosed in Children and Adolescents: A Virtual Debate

Kiki Chang, MD; Gabrielle Carlson, MD; Stephen M. Strakowski, MD


September 10, 2010

In This Article

Editor's Note

Recently, Drs. Kiki Chang, MD and Gabrielle A. Carlson, MD -- experts in bipolar pediatric disorder -- participated in a Medscape Virtual Debate via email addressing the question, "Is bipolar disorder overdiagnosed in children and adolescents?" Dr. Stephen M. Strakowski served as moderator and what follows is their conversation.


Stephen M. Strakowski, MD: There has been considerable discussion lately about the apparent increase in bipolar disorder (BD) diagnosis in young people in the United States. Dr. Kiki Chang believes that, despite this apparent increase, bipolar disorder continues to be under-recognized in some children. In contrast, Dr. Carlson believes that while the diagnosis can be missed, at this time the diagnosis is more over-used than underdiagnosed. Drs. Chang and Carlson, how would you respond to this difference of opinion?

Kiki Chang, MD: I believe that in certain populations of children, BD is still underdiagnosed.

Dr. Strakowski: What makes you say it's underdiagnosed? Is it underdiagnosed everywhere, or just in certain locations/ethnic groups/countries etc?

Gabrielle Carlson, MD: What are you counting as "bipolar"? What is your evidence for underdiagnosis? Or is it that some kids have their disorder missed and some get the label inappropriately?

Dr. Chang: I think BD in kids is underdiagnosed in certain cases. I still see children and adolescents who had been diagnosed with only depression or attention-deficit/hyperactivity disorder (ADHD), who clearly meet the DSM-IV criteria as having had a manic episode. So I believe that it can still be difficult for clinicians to recognize the symptoms of mania, particularly in younger children. It requires a good understanding of normal development to know what is "normal" and what is "abnormal" behavior. However, it is true that the majority of new consultations I see now are kids who I believe are diagnosed incorrectly as having BD -- kids who most likely have other problems. Having said that, I still feel BD in kids is more common than we thought -- certainly more common than we thought 15 years ago.


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