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Why is it difficult to diagnose a child with Bipolar Disorder?
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Psychiatric disorders, in general, are often very difficult to diagnose. There is no blood test or brain scan that can establish a diagnosis. Diagnosis comes from an examination of a patient's report of symptoms, observable behavior, family history, past responses to medications, etc. Criteria for diagnoses change and various doctors often disagree on whether or not certain sets of symptoms fit a certain diagnosis. In a sense, you can say that a diagnosis for psychiatric disorders is a matter of opinion.
Diagnosing children with psychiatric disorders before adolescence creates it's own challenges. Doctors are very wary about diagnosing pediatric bipolar disorder.
WHY?
Symptoms Look Like Other Disorders:
A major problem in diagnosing psychiatric disorders such as bipolar disorder is that there is a very real chance of misdiagnosis. Children with bipolar disorder have so many symptoms that can be associated with a variety of mood disorders, for example, ADHD, obsessive-compulsive disorder, oppositional defiant disorder, and schizophrenia.
It is suspected that many children diagnosed with ADHD actually have bipolar disorder instead of ADHD. This can prove to be disastrous, especially since ADHD medications can actually make things worse. There is also a possibility that the child may have both bipolar disorder in addition to other disorders.
DSM-IV Criteria:
The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) is a manual published by the American Psychiatric Association and it describes all mental health disorders. It contains the criteria used for diagnosing mental health disorders. Children are mentioned, but they are to be diagnosed according to the adult criteria, which is a major problem because there are a number of significant differences between the two. For example, children with bipolar disorder tend to have more irritable moods that often result in explosive outbursts. Also, the cycling between the manic highs and the depressed lows is much more rapid in children than than it is in adults. One of the major problems in using the DSM-IV in diagnosing children is the rapid cycling. The duration criteria for a hypermanic episode is one lasting throughout at least four days. For the depressive episode, the manual requires a two week period with five or more depressive symptoms. (The Bipolar Child.) A significant amount of children have a form of the condition where frequent mood and energy shifts occur several times within one day. Too rapidly to fit the criteria.
Disbelief:
Some don't believe it's possible for a child to have bipolar disorder and if the child does, it is an extremely rare event, and more often than not, unworthy of pursuing as a possibility.
Diagnosis of the Day:
A lot of people worry that bipolar disorder will end up being over-diagnosed, much like some believe that ADHD is over diagnosed.