Pediatric Bipolar Disorder: Controversy and


Objective: This document aims to inform parents about pediatric bipolar
disorder, the controversy surrounding it, and possible treatment options.

What is Pediatric Bipolar Disorder?
Historically, clinicians believed bipolar disorder appeared in children only
rarely. The past decade, however, has seen an increase in the rates of
reported bipolar disorder in children and adolescents. In the mid-1990s,
0.01% of children were diagnosed with Bipolar Disorder. By 2003, the rate
rose to 0.44 percent—a 4000 percent increase in less than a decade (Parry &
Allison, 2008).
Symptoms of pediatric bipolar disorder are distinct in several ways. While
manic and depressive episodes will last from weeks to months in adults,
mood shifts occur much more quickly in children (Carr, 2009; Bradfield,
2010). Irritability is a major component of bipolar disorder in children (Parry
& Allison). Manic phases in children tend to include extreme irritability,
inflated self-esteem, and an increased need for attention and energy. Their
depressed phases include chronic sadness, loss of interest and appetite, and
thoughts of suicide. Unlike adults, children with bipolar disorder are often
also diagnosed with ADHD, Conduct Disorder, or Oppositional Defiant
Disorder (Bradfield, 2010).

The Controversy
Controversy surrounds the increase in diagnosis of pediatric bipolar disorder.
This came to a peak in December of 2006, when a young girl diagnosed with
bipolar died of an overdose from three different medications after being
diagnosed with bipolar disorder and ADHD. This lead to a public outcry and
questions about the ethics of psychiatrists prescribing drugs to young
children (Parry & Allison, 2008). Psychiatrists often prescribe children with
bipolar disorder drugs used for adults, but there is little research on their
efficacy on children. These medications can have dangerous and permanent
side effects (Littrel & Lyons, 2010). Within the psychiatric community, there
has been controversy over methods of diagnosis, which are subjective and
inconsistent. There is no strict diagnostic criteria for pediatric bipolar
disorder, and children who fail to meet the criteria may even be diagnosed
with bipolar disorder not otherwise specified (BPD-NOS) (Sahling, 2009).

Others still argue that normal childhood behaviors are now seen as
symptoms for the disorder (Sahling, 2009).
Because of this controversy, large amounts of research have been published
on the disorder. Researchers have worked hard to improve the validity of
diagnosis using family backgrounds and structured interviews (Youngstrom et.
al, 2005; Algorta et al., 2013;). Research on screening tools finds that bipolar
children across several studies from different researchers show the same
abnormalities, meaning that despite the subjective nature of the diagnostic
criteria, clinicians can effectively and correctly diagnose children with
pediatric bipolar disorder (Youngstrom et. al, 2005).

Psychiatric Medications
The most common and controversial treatment for pediatric bipolar disorder
is psychiatric medication. These drugs have been given to adult patients for
years, but their efficacy on children has not been researched sufficiently
(Bradfield, 2010; Littrell & Lyons, 2010; Cosgrove et. al, 2013). The past few
years has seen an increase in studies done on drugs used to treat pediatric
bipolar disorder. Lithium, anticonvulsants, and atypical antipsychotics have
shown some efficacy in treatment of bipolar disorder (Smarty & Findling,
2007). Table 1 gives a brief overview of some of the research done on
psychiatric drugs.

Table 1

Average # of

length of




4.7 weeks




6.6 weeks




4.7 weeks

70.95 %

The table above shows average number of participants, length of time, and
response rates from studies done on children and adolescents for drugs used to
treat bipolar disorder. One study on anticonvulsants was discontinued. Information
found from Smarty & Findling, 2007.

While research is promising, psychiatric medications can have dangerous,
lasting side effects on children's developing bodies (Littrell & Lyons, 2010).
Serious side effects include tardive dyskenisia, an impairment causing

permanent and involuntary movements, "bone loss, possible delays in the
onset of puberty…seizures, drooling, and myocarditis (inflamed heart
muscle)" (Littrell & Lyons, 2010, p. 969). Lithium in particular can cause
weight gain, acne, baldness, bed wetting, vomiting, and in some cases
diabetes. Long periods of use can lead to kidney deterioration, which
sometimes continues even after the patient stops using lithium (Littrell &
Lyons, 2010).

Alternative Treatments
For parents who want to avoid medication for as long as possible or
altogether, there are other options. There is evidence that behavior day
programs can decrease problematic behaviors to a normal childhood range
(McTate et. al, 2012). Programs that focus of teaching children routine, self
control, organization, and problem solving, as well as teaching families how
to deal with the child's outbursts have also shown promise (Bradfield 2010).
Finally, nutritional supplements may be a viable alternative, as nutrition has
been known to affect the functioning of the brain (Frazier et al., 2012).
Overall, treatments of all kinds must be researched more, and it is important
for parents to discuss all possible treatment options with their clinicians.
Works Cited
Algorta, G. P., Youngstrom, E. A., Phelps, J., Younstrom, J. K., Jenkins, M. M.
(2013). An
inexpensive family index of risk for mood issues improves identification
of pediatric
bipolar disorder. Psychological Assessment 25(1), 12-22.
Bradfield, B. (2010). Bipolar Mood Disorder in children and adolescents: in
search of theoretic,
therapeutic and diagnostic clarity. South African Journal Of Psychology,
40(3), 241-249.
Carr, A. (2009). Bipolar disorder in young people: Description, assessment
and evidence-based
treatment. Developmental Neurorehabilitation,12(6), 427-441.
Cosgrove, V. E., Roybal, D., Chang, K.D. (2013). Bipolar depression in
pediatric populations.
Pediatric Drugs 15(2), 83-91. doi:10.1007/s40272-013-002-8
Frazier, E. A., Fristad, M. A., & Arnold, L. (2012). Feasibility of a nutritional
supplement as
treatment for pediatric bipolar spectrum disorders. Journal of
Alternative &
Complementary Medicine, 18(7), 678-685. doi:10.1089/acm.2011.0270

Littrell, J., & Lyons, P. (2010). Pediatric Bipolar Disorder: An issue for Child
Welfare. Children
& Youth Services Review, 32(7), 965-973.
McTate, E. A., Badura Brack, A. S., Handal, P. J., & Burke, R. V. (2013). A
intervention for pediatric bipolar disorder: Preliminary results. Child &
Behavior Therapy, 35(4), 279-292. doi:10.1080/07317107.2013.846194
Parry, P., & Allison, S. (2008). Pre-pubertal paediatric bipolar disorder: a
controversy from
America. Australasian Psychiatry, 16(2), 80-84.
Sahling, D. L. (2009). Pediatric bipolar disorder: Underdiagnosed or fiction?.
Ethical Human
Psychology & Psychiatry, 11(3), 215-228. doi:10.1891/15594343.11.3.215
Smarty, S., & Findling, R. L. (2007). Psychopharmacology of pediatric bipolar
disorder: A
review. Psychopharmacology, 191(1), 39-54. doi:10.1007/s00213-0060569-y
Youngstrom, E. A., Findling, R. L., Kogos Youngstrom, J., & Calabrese, J. R.
(2005). Toward an
evidence-based assessment of pediatric bipolar disorder. Journal Of
Clinical Child &
Adolescent Psychology, 34(3), 433-448.