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Bipolar Children: Cutting-Edge Controversy, Insights, and Research

2010; Lippincott Williams & Wilkins; Volume: 31; Issue: 3 Linguagem: Inglês

10.1097/dbp.0b013e3181d7b1e7

1536-7312

Katherine Steingass,

Child and Adolescent Psychosocial and Emotional Development

Bipolar Children: Cutting-Edge Controversy, Insights, and Research by Sharna Olfman, editor, Praeger Publishers, Westport, CT, 2007, 164 pp, Hardcover, $39.95. The death of Rebecca Riley in 2006 made national news. This 4-year-old had 3 psychiatric medications in her body at the time of her death: depakote, seroquel, and clonidine. All 3 were prescribed by a child psychiatrist who diagnosed her with bipolar disorder (BD) and attention-deficit hyperactivity disorder at the age of two and a half years. Over the past decade, the prevalence of BD in American children has exploded. What is the cause of this childhood bipolar “epidemic”? Why do 1% of children now carry a diagnosis that in the past was considered a rare disorder of adults with onset in late adolescence at the earliest (and which is still seen as such outside the United States)? Why did the number of antipsychotic prescriptions for children increase 5-fold between 1995 and 2002? And, what are the long-term implications of this diagnosis and the cocktails of psychotropic medications being used to treat it? Bipolar Children: Cutting-Edge Controversy, Insights, and Research, part of the Childhood in America series, explores these and other questions and examines cases of children diagnosed with BD including Rebecca Riley. This thought-provoking and intriguing book consists of chapters written by contributors from a variety of disciplines including psychology, child psychiatry, and pediatrics. Editor Sharna Olfman writes, “Together, the contributors to this book identify the complex and interrelated factors that have set the stage for the pediatric bipolar epidemic in order to raise awareness and recommend practice and policy changes.” The authors delve into possible reasons behind the rise in BD. They examine the expanded diagnostic criteria in the DSM IV and the changing definition of mania that allow for “children going through a normative crisis or phase of emotional development (e.g., adolescence) to be diagnosed, labeled, categorized, and treated as children with very severe behavioral or emotional problems with a large neurologic component.” They suggest that doctors, under pressure from insurers, have insufficient time to take a thorough history and consider differential diagnoses. The transition from the psychoanalytical to a predominantly medical model for psychiatric disorders may also play a role, “averting attention from the social, interpersonal, and environmental dimensions of (a patient's) suffering.” The influence of pharmaceutical companies is implicated with their industry-sponsored studies and direct-to-consumer marketing of mood stabilizers with “ads that encourage ‘mood watching.’” Journalist Robert Whitaker looks for a “disease-causing agent” and proposes 2 possible culprits: the stimulants used to treat attention-deficit hyperactivity disorder and the anti-depressant SSRIs, whereas medical epidemiologist Dr. Philip J. Landrigan suggests a role for neurotoxic industrial chemicals. The authors support these and other ideas with case illustrations, historical data and trends, as well as scientific studies. Each chapter will make the reader stop and think about what is happening in America today. Perhaps the most important point this book makes is the concern of several authors that when children present with acting-out behaviors, they are increasingly given the BD diagnosis and prescribed medications as their sole treatment without any consideration of what social and family factors may be contributing to their behaviors and without investigating whether they are in a safe environment. In her chapter on the diagnosis of BD in foster care children, Toni Vaughn Heineman asserts that a diagnosis of BD in these children locates the problem in the child rather than identifying these behaviors as a “response to an unpredictable and bleak environment.” She urges readers not to consider it unusual for foster children to display more intense emotions and mood swings than other children, given their frequent history of abuse and neglect combined with the unpredictability of care giving in the foster care system. Child psychiatrist Dr. Elizabeth Roberts writes of other children who may display “bipolar” symptoms including “frightened, abused, bullied, and grieving children, as well as kids making adjustments to new situations such as divorce.” Psychologist William Purcell uses a case to illustrate the consequences of applying the bipolar diagnosis to “children whose destabilization seems to relate primarily to the destabilization of their families and communities.” The long-term prognosis for children diagnosed with BD remains largely unknown. Dr. Lawrence Diller, a Development Behavioral pediatrician refers the American Academy of Child and Adolescent Psychiatry's 2007 guidelines on BD and cautions that it is not yet known whether children with BD go on to develop more classic symptoms or whether the childhood diagnosis carries the same life-long implications as it now does for adults. Psychologist Daniel Burston worries that the diagnosis may become a “self-fulfilling prophecy” and states that “children who believe they suffer from a lifelong disability act accordingly, and grow up with brains that are burdened by toxic drugs.” As advertised by the subtitle, this book offers “cutting-edge controversy, insights, and research” regarding Bipolar Disorder in children. It is worthwhile reading for pediatricians, teachers, and mental health professionals who work with children and adolescents. Katherine J. Steingass, M.D. Division of Developmental Behavioral Pediatrics Rainbow Babies and Children's Hospital Cleveland, OH.