The Bipolar Child: "It Depends On What Side Of The Controversy You Are On"

Last Friday afternoon, KUOW-FM, Seattle's NPR affiliate, did a program on the bipolar child controversy and the explosion in diagnoses of the disorder in children. The station's guest was Jon McClellan, medical director of the Child Study and Treatment Center at Children’s Hospital and Regional Medical Center in Seattle. He's also an associate professor of psychiatry at the University of Washington and is one of the principal investigators of an ongoing NIMH-=funded study of the use of Lithium in children. Also, McClellan chaired a panel of the American Academy of Child and Adolescent Psychiatry that recently concluded there is no proof that children under 6 can be diagnosed with the disorder.

Of course, there are those in psychiatry who think researchers like McClellan are wrong. They were not on the program and it's not clear to me if KUOW tried to get any of the Harvard folks on the show--knowing KUOW, they tried. Anyhow, McClellan's appearance can be accessed here. Just download the .mp3 and off you go. McClellan has, of course, been quoted in the press lately casting doubt on the whole bipolar child business.

I've transcribed a bit of his interview to give you a sense of what he's saying. My transcription is a bit rough and has gaps, but here goes.

The interviewer asked why there was a 4,000 percent increase in bipolar disorder in kids and teens.

"It depends on what side of the controversy you are on....Many kids have periods where they are quite irritable and they don't want to go to bed at night and they brag....[Classically,] they never would've been called manic. That changed in the last decade. Those kids are now being called manic."

Why?

"Well, that's a good question. Probably because some fairly influential research centers nationally decided that was the proper way to apply the diagnosis."

McClellan is referring of course to the Harvard School of Medicine. He spends a lot of time going into the differences between ADHD and bipolar disorder. He's quite clear that what's driving the bp kids diagnosis is a very loose definition of what counts as mania--a hard or soft definition.

"Some of this is really a semantic argument....The disagreement is about if it's the same thing as the classic adult illness. The descriptions are not the same. Kids do not have that syndrome like adults do....I think you need the classic adult disorder in order to be characterized with that [having bipolar disorder]."

He goes onto discuss that long-term studies of kids with bipolar disorder have shown that they don't develop the full-blown disorder as adults. The interviewer asks, "Wouldn't that suggest to you they aren't the same diseases [child and adult bipolar]?"

"It would to me," says McClellan.