Bipolar Disorder in Children - Diagnosis

Diagnosis

The diagnosis of childhood BD is controversial, although it is not under discussion that BD typical symptoms are dysfunctional and have negative consequences for minors suffering them. Main discussion is centered on whether what is called BD in children refers to the same disorder than when diagnosing adults, and the related question on whether adults criteria for diagnosis are useful and accurate when applied to children. More specifically main discussion over diagnosis in children circles around mania symptomatology and its differences between children and adults. For the diagnosis of mania the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV-TR) requires a "distinct period of abnormally and persistently elevated, expansive or irritable mood" during at least four days, and a number of extra behavioral and cognitive symptoms such as grandiosity, reduced sleep need and risk seeking behaviors. Regarding diagnosis of children some experts recommend to follow the same DSM criteria than for adults, although taking into account the age of the individual and the normal behavior of those of his age. Others believe that these criteria do not separate correctly children with BD from other problems such as ADHD, and emphasize fast mood cycles. Still others argue that what accurately differentiates children with BD is the distinct irritability with which it courses. The practice parameters of the American Academy of Child and Adolescent Psychiatry encourage the first strategy. Family history, and the use of questionnaires, checklists, and diagnostic interviews have been helpful in diagnosing children with bipolar disorder. A way to determine the differences between PBD and other childhood mood disorders such as, ADHD and conduct disorder, is the prevalence of irritability in addition to extreme elation, other manic symptoms, and if it is episodic.