New Diagnosis Proposed For Kids Labeled 'Bipolar'

The American Psychiatric Association has released the list of mental disorders that it intends to publish in its new Diagnostic and Statistical Manual. The DSM describes the different mental disorders recognized by modern psychiatry. One big change could affect kids diagnosed with bipolar disorder. A new diagnosis, Temper Dysregulation Disorder, is preferred.

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STEVE INSKEEP, host:

Its MORNING EDITION from NPR News. Good morning. Im Steve Inskeep.

RENEE MONTAGNE, host:

And Im Renee Montagne.

And many Americans are waking up this morning to news that they are not suffering from the mental disorders they thought were afflicting them. Nobodys symptoms have changed. The names we give those symptoms have changed.

INSKEEP: Today the American Psychiatric Association releases a list of disorders that it intends to publish in its new manual. The Diagnostic and Statistical Manual, or DSM, is important because what you call a disease affects how you treat it. We begin with a change for kids diagnosed with bipolar disorder.

Here's NPRs Alix Spiegel.

ALIX SPIEGEL: Bipolar disorder in adults is a disease characterized by intense highs and lows. There are periods of mania, there are periods of depression, and its seen as very serious, a lifelong biological dysfunction. Now, today there are close to one million kids diagnosed with bipolar, but thats new. Almost no kids were given the label before the mid-'90s. So what happened? According to David Shaffer, one of the people behind the new DSM, there has been a massive, massive case of misdiagnosis.

Dr. DAVID SHAFFER (Columbia University Medical Center): I dont think anybody is arguing that these are perfectly normal children that get the label. We are saying these kids are very sick, but they probably dont have bipolar disorder and they probably do deserve a name which adequately describes what they are doing.

SPIEGEL: And so Shaffer and his colleagues today proposed in the new DSM a diagnosis called Temper Dysregulation Disorder, a diagnosis they hope will be used by clinicians instead of the bipolar label.

Dr. SHAFFER: In a sense, we are offering a home for the children that we have been describing, which I think might be seen as more useful and more applicable.

SPIEGEL: So how is it that a million kids were given the bipolar label in the first place? The rise of childhood bipolar disorder got its start in the early 90s through a 34-year-old researcher named Janet Wozniak. Wozniak was researching kids with ADHD, Attention Deficit Hyperactivity Disorder, who had this incredible explosive anger.

Dr. JANET WOZNIAK (Massachusetts General Hospital): These children were continuing as they got older, past the preschool years, to have outbursts that were occurring on a regular basis, were huge scenes - swearing, kicking, hitting, biting, spitting.

SPIEGEL: Now, kids with ADHD have trouble controlling their impulses. So anger isnt unusual. But to Wozniak, this felt different. Then one day, she says, she had this breakthrough. The problem with the kids wasnt impulse control. The problem was: they couldnt control their mood. The kids were bipolar.

Dr. WOZNIAK: This child who I was thinking of as having really difficult-to-treat ADHD, I really was ignoring the serious mood component.

SPIEGEL: Wozniak wrote up a paper which proposed that many of the kids diagnosed with ADHD were actually bipolar, and it was hugely influential. But David Shaffer and many other psychiatrists were never convinced. He says that in order to claim that these kids were bipolar, Wozniak had to change one critical component of the traditional definition of bipolar disorder, also known as manic depression.

Dr. SHAFFER: The defining feature of manic depression was that it was episodic, that you had episodes of depression and episodes of mania and episodes of normal mood.

SPIEGEL: But the kids Wozniak described rarely had discrete week-long or month-long episodes. They just had consistent problems with rage. The fact that the kids dont have episodes, Shaffer says, is one reason that people at the DSM were skeptical of the childhood bipolar label. And he also points out that bipolar disorder is supposed to be a lifelong condition, but the kids Wozniak identified dont always grow up to have problems with their moods.

Dr. SHAFFER: Its not any very good evidence that they grow up to be bipolar or that if you look at the background of established bipolar adults, that they were like this when they were children.

SPIEGEL: Shaffer says he and his colleagues were also concerned because of the bipolar drugs given to kids, particularly antipsychotic medications.

Dr. SHAFFER: Which we think have quite profound effects on important mechanisms in the brain.

SPIEGEL: Its impossible to say what will happen, whether clinicians will actually alter their practice. But critics of bipolar say this change is long overdue.

Alix Spiegel, NPR News, Washington.

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