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A dysfunctional mental-health system is why more children are diagnosed with bipolar disorder, doctor argues

Slate magazine ran an interesting article earlier this month on why there’s been an explosion during the past decade in the diagnosis of bipolar disorder in children.
And, no, it’s not because parents would rather drug than discipline their “difficul

Slate magazine ran an interesting article earlier this month on why there’s been an explosion during the past decade in the diagnosis of bipolar disorder in children.

And, no, it’s not because parents would rather drug than discipline their “difficult” children. The article points instead to a “dysfunctional and overburdened mental health care system,” one in which there’s a stronger incentive to give a child a pill than to do the labor-intensive work of cognitive and behavioral therapy for kids with explosive behavior.

The article, written by Dr. Darshak Sanghavi, a pediatric cardiologist and assistant professor at the University of Massachusetts Medical School as well as a columnist for Slate, points out that the number of kids receiving bipolar diagnoses really began to take off in the late 1990s after the publication of a book called “The Bipolar Child” and the establishment of the parent-instigated Child and Adolescent Bipolar Foundation. (Full disclosure: I did some writing for the foundation’s website when it was launched.)

“Pretty soon,” writes Sanghavi, “many easily frustrated and chronically inflexible children were receiving a label previously reserved for adults. From 1994 to 2002, the number of children with the diagnosis increased 40-fold.”

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In 2000, while acknowledging that bipolar disorder exists in children, the National Institutes of Mental Health was unable to come up with specific advice on how to diagnose it, a failing that has led to a “mini-industry in ways to identify the condition,” says Sanghavi.

“All this has led to even more diagnoses, a putative epidemic of bipolar among the nation’s children, and a corresponding increased in the pediatric use of antipsychotics, mood stabilizers, and other drugs often used to treat bipolar adults,” he adds. “… That’s worrisome since, according to a British government review, the evidence behind drug treatment for the condition is ‘extremely limited,’ and several drugs cause major weight gain (roughly 20 pounds in two months on average), hormone problems, and other side effects.”

The underlying problem
Sanghavi empathizes with the parents of these children. “Normal families don’t seek out stigmatizing labels and give their kids scary drugs for the hell of it,” he writes. “They do these things because they are at wit’s end.”

Furthermore, the mental health system “is so fragmented, variable in quality, and frankly unfair to those without money” that parents often have no choice than to accept the bipolar label for their children. It’s what will get them care. “Many insurers, for example, won’t cover old-fashioned diagnoses like ‘conduct disorder,’ writes Sanghavi, “but will cover the more serious-sounding bipolar disorder.”

“In addition,” he adds, “there was a strong incentive to expand drug therapy because giving pills is less labor-intensive than cognitive and behavioral therapy. The perverse result: Kids get more and more disturbing labels and medications.”

The huge shortage in pediatric psychiatrists (1 for every 11,000 children in this country) is contributing to the problem. “There simply aren’t enough doctors around to provide the key treatment for explosive behavior: face-to-face time for cognitive and behavioral therapy. Just getting an appointment with a good child psychiatric expert in many parts of the country can take six to eight months.”

“Much of the debate around bipolar disorder in kids is fixated on quixotic attempts to shoehorn complex behaviors into neat labels instead of studying and treating the various complex symptoms themselves, like inflexibility, irritability, and anxiety,” Sanghavi concludes. “We now have great behavioral tools for relieving those symptoms. But so long as the right resources are only deployed for those children who can score a label like ‘bipolar disorder,’ we’re doomed to an endless cycle of coming up with new names for old problems.”

You can read Sanghavi’s article here.