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The Juvenile Bipolar Research Foundation has assembled an internationally-recognized group of over 80 researchers and clinicians to participate in an online colloquium to foster a consensus as to which symptoms and behaviors should define the diagnosis of bipolar disorder in children. At present, there is no reliable diagnostic system to make this diagnosis. The JBRF has compiled a set of case histories drawn from research studies of children and adolescents with a range of symptoms typical of youth with bipolar disorder. These case histories are presented via the Internet, accessible to the experts at the JBRF Web site in a password-protected area. All case histories are fictionalized to ensure confidentiality. Participating experts will have immediate access to the family history, course of illness and treatment, and to comprehensive information, including diagnostic interviews, as well as symptom inventories derived from parents, clinicians, teachers, and the children themselves. This in-depth information will allow colleagues the opportunity to examine, deliberate, and then discuss the various features, advantages and disadvantages of three separate diagnostic systems:
What is the plan for analyzing the data? The statistical analysis will focus on searching for agreement among raters as to which diagnostic system of the three mentioned above appears to yield the most coherent and reproducible diagnostic indications. These results can also be used to inform the selection of items from each of the three diagnostic schemas to form a consolidated "best estimate" system. Why is there a need for an expert diagnostic workshop? Until recently, it was thought that bipolar disorder occurred only rarely in pre-pubertal children. Therefore, diagnostic criteria that pinpoint how the illness actually manifests in youngsters have not been developed. Researchers continue to grapple with the thorny issues that arise when attempting to diagnose this disorder without a reliable system. No consensus has been reached as to core symptoms and behaviors. Why is this consensus so difficult to achieve? The Diagnostic and Statistical Manual of Psychiatry (the DSM) originally defined the bipolar spectrum disorders using adult patients. However, adults with the illness typically have time-limited periods of depression and mania, interspersed with well intervals. Children rarely present in this way. They cycle very frequently—often many times throughout the day—and it is common for them to exhibit extreme irritability, and temper tantrums and rages, especially in the home setting. The duration criteria mentioned in the paragraph above is a major sticking point for clinicians and researchers. Another factor renders consensus difficult: there is a tremendous overlap in symptoms between bipolar disorder and other commonly diagnosed psychiatric disorders in children. Over 90% of the children with a bipolar spectrum disorder have a co-occurring attention-deficit disorder with hyperactivity (ADHD); many present with depression initially; and many suffer obsessive-compulsive disorder (OCD), or seem to fit criteria for oppositional defiant disorder (ODD). It is not uncommon for psychiatrists to first diagnose any or all of these conditions before finally making a diagnosis of bipolar disorder. What is at stake if consensus is not achieved? A correct diagnosis guides the treatment plan (it is critical to note that the wrong medication can worsen the situation and have severe adverse effects on a child). Children who go undiagnosed or misdiagnosed endure suffering that no child should have to know. They are at high risk for school failure, substance abuse, and potential interactions with the juvenile justice system. Moreover, the family can be split apart if the child suffers this illness unchecked by proper diagnosis and treatment. Children with bipolar disorder are often extremely bright and talented. We all lose if these children remain incorrectly diagnosed and improperly treated. How will JBRF disseminate the information discovered in the Expert Diagnostic Interview?
Why is this online colloquium so important? The data that emerge from the diagnostic workshop, coupled with expert deliberations and peer discussions online, will potentially be of considerable importance in the collaborative efforts to achieve consensus in the field as to how to diagnose this troubling disorder of childhood. Hopefully this colloquium will influence the evolution of the DSM-V so that the required criteria for the diagnosis of bipolar disorder in children more closely reflects the true manifestation of the disorder in the young. Before any large-scale epidemiological and genetic studies can proceed in earnest, it is imperative that the field achieve consensus about one or several behavioral phenotypes defined as juvenile-onset bipolar disorder. If you are a researcher or clinician interested in participating in this online colloquium please contact Demitri Papolos, M.D. at dpapolos@jbrf.org.
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The Juvenile Bipolar Research Foundation Launches Educational Forum for Parents and Educators Time Magazine Tackles Juvenile Bipolar Disorder First Fellowship In Juvenile-Onset Bipolar Disorder To Be Offered Juvenile Bipolar Research Foundation To Start First Professional ListServ For Bipolar Disorder Demitri F. Papolos, M.D. to Receive the 2002 Rosenberry Award |
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