Question: How is bipolar disorder diagnosed, and is the approach different for children?
Answer: Currently, we diagnose bipolar disorder the way we have always done. We base it on symptoms. In other words, there's no blood test, there's no brain test. You still have to meet the criteria for a manic episode. And by that I mean 7 days in which you're predominant mood is either irritable, elated, or expansive, and you have a bunch of other symptoms at the same time.
Now those symptoms do differ between children and adults in the way they're presented, although they are the same symptoms written down. In other words, one of the symptoms is increased goal-directed activity, or doing things that are very pleasurable that have a high possibility of a painful outcome. So for adults, it would be something like driving very fast in your car or buying a lot of things off the internet that you don't need. Now, say, a child of ten or twelve years old is not going to really have access to a car or possibly credit cards, and so therefore they may display their symptoms in a different manner. Either going down to the kitchen and cooking a lot of things in the middle of the night. Or waking up early in the morning and going down the street knocking on neighbor's doors. Those are things that are goal-directed, but obviously seem excessive and impulsive and a little bit risky in some ways.
So it's important for the practitioner to really understand the differences between children and adults when applying this kind of criteria to bipolar disorder. Having said that, in the future, hopefully our next manual that we use to make these diagnoses, the DSM (Diagnostic and Statistical Manual of Mental Disorders), will include developmental differences so that clinicians can have an easier time of making a diagnosis in a child when using this kind of adult-based criteria.
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