Childhood Bipolar Disorder: Are Too Many Misdiagnosed?

If you find yourself dealing with the diagnosis of a child with bipolar, natural questions to ask are, “How accurate is this type of diagnosis?” and “Are too many kids diagnosed with bipolar disorder?” Some studies have delved into this very question. It’s true that bipolar disorder in a young child or adolescent can be difficult to diagnose, and some suggest that this actually leads to both an overdiagnosis and underdiagnosis of bipolar disorder in children.

Complicating Factors in Diagnosing a Child with Bipolar

Diagnosing a child with bipolar disorder is tough because there are no set-in-stone criteria for the diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which contains all criteria for all mental disorders, does not list childhood bipolar disorder separately from adult bipolar disorder. This is a problem because it is known that bipolar disorder does manifest differently in children than in adults. However, not enough study has been done to nail down these symptoms reliably.

Additionally, there is a major overlap between attention-deficit/hyperactivity disorder (ADHD) symptoms and child bipolar symptoms. For example, children with either disorder can be seen as distractible and/or irritable. For this reason, there can be confusion between the two disorders and this can lead to both overdiagnosis and underdiagnosis of bipolar disorder.

Is Bipolar Disorder in Children Overdiagnosed?

A review looking at the overdiagnosis of mental illnesses in children found evidence of frequent misdiagnosis, but this is mostly a disagreement over which mental illness a youth has rather than whether a youth has a mental illness at all.

The study found that there was a major overdiagnosis of ADHD in children, especially in boys. For bipolar disorder, though, there appeared to be both an overdiagnosis and an underdiagnosis. In 2011, Chilakamarri and Filkowski looked at 64 youth, aged 7-18, with a mental illness diagnosis and found bipolar disorder was underdiagnosed. However, in 1995, Milberger et al. reevaluated cases of ADHD and co-occurring bipolar disorder and when the symptoms of ADHD were subtracted, only 56% retained their bipolar disorder diagnosis. This shows that when ADHD is present, bipolar disorder can be overdiagnosed.

How Do You Know if Your Child’s Bipolar Has Been Misdiagnosed?

There is no single, clear-cut way to ensure a child’s bipolar disorder diagnosis is accurate due to the differing opinions on how bipolar disorder manifests in children. That said, clinicians with experience in childhood bipolar disorder are more likely to be able to accurately spot its existence, or not, in your child. If you haven’t seen one of these specialists (usually a child psychiatrist), one should be sought out for confirmation of the diagnosis.