Pediatric Bipolar: How’d We Get Here?

The pieces on pediatric bipolar will be written by my daughter, Rhona, a science writer who has played a seminal role in the blog since its birth. (That’s lucky for me, as, frankly, I still don’t know what that “html” tab does.) All comments and questions will still come to me–and I’m quite receptive. Thanks for your support, Candida

Recall the movie with the sadistic dentist and the flesh-eating plant? I’m counting on you here.

Anyway, “Little Shop of Horrors” starts off with these words:

On the twenty-third day of the month of September in an early year of a decade not too long before our own, the human race suddenly encountered. . . .

Well, you know what the mental health-connected part of the human race encountered? Come on–three guesses.

It may not have been the 23rd of September, and you have to be flexible about what ‘an early year’ means (I mean, ‘5’ rounds up, generally, but, for poetic license, we could round it down, right?), but it most certainly was a decade not too long before our own that an illness, almost completely new, was applied to children.

And, like the flesh-eating Audrey, that diagnosis of childhood bipolar grew. . .and grew. . .and grew–until, some wonder if it hasn’t eaten more than its fair share of the diagnostic options for temperamental youth.

The diagnosis first went to children prone to uncontrollable outbursts and meltdowns. These uncontrollable episodes, so went the early theory, reminded practitioners of the ups and downs of bipolar disorder.

But forming and applying the diagnosis for children was a slow task. The first article devoted to the topic appeared in 1995. The next two years saw some more literature on the topic, as clinicians worked behind the scenes to make sense of what they were seeing.

Meet Dr. Janet Wozniak, assistant professor of psychiatry at Harvard Medical School, and now, after all the research, Director, Pediatric Bipolar Disorder Clinical and Research Program, Massachusetts General Hospital. She was one of the first people to bring the concept of bipolar children to the public.

An expert in ADHD, she wrote that 1995 paper, “Mania-Like Symptoms Suggestive of Childhood-Onset Bipolar Disorder in Clinically Referred Children,” published in the prestigious Journal of the American Academy of Child & Adolescent Psychiatry, asserting, “the clinical picture was fully compatible with the DSM-III-R diagnosis of mania in 16% . . .of referred children”–despite the concurrent diagnosis of ADHD.

Wozniak was on to something, and the clinical and research community both realized it. Her paper became one of the ten most cited papers ever published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Not everything changes overnight, and a couple years passed without immediate clinical response. But things were percolating beneath the surface.

And then a publication–not in a premier journal, not by a researcher, not even by a child psychiatrist–seemed to break the field wide open. Dr. Demitri Papolos of Albert Einstein University was involved in communications on an Internet listserve on the topic of pediatric bipolar. Papolos believed he heard painful truths in these stories–and the frustration of parents who weren’t being attended to.

Conveniently enough for the doctor, his wife was a writer, and together they published the first edition of The Bipolar Child in 2000, which made more of a difference in the story of pediatric bipolar than any of the scientific lit–best journals or no.

Cover of "The Bipolar Child: The Definiti...
Cover via Amazon

The book has its own webpage–and on it the authors claim that the text was called “The shot heard round the psychiatric world.” Parent would walk into psychiatrists’ offices armed and ready. Holding out the book, they’d say, “This is what my child has. And this is what she needs help for.”

And how things have changed. According to a piece on npr’s blog entitled “Children Labeled ‘Bipolar’ May Get A New Diagnosis,” since the mid-90s, the number of children to be diagnosed with bipolar has increased 4,000% [italics mine].

Perhaps that number simply indicates just how many cases of pediatric bipolar we as a society were allowing to slip below the clinical eye, untreated, mistreated, headed for trouble. And in that case this story has a happy ending.

But there’s another possibility. And it’s not a terribly pleasant one.

It’s the possibility that this rage for diagnosing our difficult children with bipolar disorder is misguided, has become a trend that runs on its own steam, and is damaging to the children in the end, due to psychotropics wreaking havoc on their systems, due to stigma, due to time distracted from their real issues.

So when the DSM-5–yes, making trouble again–announced that what was pediatric bipolar will no longer exist, but will now be a condition known as ‘temper dysregulation disorder,’ many were up in arms. But perhaps just as many are happy to see the backside of pediatric bipolar disorder.

Let’s examine why in more detail, in the next post.


Ghaemi SN, Martin A. Defining the boundaries of childhood bipolar disorder. American Journal of Psychiatry 2007; 164:185-188.

Wozniak J, et al. Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. Journal of the American Academy of Child and Adolescent Psychiatry 1995; 34(7):867-76.

Wozniak Janet. Faculty listing for Massachusetts General Hospital.

by Rhona Finkel

Leave a Reply