How Doctors Diagnose Your Child with Bipolar Disorder

Bipolar Disorder In Children
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One approach your doctor may use in diagnosing your child with bipolar disorder is emphasizing irritability as the primary symptom of mania and, therefore, bipolar disorder. Meaning that if your child is persistently and severely irritable, it could be a sign he or she has bipolar disorder.

However, this is a relatively new and emerging theory for diagnosing bipolar disorder, and still up for debate as to how accurate it is.

It could indicate other problems, too. Either way, if you have a child with near-constant irritability, it's important to discuss this with your doctor.

A bit of background: One group of researchers at Massachusetts General Hospital have taken this approach because they believe “the irritability of pediatric mania [is] qualitatively and quantitatively distinct from other forms of irritability and thus can be used to identify bipolar disorder."

If your doctor subscribes to this school of thought in diagnosing bipolar disorder, he or she will evaluate how irritable your child gets while paying less attention to the defined episodes in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Emphasizing Irritability

Would you describe your child as super angry, super grouchy or super cranky? Is this how your kid behaves all or most of the time? Does the smallest distraction or inconvenience send your youngster over the edge into angry and touchy fits?

This is what your doctor will specifically look for -- persistent and severe irritability -- to establish a diagnosis of bipolar disorder.

The findings from COBY, a large body of research on bipolar disorder, also support the importance of irritability in diagnosing kids. One of the tentative findings of the COBY series of studies is that children get irritable, not manic.

But Dr. Jeffrey Hunt, who also has studied childhood bipolar disorder, said only 10 percent of the participants in his research study were found to have irritable-only mania. “Our findings confirm that while irritable-only mania is uncommon, it does exist – particularly in younger children – and should be considered in a bipolar diagnosis." What this all means: At this point, research shows irritability can be an important sign indicating bipolar disorder in children, but more research is still needed before it is considered the primary symptom of mania.

De-emphasizing Episodes

In the other two systems for diagnosing bipolar disorder -- standard DSM-IV criteria and cardinal symptoms -- your doctor would check to see if your child’s symptoms meet the criteria for specific episodes. However, in this system, this is not necessary.

Your child does not have to have any of the other symptoms associated with a manic or hypomanic episode. Nor does your child’s irritability have to be a change in behavior.

Persistent and severe irritability is sufficient.

Theories in Diagnosing Children with Bipolar Disorder


American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR).

Hunt, J. et al. (2009). Irritability without elation in a large bipolar youth sample: Frequency and clinical description. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 730-739.

Leibenluft, E. & Rich, B.A. (2008). Pediatric bipolar disorder. Annual Review of Clinical Psychology, 4, 163-187.

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