Table 1 Timeline: The Recent Debate about BP in Children

Early 1980s

Gabrielle Carlson et al. observe that bipolar symptomatology in preadolescent children can include severe irritability and emotional lability (as opposed to the classic symptoms that appear in adults and adolescents) [27].

1994

Geller et al. report in Journal of American Academy of Adolescent and Child Psychiatry (JAACAP) conversion to BP in 32% of a sample of children with major depression [31].

1995

Geller et al. in Journal of Affective Disorders suggested that children and adolescents with rapid-cycling mania characterized by elevated/expansive and/or grandiose mood have BP; the researchers did not use irritability to characterize BP because it also commonly appears in ADHD [29].

1995

Wozniak et al. [11] and Biederman et al. [30] in two JAACAP articles report that 16% of a clinical population of children met the criteria for mania primarily by exhibiting chronically irritable mood and describe their use of the Child Behavior Checklist to confirm their diagnoses of BP in these children.

1998

Klein et al., critique the move to consider chronic irritability a form of mania [47].

2000

Publication of The Bipolar Child by Demitri and Janice Papolos, a book aimed at parents, whose success coincides with an increase in visits to doctor's offices by parents regarding a bipolar diagnosis for their children [6].

2002

Time magazine runs a cover story on children with BP [15].

2003

Leibenluft et al. describe a new syndrome, Severe Mood Dysregulation, (SMD), which aims to bring some conceptual order to the increasingly heterogeneous class of children receiving a BP diagnosis [28, 48, 49, 51].

2005

Article by Kowatch et al. describing treatment guidelines for children and adolescents with BP published in JAACAP. Accompanying commentary calls attention to lack of evidence that childhood diagnosis is contiguous with adult BP and critiques some symptoms as difficult to distinguish from developmentally normal childhood behavior [46].

2006

Brotman et al. use the label Severe Mood Dysregulation in the title of a scientific article, offering a new label for many children now receiving the BP diagnosis [49].

2007

JAACAP publishes practice parameter for diagnosis and treatment of BP in children and adolescents. Parameter follows Geller et al. diagnostic criteria more than those proposed by Biederman et al. but warns of difficulty differentiating symptoms from normal childhood behavior and urges periodic revisions of any diagnosis and treatment plan [57].

2007

Archives of General Psychiatry publishes study reporting a 40-fold increase between 1994 and 2003 in the number of office visits in which children (0-19) had a diagnosis of BP [1].

2009

Zito et al. report a 10-year trend for Medicaid-insured youth with clinician-reported pediatric bipolar disorder showing a proportional increase in minority youth with this diagnosis from 1997 to 2006 (23% increase in African-American and other minorities and corresponding drop in white youth) [85].

Crystal et al. report that poor children are four times more likely than wealthy children to receive atypical antipsychotics [70].

2010

Olfson et. al. report a doubling of the number of privately insured 2-5 year-old children with a psychiatric diagnosis who receive an antipsychotic, and lament the sparseness of non-pharmacological mental health resources [3].

Authors working on DSM V propose adding new diagnostic category, which is based on Severe Mood Dysregulation and may be called Temper Dysregulation Disorder with Dysphoria [54].