The new DSM 5, the bible for psychiatric disorders, intends to do away with a bipolar diagnosis for many children and teens. A new diagnostic category, temper dysregulation disorder (TDD) is being proposed and would include symptoms of bipolar disorder. The new diagnosis of TDD (does this really denote a serious medical condition?) will surprise and dismay many parents. Families usually struggle for years with their child’s unpredictable behavior, intense moods and volcanic temper tantrums while strangers, friends and family assume that what is wrong is inadequate parenting. A bipolar diagnosis has helped many parents get treatment, school services and a recognition that what they are dealing with at home is serious stuff indeed.
The DSM is many things to many people. Mental health clinicians rely on it to help form an accurate diagnosis. Insurers use it to authorize payment for medically necessary treatment. Schools often cite diagnoses in the student’s education plan. Even juvenile courts use it to better understand the behaviors that might bring a youth into court.
The DSM 5 Child and Adolescent Disorders Workgroup has listed several reasons for the recommended change. The rise in prescribing psychotropic medications for children is one. The group also cites a study that “found a 40-fold increase between 1994 and 2003 in the number of outpatient pediatric psychiatry visits associated with the diagnosis of BD [bipolar disorder].” Yet, a 2007 study found that youth released from the hospital with a primary diagnosis of bipolar amounted to less than one in a thousand.
But in 1994, practically no children were diagnosed with bipolar disorder, so any increase from “almost nothing” would be startling. In the early 90s, I was running support groups where parents would share stories with each other about their child’s moods (from rage to extreme silliness to wanting to die), the nightmares that came almost every night, the rigid food preferences and risky behaviors. Most parents worked, had little support and felt overwhelmed by the impact on their family. Parents were told their children had ADHD, anti-social personalities, were oppositional or had conduct disorder. Somehow these diagnoses didn’t capture the gravity or complexity of the situation.
The DSM is not a coding system set up for the convenience of the insurance industry or to create a shorthand for schools. Yet, a child must often be labeled “something” in order to get services. We all give lip service to measuring the “functioning” of a child but that still doesn’t open doors or get services paid for. The reality is that parents often have to fight for services. We may decry the need for labels and powerful diagnoses, but at this point in time it’s what we have. Those diagnoses have to increase access for children as well as describe their symptoms.
Most of the children and youth who now have a bipolar disorder diagnosis require medication, therapy, special education strategies and a loving, dedicated parent who is willing to do battle to obtain the needed treatments and services in order to improve things. It’s a diagnosis that does not imply that “bad” parenting is the cause, which allows parents to be partners in creating and carrying out a treatment plan, just as they would if this were any other medical illness. It also does not imply the child is to blame, which is often equally important.
Any new diagnosis proposed by the DSM 5 needs to send a clear signal to insurers, schools and the general public that bipolar in children is very real and very serious. Parents already know this. There is still time for comments at www.dsm5.org until April 20, 2010.
Yes, there’s been a gap between the last post and this one. I got a house ready to be sold, sold it and am getting ready to move. It certainly devoured a lot of my time. But I have been thinking about children’s mental health a great deal and the posts will keep on coming!