Approach to diagnosing bipolar disorder in children

Bipolar disorder is extremely rare before puberty. Urgently refer children who display symptoms of bipolar disorder to a specialist centre (eg Headspace for children 12 years or older) or, if a specialist centre is not available, a psychiatrist or mental health team experienced in treating bipolar disorder in children. Diagnosing bipolar disorder in children is difficult, and requires expertise; the diagnosis is unstable and requires confirmation with prospective longitudinal monitoring.

Bipolar disorder is overdiagnosed in children with chronic irritability and disruptive behaviour—symptoms that are also characteristic of relational or attachment problems, and other psychiatric disorders. Disruptive mood dysregulation disorder is a new diagnosis intended to describe many children with chronic irritability and disruptive behaviour, who would previously have inappropriately received a diagnosis of bipolar disorder. The creation of the diagnosis aims to reduce misdiagnosis and overtreatment, but it is not universally accepted.