An editorial by Dr. Gabrielle Carlson, Director of the Division of Child and Adolescent Psychiatry at Stony Brook University, was published in the March 2011 issue of the British Journal of Psychiatry.
In the editorial, titled “Will the child with mania please stand up,” Dr. Carlson suggests that the fact that children in the United States are much more likely to be diagnosed with bipolar disorder than children in the United Kingdom has more to do with differences in how the disorder is diagnosed than with an objective difference in prevalence rates.
After reviewing differences in the diagnostic criteria and the way clinicians in the two countries conceptualize mania/bipolar disorder and its symptoms, Dr. Carlson recommends that a cross-national study -- similar to the International Pilot Study of Schizophrenia which was started in 1967 and helped standardize the way schizophrenia is diagnosed around the globe -- be undertaken to resolve differences among regions. “Until we understand how clinicians ask and understand parent and child responses to questions about their episodes and symptoms, and how they apply criteria that the DSM and ICD committees establish,” Dr. Carlson concludes, “we are trapped in an endless nosological debate."
Peter Tyrer, the journal’s editor, featured Dr. Carlson’s comments in his “From the Editor’s Desk” column. While highlighting the value of diagnostic manuals and rating scales, he agrees with Dr. Carlson that the disparity in the rate of diagnosis between the two countries signals differences in the way the criteria and scales are used and provides a rationale for conducting an international study of bi-polar disorder in children.
