What Does the DSM-IV Say About Children and Mood Disorders?
Children are mentioned in the DSM-IV, but they are to be diagnosed according to adult criteria. And this is where huge problems develop. Clinical investigators are beginning to realize that bipolar disorder in childhood presents in a very different pattern–one that bears little resemblance to classical cycles of mania and depression as they are expressed in adulthood. For instance, children have more irritable moods with explosive outbursts, and their cycles of mania, hypomania, and depression are far more rapid than the typical adult presentation. Yet the DSM-IV specifies that a mood episode must last for a specified period of time. For instance, duration criteria for the diagnosis of a hypomanic episode requires a “period of persistently elevated, expansive, or irritable mood lasting throughout at least four days.” (Italics ours.) Yet a significant proportion of early-onset bipolar children have a form of the condition that is marked by frequent mood and energy shifts that occur mul
