The Paediatric Bipolar Hypothesis: The View from Australia and New Zealand

Background: The paediatric bipolar disorder (PBD) hypothesis arose in the USA and proposes childhood onset and high rates of prevalence. Method: Child and adolescent psychiatrists in Australia and New Zealand were surveyed about the PBD hypothesis. Results: Sixty percent responded (N = 199) and most (53%) reported never having diagnosed pre-pubertal PBD and a further 29% estimated seeing '1 or 2' cases. Most (83%) rated pre-pubertal PBD as 'very rare', 'rare' or 'not diagnosable'. Opinion varied as to whether PBD was over-diagnosed (25%), appropriately diagnosed (42%), or under-diagnosed (28%) in Australia and New Zealand, 5% were unsure. In contrast there was a consensus of views that PBD was over-diagnosed in the USA (90%), whilst less felt it appropriately diagnosed (3%), or under-diagnosed (1%) and 6% were unsure. Conclusions: The majority view was consistent with classical descriptions of bipolar disorder. Key Practitioner Message: Paediatric bipolar disorder (PBD) as defined by USA researchers, applies to a range of child behavioural patterns that differ in varying degrees from traditional descriptions of bipolar disorder PBD has become a common diagnosis in the USA There is some evidence to suggest that adoption of the PBD diagnosis in the UK and Europe has been limited This paper reports on a survey of Australian and New Zealand child and adolescent psychiatrists and finds a solid majority retain a traditional view of bipolar disorder and are sceptical of the new PBD phenotypes The PBD phenotypes remain hypothetical and the alternative hypothesis is that responses to trauma and other more recognised emotional and behavioural disorders of childhood remain sufficient diagnostic explanations