New guidelines have been issued for treating bipolar disorders inchildren.

"Clinicians who treat children and adolescents with bipolar disorderdesperately need current treatment guidelines," write the guidelines'authors, who included Robert Kowatch, MD, of the psychiatry department atCincinnati Children's Hospital.

Kowatch and colleagues don't claim to have all the answers. Their reportsays the guidelines aren't intended as an "absolute standard," and theycall for more studies on bipolar disorders -- and their treatments -- inchildren.

The guidelines appear in the March edition of the Journal of theAmerican Academy of Child & Adolescent Psychiatry. The guidelines weredrafted by a team of doctors, clinicians, and members of the Child andAdolescent Bipolar Foundation (CABF).

The CABF is a national nonprofit advocacy group for families raisingchildren diagnosed with or at risk for bipolar disorder.

The guidelines focus on diagnosis, therapy, and the use of mood-stabilizingdrugs. The authors also say they don't know how bipolar children will fare asadults. "No one can say for sure what these children will look like whenthey grow up," they write.

"However, it is clear that they manifest a serious disorder and thatearly diagnosis and aggressive treatment are necessary for these patients tofunction successfully within their families, peer groups, and schools. There isalso the hope that early recognition and treatment of pediatric bipolardisorders will reduce or eliminate the many negative outcomes associated withthese disorders."

More Pediatric Bipolar Diagnoses

"Once considered rare in children, pediatric bipolar disorder is nowwidely diagnosed in the United States," says Jon McClellan, MD, in ajournal editorial.

Bipolar disorder is more likely to affect children of parents who have thecondition, according to the National Institute of Mental Health. Adults withthe disorder have clearly defined periods of mania and depression yet childrenand teens have very fast episodes of mood swings. They can suffer episodes ofdepression and mania many times a day. They tend to be more irritable anddestructive rather than overly happy. It can also be difficult to tell thedifference between normal behavior and other problems seen during this ageperiod.

McClellan, a member of the psychiatry department at Seattle's University ofWashington, did not work on the guidelines. In his editorial, he calls theproject "laudable" given the "considerable controversy" aboutpediatric bipolar disorder.

The guidelines only apply to children aged 6 and older. That's commendable,says McClellan's editorial. "There is no valid justification for diagnosingbipolar disorder in preschoolers," he writes. "Labelling severetantrums in toddlers as major mental illness lacks face validity and underminescredibility in our profession."

How to Distinguish Misbehavior From Mental Illness

The guidelines call for careful diagnosis to separate normal childhoodantics and misbehavior from true bipolar disorder, in which patients experiencebouts of mania and depression. The child and at least one parent are needed toassess the child's mental health.