title: Misdiagnosis of bipolar disorder in children and adolescents: a comparison with ADHD and major depressive disorder.
abstract: BACKGROUND
  Controversy surrounds the frequency of underdiagnosis vs overdiagnosis of bipolar disorder (BD) in children and adolescents compared with diagnoses of attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD).
  
  
  METHODS
  Sixty-four children and adolescents (age 7 to 18) treated in a community setting were systematically assessed for diagnostic and treatment histories. Best estimate consensus diagnosis was made using DSM-IV criteria.
  
  
  RESULTS
  ADHD was overdiagnosed (all patients with ADHD had received the diagnosis, as did 38% of patients with MDD and 29% of patients with BD, respectively), while MDD was partially underdiagnosed and partially overdiagnosed (57% of MDD patients received the diagnosis, 43% did not; 33% of patients with BD were incorrectly diagnosed with MDD). BD was underdiagnosed, not overdiagnosed (38% received the diagnosis, 62% did not; BD was not diagnosed in the ADHD sample, and in only 5% of the patients with MDD). The absence of a positive family history predicted misdiagnosis of BD (relative risk = 2.48, 95% confidence interval 1.10 to 5.56). Observational treatment response to stimulants was equally high in all groups (75% to 82%).
  
  
  CONCLUSIONS
  In the first controlled study on this topic, BD was not over-diagnosed in children and adolescents, as it is often claimed, and ADHD was. Stimulant response was nonspecific and diagnostically uninformative. Studies with larger samples are needed to replicate or refute these results.
authors.affiliation: Department of Psychiatry, Emory University, Atlanta, GA, USA.
authors.forename: Jagan K
authors.initials: JK
authors.lastname: Chilakamarri
authors.forename: Megan M
authors.initials: MM
authors.lastname: Filkowski
authors.forename: S Nassir
authors.initials: SN
authors.lastname: Ghaemi
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D035841:Behavioral Research; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002662:Child Health Services; D003156:Community Mental Health Services; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales
chemical_list: D000697:Central Nervous System Stimulants