Dr. Finnerty tells parents and professionals why they should throw out those popular books about bipolar children
In less than 10 years the rate that children are diagnosed with bipolar disorder increased a shocking 4000%! This was due in part to the increased use of “alternative,” unsanctioned approaches to making the diagnosis in children. As more research has been conducted and we’ve gained more experience with the bipolar child, it turns out that most don’t grow up to have bipolar disorder and they’re distinctly different from the much smaller number of children who really do have bipolar disorder. These kids not only have not had an “early onset” of bipolar disorder, they haven’t had an onset of bipolar disorder at all. We must move forward with better research and better approaches to treatment. These children can’t afford for us to cling to unsupported diagnoses. Under DSM-5 most of these kids are now better suited for the new DSM-5 diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). DMDD is a unipolar (not bipolar) mood disorder characterized by very severe irritability. Any parent of a DMDD child can tell you that their problems are not simply normal, developmentally appropriate “temper tatrums.” Kids with DMDD are already in need of treatment, they’re just not getting the best treatment that they could be. DMDD shares qualities with ADHD and ODD but also reflects substantial emotional concerns as severe as any bipolar disorder. In this book Dr. Finnerty confronts the popularized notion of “the bipolar child” and offers resources and “less toxic” advice for parents and professionals. If you previously thought that books about bipolar children were a "bible" on early-onset bipolar disorder, you need to read this book now.
Note: the book is available for shipping now; Published May, 2013.
Order the book Disruptive Mood Dysregulation Disorder (DMDD), ADHD and the Bipolar Child Under DSM-5: A Concise Guide for Parents and ProfessionalsFREE SHIPPING on this NEW BOOK by psychologist Dr. Todd Finnerty! This book was written with parents in mind
The simplest and most evidence-based explanation for why some authors have had to bend-over-backwards to propose
different clinical descriptions and different diagnostic criteria for "the
bipolar child" is that what they're looking at, in most cases, isn't bipolar disorder at all. Yes, it's true that in my new book I
get saucy enough to actually tell parents and professionals to throw away a popular, well-known book about bipolar
disorder in children. My book is worth reading just from me addressing themes from that particular book
and telling people to throw it away. What you may know or have heard in the last decade about "early-onset bipolar disorder" is possibly wrong, and an
alternative approach is now codified in DSM-5 and reflected in my new book. The book also includes a
discussion of the DMDD diagnostic criteria, treatment options and some insights from my recent interviews of folks like
Ellen Leibenluft, Russell Barkley and Alan Kazdin. (sincerely, Todd Finnerty, Psy.D.)
The Book is also available on Amazon now!
|Order the book on Amazon now!|
Listen to Dr. Finnerty discuss DMDD w/ Dr. Leibenluft now!You can listen to Dr. Finnerty discuss DMDD in DSM-5 with DSM-5 work group member Dr. Ellen Leibenluft free online right now! This recorded interview is available here Mental Health Day Podcast 14: Dr. Ellen Leibenluft on DMDD and Bipolar Kids in DSM-5. There are also great interviews there that Dr. Finnerty conducted with professionals like Dr. Alan Kazdin, Dr. Russell Barkley and more!
Disruptive Mood Dysregulation Disorder and DSM-5
DMDD is not just a kid with temper tantrums or an invitation to medicate more children. DMDD is a useful diagnosis for kids who are already being treated but often treated poorly. DMDD is included in the new DSM-5 to encourage clinicians to make accurate pediatric bipolar diagnoses. It also gives a new "unipolar" diagnostic home to many children who might benefit from different approaches than someone with a bipolar disorder. Most of the children with DMDD do not grow up to have classic bipolar disorder. While some critics like to argue that DMDD would lead to "overmedicating" kids, there is no support for this assertion. It could theoretically also lead to a reduction in the number of kids getting "medicated" for bipolar disorder unnecessarily and an increase in kids getting more appropriate interventions. A bipolar diagnosis leads professionals to de-emphasize psychotherapy. It also leads professionals to avoid less toxic antidepressants and stimulants for fear of inducing a manic episode. However, most of the time what these kids are experiencing isn't mania and professionals may be unnecessarily jumping to more toxic medications that aren't even FDA approved for children.
What is Disruptive Mood Dysregulation Disorder and why do we need it?
Disruptive Mood Dysregulation Disorder is a new proposed diagnosis for DSM-5 that is designed to reflect a population of individuals, particularly children, who are under-served and who are often misdiagnosed as having a Bipolar Disorder. These kids may fail to get appropriate treatment and often get inaccurately labeled with a diagnosis that implies a lifetime of mood cycling and medications. The may unnecessarily get a diagnosis that could prevent them from getting certain jobs when they are older. This DSM-5 proposal was originally termed Temper Dysregulation Disorder with Dysphoria and garnered criticism from some who feared pathologizing "temper tantrums." However, this is a mischaracterization of the individuals that the DSM-5 proposal sought to target. These children have developmentally inappropriate and significant difficulties which have led them to already receive labels such as Bipolar Disorder. Their problems are just as severe and worthy of being taken seriously as children who experience bipolar disorder or other problems. However, these "bipolar kids" are often diagnosed with early-onset bipolar disorder despite the fact that they do not show the same characteristics of individuals with classic bipolar disorder (ex: episodic grandiosity/elevated mood/manic episodes) and do not grow up to have classic bipolar disorder. While "child bipolar" does exist, the children that tend to continue to display bipolar disorder concerns in to adulthood are those with more classic manic presentations and episodicity. The children who fall in to the Disruptive Mood Dysregulation Disorder (DMDD) group do not tend to display bipolar concerns in to adulthood and do not share as many characteristics (ex: a family history of bipolar disorder) as the more "classic" bipolar disorder kids. These children tend to show irritability but are more likely to have unipolar depression later in life, not bipolar disorder.
Unfortunately, the rapid increase in pediatric bipolar disorder diagnoses was fueled in part by professionals using a "loose" interpretation of the DSM-IV criteria, including vague approaches to the nature of episodes and mania. Many books were written for practitioners which deviated from DSM-IV and different bipolar disorder research groups began using different research criteria and these began to find their way in to clinical practice. Unfortunately the approaches were not always well-tested. Dr. Finnerty's new book presents the new, alternative perspective on how these "bipolar child" books should be viewed. There is no new and different criteria for bipolar children in DSM-5 and there shouldn't be. Instead, as Dr. Finnerty notes in his book, the current versions of these popular books about the bipolar child should just be thrown away.
Severe Mood Dysregulation
Researchers, including those in Ellen Leibenluft, MD's lab at the NIH, began to find that many of the children labeled with "Bipolar Disorder" not only did not share the same characteristics as adults with bipolar, they didn't share the same characteristics as children who met a more traditional and rigorous DSM-IV diagnosis of bipolar. Despite this, countless young people were increasingly receiving treatments for bipolar disorder, including medications, which may not have been best-suited to them.
Learning to manage our emotions
Elsewhere professionals have focused on how we control our emotions. It is influenced in part by cognitive processes involved in executive functioning. Russell Barkley, Ph.D. has emphasized how impulsive emotional responding can be related to ADHD. Other psychologists, including Ross Greene, Ph.D., emphasized how the ability to regulate our mood develops over time, and some children may experience a developmental delay in these areas much like they do with a learning disability. He suggested skills like flexibility/ adaptability, frustration tolerance, and problem solving may lag behind others in these individuals.
Here are some books Dr. Finnerty thinks you can keep/buyHere are some books that Dr. Finnerty recommends:
- The Kazdin Method for Parenting the Defiant Child
- Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents
- Your Defiant Child, Second Edition: Eight Steps to Better Behavior
- Defiant Children, Third Edition: A Clinician's Manual for Assessment and Parent Training
- The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children
- 1-2-3 Magic: Effective Discipline for Children 2-12
- Disruptive Mood Dysregulation Disorder (DMDD), ADHD and the Bipolar Child Under DSM-5: A Concise Guide for Parents and Professionals
For children with mood disorders check out The Balanced Mind Foundation
For children with ADHD check out CHADD
Find EVEN MORE RESOURCES on Disruptive Mood Dysregulation Disorder, Pediatric Bipolar Disorder, ADHD and other problems... on the NEXT PAGE
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