Hi, I have noticed that solutions offered here to help our challenging kids tend to focus solely on the diagnosis and the right medication. in my humble opinion I think we need to relate to the whole child and his environment , the pathways and triggers , the lacking cognitive skills such as executive functions, language processing skills, emotional regulation skills, social skills and cognitve flexibility etc. I am sure most parents don't see medications as a long term solution. here is an article by Ross Greene , from his blog http://thinkkids.org . I find all the blogs , not only the one for parents very helpful . The title refers to BiPolar (BP) , but applies to diagnosis's in general. Is A Child You're Treating Bipolar? Why It May Not Matter 5/23/2007 So what do you make of the diagnosis of bipolar disorder in children? Controversial, to be sure, but youve no doubt worked with a few kids to whom you thought the diagnosis might apply. Of course, your perspective on pediatric bipolar disorder probably hinges, at least partially, on the extent to which you find psychiatric diagnoses to be useful in general. Here in the Collaborative Problem Solving Territories, we find it most helpful to understand challenging kids in the context of the cognitive skills they lack and the problems or triggers that precipitate their challenging moments. And so our perspective on pediatric bipolar disorder is, in many ways, the same as our perspective on other psychiatric diagnoses: since they dont provide any information whatsoever about the cognitive skills a challenging child is lacking or the problems precipitating the childs challenging moments, diagnoses arent especially useful for helping adult caretakers understand a childs difficulties or pinpoint targets of intervention. Of course, diagnoses can be useful on the fringes. They help researchers identify supposedly homogeneous groups of clinical populations that can be studied. They may bestow an official stamp of impairment so that a childs difficulties are taken more seriously. They may help parents identify support groups to which they can belong. Sometimes they help practitioners get reimbursed for their services by managed care. And some practitioners have been trained to believe that a diagnosis provides useful information to guide decision-making on pharmacologic intervention (you cant know what medication to use until you know the childs diagnosis, goes the mantra). But and we do try to be open-minded about such things we find that the downside of diagnoses frequently outweigh the upside, and this is perhaps especially the case with pediatric bipolar disorder. The lack of consensus criteria for the disorder is extremely problematic, as different researchers have adapted the adult criteria for bipolar disorder in variable ways to fit children (even while acknowledging that bipolar disorder in children bears little resemblance to the adult form of the disorder) and the adaptations often test the bounds of credibility. Researchers have reported that features such as grandiosity, rapid flight of ideas, a driven pursuit of reckless activities without regard to consequences, and pressured speech are more common in children than previously known. Of course, what youre seeing and believing is completely a function of the lenses youre wearing in other words, the criteria youre using. Alas, the devil truly is in the details, and the fact that diagnoses are supposed to reflect a significant level of developmental deviance seems not to have been a major or even minor consideration. So we are left to ponder the developmental deviance of criteria such as class clown relative to other children and immature, babyish (these have been used as indicators of elevated mood); bathroom humor and off-color jokes (hyper-sexuality); talkative relative to other children even if only during a rage episode (pressured speech); statements like You dont care about me and You dont love me (paranoia); and extreme defiance beyond mere ODD, and controlling (grandiosity). Of course, one of the biggest concerns about diagnosing bipolar disorder in children is the fact that the diagnosis typically places the child on a pharmacologic slippery slope, usually in the direction of mood stabilizing medications. These medications are often used in combination, yet they havent been adequately tested for use in children even when prescribed alone. Their side-effect profiles are often quite concerning. Most troubling, perhaps, is the fact that diagnosing a child with bipolar disorder pathologizes the child and therefore often obscures the fact that challenging behavior in kids is a complex, transactional phenomenon also involving the childs interaction partners and environments. Back in the 50s, a prominent psychiatrist named Thomas Szasz characterized psychopathology as problems in living. How apt a description for kids being diagnosed with bipolar disorder! What are their problems in living? They lack the skills to handle frustration, regulate emotions, and solve problems adaptively. Can these skills be identified and taught? Indeed, they can. Can medication be helpful in setting the stage for such teaching? In some cases, yes. Does medication teach lacking thinking skills or solve problems? No, medication does not. Is diagnosing a child with pediatric bipolar disorder a necessary first step? In general, no.