Is It Bipolar Disorder? Or Autism?

the Psychiatry Advisor take:

Could bipolar disorder be severely misdiagnosed in childhood? That’s one one psychiatrist says, who argues that the misdiagnosis occurs since severe irritability, common in many children, is associated with bipolar disorder.

Irritability associated with autism, which is estimated to affect about 20% of those with the disorder, leaves these children vulnerable to an incorrect diagnosis of bipolar disorder, according to Stuart L. Kaplan, MD, a clinical professor psychology at Penn State University and a distinguished life fellow of the American Academy of Child and Adolescent Psychiatry.

“In my experience, this is especially true in those autistic children who are in residential care,” Kaplan wrote. “Often these are the autistic children without language and with serious intellectual disabilities. Such children are often placed in residential care because of unmanageable aggression despite the best and often heroic efforts of concerned family members and other caretakers and despite the use of standard medications.”  

Kaplan suggested considering autism spectrum disorder (ASD) as the basic underlying diagnosis with the understanding that children with an ASD are susceptible to other DSM psychiatric diagnoses.

Children with an ASD who meet DSM criteria for bipolar disorder are rare to non-existent, according to Kaplan. Aggression associated with autistic disorder is a symptom and should be treated rather than coming up with a diagnosis such as bipolar disorder and attempting to treat aggression with medications for a diagnosis the child does not have.