Whereas the shift to include Aspergers under Autism is one that has progressed naturally, based on two decades of practice and research, medical professionals are breaking out the category of bipolar disorder for children. The new DSM is proposing a new term, distinct from bipolar disorder, called Temper Dysregulation Disorder (TDD).
Temper Dysregulation Disorder is intended to find help for the child who is consistently irritable, who throws temper tantrums several times a week and has explosive temper issues with little provocation. In other words, that child that you walk on eggshells around, waiting for the inevitable screaming and throwing. The one that gets kicked out of preschools; the one that pushes parents’ buttons; the one where you know that something is wrong, but what?
Prior to the 1990s, bipolar disorder was only diagnosed in adults, and it was understood that full-fledged bipolar behavior started around adolescence. Parents and teachers, of course, could describe erratic behaviors much younger, but the medical professional field did not recognize this childhood behavioral issues as anything other than something that behavior management could control. Parents were, understandably, upset at the implication that their child’s behavior was caused by poor parenting.
Since the mid90’s, the diagnosis rates of bipolar disorder for children has skyrocketed over 4000%. Given that it was practically 0% before, this is not unusual for it to shoot up (new label means more diagnosis which means increased rate), but it is still an alarming rate for an “experimental” label. Along with the label of bipolar comes an inference that it is a biological issue, rather than poor parenting- and biology often implies medication. The medications approved for adult use are not lightweight medications- these are no aspirins. Certainly, the use of serious medications on a child’s developing nervous system and physical growth has to be accounted for. Doctors and parents have carefully monitored medications and struggled with trying to determine what is working, what is an appropriate dosage and what other alternatives might work.
The other challenge is that not all people who were identified as having bipolar disorder as a child developed the full range of mania/depression that characterizes adult bipolar disorder. Many of the children “lost” their label as they aged, whereas some children who had not been identified DID develop bipolar as adolescents. Clearly, there is no well-established line of determination.
And so now we have TDD- an attempt to bridge the chasm between nature and nurture, between child and adult, between poor parenting and biology, between medication and behavior management. It’s a “new” label that the American Psychiatric Association hopes will provide options for treatment, for causality… for hope.
It’s a label I’ll be teaching my teachers and one that I hope that brings strategies and ideas. Good luck TDD…