Delayed Diagnosis of Pediatric Bipolar Disorder in a Community Mental Health Setting

OBJECTIVE: There is evidence that delayed diagnosis is a significant problem in adult bipolar disorder. It is not known if this also occurs among pediatric patients with this illness. The goal of this study was to determine the frequency of delayed and missed diagnosis of pediatric bipolar disorder in a community mental health setting. METHOD: Charts of youths with a diagnosis of bipolar I or II disorder, cyclothymia, or bipolar disorder not otherwise specified (NOS) who were treated at a community mental health outpatient clinic between February 2000 and April 2003 were retrospectively reviewed. RESULTS: The mean number of years from the onset of mood symptoms until diagnosis of bipolar disorder was 5 years (SD = 3.5), with a maximum of 12 years. Only 2 patients (4.8%) received the correct diagnosis within the first year following symptom onset. For 33 patients (78.6%), 2 or more years elapsed, for 22 patients (52.4%) 5 or more years elapsed, and for 7 patients (16.7%) 10 or more years elapsed before they were diagnosed correctly. CONCLUSIONS: Although the study has several limitations, it suggests that delayed and missed diagnosis may be common among pediatric patients with bipolar disorder who receive treatment in community mental health settings. More rigorous studies are warranted and clinicians who work with pediatric patients should be aware of the risk of misdiagnosis of bipolar disorder in this population.