What to know about what you don’t know you know. #1: Intuition is very efficient—if you don't overthink it.
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The title of my colleague's book and blog is misleading, because most people think of childhood as preceding adulthood, which is defined legally as age 18. If one wants to use the English word "child" to mean non-adolescent, then my colleague is right that the NCS study was about adolescents, but in that case I suggest he retitle his blog and book as above, so that he is more clear about what he means.
My colleague makes a big distinction about age 12, apparently. Before that age you are a child; after that age you are not. His claim is there is ZERO bipolar disorder in children, meaning before age 12. He cannot deny that suddenly, miraculously, mania begins at age 13, because the NCS proves this to be the case, as documented below, in 1.9% of 13 year-olds. What this miracle exactly is we do not yet know.
The BJP study cited above, according to his definitions, is not about childhood depression and later development of bipolar disorder; it is about adolescent depression: the authors clearly state so, with a mean age of about 14 years, in contrast to 10 years in the Geller study.
In another adolescent study, by Strober and Carlson, adolescents had a 20% switch from depression to mania in only 3-4 years of follow-up. These authors have been critical of risk of overdiagnosis of bipolar disorder in children. http://archpsyc.jamanetwork.com/article.aspx?articleid=492789
Thus, there is still no similarly conducted prospective 10 year or longer study of children (below age 12) with depression that contradicts the Geller study. If my colleague knows of such data, he can inform us.
My colleague also needs to contend with Goldberg's study of young adults with MDD (not bipolar disorder) (http://www.ncbi.nlm.nih.gov/pubmed/11481161), mean age 23, who, followed for 15 years, develop bipolar disorder in 46% of cases, similar to the Geller data. Goldberg has published against bipolar overdiagnosis, so I wonder what bias he has.
The NCS data are below:
In the abstract:
The National Comorbidity Survey-Adolescent Supplement NCS-A is a nationally
representative face-to-face survey of 10,123 adolescents aged 13–18 years in the continental U.S.
DSM-IV mental disorders were assessed using a modified version of the fully structured World
Health Organization Composite International Diagnostic Interview.
Results—Anxiety disorders were the most common condition (31.9%), followed by behavior
disorders (19.1%), mood disorders (14.3%), and substance use disorders (11.4%), with
approximately 40% of those with one class of disorder also meeting criteria for another class of
lifetime disorder. The overall prevalence of disorders with severe impairment and/or distress was
22.2%; (11.2% with mood disorders; 8.3% with anxiety disorders; 9.6% behavior disorders). The
median age of onset for disorder classes was earliest for anxiety (6 years), followed by 11 years for
behavior, 13 years for mood, and 15 years for substance use disorders.
Table 2 presents the lifetime prevalence rates of DSM-IV mental disorders by sex, age group,
total DSM-IV disorders and disorders with severe impairment. Mood disorders affected 14.3%
of the total sample, corresponding to 11.7% who met criteria for MDD or dysthymia and 2.9%
Bipolar disorder was present in 1.9% of children age 13-14, 3.1% age 15-16, 4.3% age 17-18. Total = 2.9%
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