Rising media exposure and stress levels can be linked to the rise in the diagnosis of bipolar disorder in children over the past twenty years, according to a top Minnesota child psychiatrist.

Dr. L Read Sulik, senior vice president of behavioral health for Sanford Health, is one of numerous experts I interviewed for Sunday's premium access story on the rise in the diagnosis of bipolar disorder in children. (Check back Wednesday for open access to the story online.) The story quoted a study, which found a 40-fold increase in child bipolar diagnoses in a recent 10-year timeframe, as well as a host of top psychiatrists who acknowledge that bipolar has been misdiagnosed in many children.

Sulik agreed that bipolar has been overdiagnosed -- and that children as a result have been prescribed "big-gun medications" such as antipsychotics inappropriately. "When you see one of those kids who has a true bipolar disorder, it's significant. It's apparent," Sulik said. "So many kids that I've seen who have had that diagnosis applied to them, to me, are children who are just not able to manage their physical arousal very well" and who don't have the disorder. 

Physical arousal has been a specific research interest for Sulik, who previously was in charge of mental health reforms and programs for the Minnesota Department of Human Services. It basically refers to how children's emotions are activated. Sulik said the environment in which today's children are raised makes it more difficult for them to regulate their physical arousal levels, which makes them more explosive and chronically irritable. That can set them on a path on which bipolar or some other mental health diagnoses might be a consideration. 

"So are we doing enough to help our kids develop the level of capacity that they need to regulate their arousal?" Sulik asked. "It’s a much bigger underlying issue. Our kids today are by and large stimulated at a much higher level and stressed at a much higher level than before … We should be stepping back and saying, 'OK, our children are clearly a barometer in many ways of the world in which they are in. What is changing? What is changing that we are seeing such an increase in the number of children that are having significant emotional behavioral problems?'"

There is also growing awareness, Sulik said, that children develop emotionally at different rates -- just as children grow physically and intellectually at different rates early on. Children who are younger, emotionally speaking, are going to face struggles as they interact with other kids and are more likely to be labeled as problem kids.

"It fits that there are just some kids who are just much younger emotionally and are therefore much less able to regulate themselves in this regard," Sulik said. "It's really easy for them to become pathologized into certain categories as a result."

Sunday's story was the first in a series on this issue. I am interested in talking with parents whose children have been diagnosed with bipolar disorder and related conditions -- regardless of whether it was a suitable diagnosis that really helped children get better, or whether it was a misdiagnosis that caused harm. Call me at 612-673-7744 or email jeremy.olson@startribune.com if you have a story on this subject that you want to tell.

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