DSM Applications to Young Children: Are There Really Bipolar and Depressed Two-Year-Olds?

Scientific commonsense would suggest that very young children cannot have psychiatric disorders such as bipolar disorder or major depression since they do not have the level of development to express the complex characteristics of these disorders. This chapter provides a detailed survey of current evidence supporting this common sense claim. The chapter first gives a general perspective on DSM that will be applied in looking at childhood psychiatric diagnoses and should be of some interest in its own right. I argue that there are some DSM based categorizations--those of major depressive disorder and bipolar disorder--that have substantial empirical support. I look at these two classifications as the best case for pediatric psychiatric disorders. I argue that this best case fails given our current state of knowledge, raising doubts in general about psychiatric diagnoses in small children. This conclusion has practical importance, since small children are increasingly being given powerful psychoactive drugs.