The following letter was written to the New York Times Magazine in response to the article, "The Bipolar Puzzle," on children's bipolar disorder published on September 14, 2008. The letter was not selected for publication but I believe it remains of interest to readers of this website:

In my thirty years of practice as a behavioral-developmental pediatrician, of recent I regularly see children under the age of six whose worried parents have been told their children are bipolar. There have always been very difficult to manage, highly persistent, intense and sensitive children who test their parents' and other caregivers' authority.

I have repeatedly found that a basic reframing of these children's behavior -- the children's unconscious need, for the sake of their security, to have the parents in control -- is very helpful towards alleviating parents' worry and preparing them for the heavy lifting work of setting effective limits. Developing an effective time out procedure which may require a politically incorrect physical component (at least keeping the child restrained in a hold) is often necessary for success. Nearly every parent of this kind of child says "We've tried that," yet with the proper support and motivation, in as little as two or three days, remarkable changes can occur.

The trouble for most parents is finding a professional who is willing and comfortable in a critical leadership and supporting role. Too often "easy" diagnoses like ADHD and bipolar disorder are offered which lead everyone to believe the children "can't" control their behavior. An inevitable path to drug treatment begins. Drugs can work at times but reinforce a family's perception of permanent patienthood. The bipolar diagnosis in young children is an absurdity and its drug cocktail treatment, an obscenity, when they prematurely close the door to otherwise potentially profound changes in family behavior.