"Rebecca died next to her parents' bed in Hull, Massachusetts, on 13 December last year. This Wednesday a pre-trial hearing began that will be followed by a full trial to determine whether her parents, Carolyn and Michael Riley, intentionally gave Rebecca too much of the drug, or whether she died of an accidental overdose. Whatever the verdict, Rebecca's tragic story forms part of a wider narrative: the growing numbers of young children in the US being diagnosed with bipolar disorder and given drugs to treat it."

"While the trend is clear, the reasons behind it are not. Psychiatrists also disagree over whether children are being helped or harmed by being diagnosed with the condition."

"Bipolar disorder used to be called manic depression. People with it swing across an extreme spectrum of moods, usually from a state in which they feel euphoric and active, to one of depression and despondency, and back again."

"In 1994, the official psychiatric manual, DSM-IV, widened the definition of bipolar disorder. The classic condition, characterised by the symptoms described above, was named bipolar disorder I, and was joined by three newly defined conditions: bipolar disorder II, which is a milder version of disorder I; cyclothymic disorder, in which mood swings manifest themselves more subtly; and bipolar disorder not otherwise specified, a catch-all category for people with bipolar-like symptoms who do not fit the other three diagnostic criteria."

"Some specialists see this widening of the diagnostic criteria as the cause of the explosion in the numbers of children diagnosed with bipolar disorder. "When DSM expands its symptomology there's obviously a greater basis for diagnosis and prescription," says Lisa Cosgrove, a clinical psychologist at the University of Massachusetts, Boston, who studies the links between psychiatrists and the drug industry."

"Child psychiatrist Gabrielle Carlson agrees. She and colleague Joseph Blader, both at Stony Brook University, New York, analysed data on people with bipolar disorders discharged from US hospitals. Between 1996 and 2004 the rate "went up minimally in adults, but rose astronomically in children", Carlson says."

"In 1996, 13 out of every 100,000 children in the US were diagnosed as having bipolar disorder. In 2004, the figure was 73 in 100,000, a more than fivefold rise, they report in a paper to be published in "

". Among children diagnosed with a psychiatric condition in 1996, 1 in 10 were deemed to have bipolar disorder. By 2004, 4 out of 10 children with a psychiatric condition were told they were bipolar "

"Some say this high prevalence of bipolar disorder in children in the US, which far exceeds that in most other countries, is genuine. "I think it's down to increased recognition that the condition exists in children, which wasn't accepted until a decade ago," says Susan Resko, executive director of the Child and Adolescent Bipolar Foundation, an advocacy group for families with a bipolar child based in Wilmette, Illinois."

" by Michael Miller, a psychiatrist at Harvard Medical School in Boston, the jury is still out. "We simply don't have all the information we need to connect the dots between behaviour, causes and symptoms. We don't know yet if kids are being under-medicated, over-medicated or mis-medicated," he told "

"That uncertainty over both the cause and true prevalence of bipolar disorder raises concerns that children are being prescribed inappropriate drugs with damaging side effects. Lithium, for example, can cause excessive weight gain, thirst and acne in young children. It also makes children want to urinate more. Valproate can trigger excessive hair growth and, in adolescent girls, polycystic ovary syndrome, a leading cause of infertility."

"Another worry is that drugs prescribed for other psychiatric conditions could be triggering bipolar disorder. Around 2 million children in the US are diagnosed as having attention deficit hyperactivity disorder (ADHD), which in children presents similar symptoms to bipolar disorder "

"This possibility is backed by a review of worldwide rates of bipolar disorder in children published in 2005 by C�sar Soutullo of the University of Navarra in Pamplona, Spain, and colleagues ("

", vol 7, p 497). One study they cited found that children given antidepressants go on to develop a bipolar disorder at
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