Objective: To survey attitudes of Australian and New Zealand (ANZ) child and adolescent psychiatrists regarding paediatric bipolar disorder (PBD) particularly as applied in the USA in recent years, in light of varying international attitudes and recent debate within ANZ.

Methods: A 16 item questionnaire plus space for comments, regarding PBD in ANZ and the USA, was sent to ANZ child & adolescent psychiatrists during late 2007.

Results: 60% response (n = 199), 53% reported never having seen a pre-pubertal case of bipolar disorder, a further 29% estimated seeing “1 or 2” cases. 12% reported diagnosing pre-pubertal bipolar disorder in the previous 12 months. Most (83%) rated pre-pubertal bipolar disorder as “very rare”, “rare” or not diagnosable. In contrast 57% rated adolescent bipolar disorder as “uncommon”, 96% reported seeing a case in their career and 56% had diagnosed case(s) in the prior 12 months. Opinion varied as to whether PBD was over-diagnosed (25%), appropriately diagnosed (42%), or under-diagnosed (28%) in ANZ, 5% were unsure. In contrast there was a consensus that PBD was over-diagnosed in the USA (90%), whilst few felt it appropriately diagnosed (3%), or under-diagnosed (1%), 6% were unsure. Only 13% favoured PBD diagnosis over traditional diagnoses (e.g. ADHD, Anxiety, Adjustment, PTSD, parent-child problems, peer relationship problems) in ANZ, 85% thought traditional diagnoses probably explain many US PBD cases.

Conclusions: Whilst some ANZ child & adolescent psychiatrists diagnose PBD phenotypes, a majority remain sceptical and hold to traditional views of bipolar disorder as rare to very rare pre-puberty.