The prevalence of bipolar disorder in kids is considerably higher in the U.S. than in Europe.

Why?  Either American kids are more whacked then Europeans-- and you can blame genetics or environment for this; or, the process of diagnosis is whacked, either here or abroad.  Go on, pick: Tatooine or Hoth.

One way to answer this is to use American style diagnostic tools, such as the NIMH's Child Behavior Checklist (CBCL), on Europeans.  The answers on the CBCL can be grouped into different profiles, relating to different diagnoses.  For example, elevated scores in certain areas gives a CBCL-pediatric bipolar profile.

Using this approach, we were in fact able to show that the prevalence rate of children meeting this profile in Germany was comparable to pediatric bipolar rates in other countries using different diagnostic approaches.

In other words,

The prevalence of CBCL-pediatric bipolar disorder subjects in the general German population compares to rates of pediatric bipolar disorder in the US...

...However, no patient [with the CBCL bipolar profile] received a diagnosis of bipolar disorder.  Instead, 3 of 4 children with this profile (whose conditions would presumbaly have been diagnosed as bipolar disorder by some colleagues in the U.S.) received diagnoses of ADHD, oppositional defiant disorder, and conduct disorder.

So there you have it: the diagnosis is whacked.

Ah, you say, come on, what's the difference what you call it?---

Regardless of whether these subjects are affected by 'real' pediatric bipolar disorder or 'severe, pervasive ADHD' [etc]... they constitute a group of seriously disturbed children and adolescents.

Yes, but even though the world agrees the symptoms are the same, the consequences of each label is very different, right?  The epidemiology, the prognosis-- the meds?

But the real difference is the societal implications.  Getting a diagnosis changes the way you relate to the world, and the world relates to you.   The label changes your identity and how you think.

Don't agree?  Try killing someone and using "pervasive ADHD" as a defense.  Get it?

We pretend that psychiatry is an emerging science, and hide behind a feigned ignorance ("we don't know everything, but we're making progress!")   And so no one has to take responsibility, or even admit, that psychiatry is changing the evolution of humanity, right in front of our eyes, with nothing more than words.