Joseph Biederman (29 September 1947 – 5 January 2023) was an American academic psychiatrist. He was Chief of the Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD at the Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School.
From 2019 to 2022, his citation metrics placed him in the top 0.01% of scientists across all fields. His research was and is highly cited: Biederman had a lifetime h-index of 121, which is one of the highest in the field of mental health. These metrics indicate that his publications have had a substantial impact on the field. Although his biggest focus was on attention-deficit/hyperactivity disorder (ADHD) in youth and adults, he also studied obsessive-compulsive disorder, bipolar disorder, tic disorders, depression, and substance use disorders in youth. Due to this work, he is regarded as the father of pediatric psychopharmacology. He attracted controversy and public attention for his role in promoting the diagnosis of childhood bipolar disorder and his financial ties to the pharmaceutical industry.
Awards and honors In 1995, Biederman was inducted into the CHADD Hall of Fame. He was awarded the 2021 World Federation of ADHD Gold Medal Award for lifetime contributions to the field of ADHD. In 2023, he was awarded the Lifetime Achievement Award of the American Professional Society of ADHD and Related Disorders. After his death, his contributions to ADHD clinical practice and research were memorialized by naming the Lifetime Achievement Award in his honor. During his lifetime, he was awarded over 15 million dollars in grant funding from the National Institutes of Health to support his research into the nature, causes and treatment of mental health disorders in youth.
Career Described as "one of the world's most influential child psychiatrists", Biederman published hundred of papers on attention-deficit hyperactivity disorder (ADHD) and ranks as one of the most-cited researchers on the subject. He was one of the first to systematically study the co-occurrence of ADHD with mood, anxiety and substance use disorders.Biederman, Newcorn and Sprich (1991) Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry. 148 564-577 His work showed that these disorders were common among ADHD patients. Biederman also completed the first large scale case-control family studies of ADHD.Biederman, Faraone, Keenan, Benjamin, Krifcher, Moore, Sprich-Buckminster, Ugaglia, Jellinek, Steingard, Spencer, Norman, Kolodny, Kraus, Perrin, Keller and Tsuang (1992) Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder. Patterns of comorbidity in probands and relatives in psychiatrically and pediatrically referred samples. Archives of General Psychiatry. 49 728-38Biederman, Faraone, Keenan, Knee and Tsuang (1990) Family-genetic and psychosocial risk factors in DSM-III attention deficit disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 29 526-533
Biederman also led studies concluding that a substantial minority of children diagnosed with ADHD actually had pediatric bipolar disorder. This theory was proposed at a time when it was unheard for young children to be diagnosed with bipolar disorder, which is characterized by severe mood swings. According to the New York Times, between 1994 and 2003, there was a controversial 40-fold increase in the diagnosis of pediatric bipolar disorder.
Although Biederman was one of the first to systematically study childhood onset bipolar disorder, the existence of bipolar disorder in childhood had been shown by many prior reports.Feinstein and Wolpert (1973) Juvenile manic-depressive illness: Clinical and therapeutic considerations. Journal of the American Academy of Child and Adolescent Psychiatry. 12 123-136Campbell (1952) Manic depressive psychosis in children: Report of 18 cases. Journal of Nervous and Mental Diseases. 116 424-439Coll and Bland (1979) Manic depressive illness in adolescence and childhood: Review and case report. Canadian Journal of Psychiatry. 24 255-263Davis (1979) Manic-depressive variant syndrome of childhood: A preliminary report. American Journal of Psychiatry. 136 702-706Feinstein (1982) Manic-depressive disorder in children and adolescents. Adolescent Psychiatry. 10 256-272Frommer (1968) Recent developments in affective disorders. British Journal of Psychiatry. 2 117-136Geller, Fox and Clark (1994) Rate and predictors of prepubertal bipolarity during follow-up of 6-to 12-year-old depressed children. Journal of the American Academy of Child and Adolescent Psychiatry. 33 461-468Kasanin (1931) The affective psychoses in children. American Journal of Psychiatry. 10 897-926McHarg (1954) Mania in childhood. Archives of Neurology and Psychiatry. 72 531-539McKnew, Cytryn and White (1974) Clinical and biochemical correlates of hypomania in a child. Journal of the American Academy of Child and Adolescent Psychiatry. 13 576-584Potter (1983) Manic-depressive variant syndrome of childhood. Diagnostic and therapeutic considerations. Clinical Pediatrics. 22 495-499Poznanski, Israel and Grossman (1984) Hypomania in a four-year-old. Journal of the American Academy of Child and Adolescent Psychiatry. 23 105-110Reiss (1985) Developmental manifestations in a boy with prepubertal bipolar disorder. Journal of Clinical Psychiatry. 46 441-443Sadler (1952) Juvenile manic activity. Nervous Child. 9 363-368Sylvester, Burke, McCauley and Clark (1984) Manic psychosis in childhood. Report of two cases. Journal of Nervous and Mental Diseases. 172 12-15Thompson and Schindler (1976) Embryonic mania. Child Psychiatry and Human Development. 6 149-154Tomasson and Kuperman (1990) Bipolar disorder in a prepubescent child: Case study. Journal of the American Academy of Child and Adolescent Psychiatry. 29 308-310Varanka, Weller, Weller and Fristad (1988) Lithium treatment of manic episodes with psychotic features in prepubertal children. American Journal of Psychiatry. 145 1557-1559Varsamis and MacDonald (1972) Manic Depressive Disease in Childhood. Canadian Journal of Psychiatry. 24 279-281Warneke (1975) A case of manic-depressive illness in childhood. Journal of Canadian Psychiatry Association. 20 195-200Weinberg and Brumback (1976) Mania in Childhood. American Journal of Diseases of Children. 130 380-385 In 1986, Weller et al.Weller, Weller, Tucker and Fristad (1986) Mania in prepubertal children: Has it been underdiagnosed? Journal of Affective Disorders. 11 151-154 searched the literature of case reports describing children with severe psychiatric symptoms. Of 157 such cases, 24% had childhood onset bipolar disorder. This review suggested that juvenile mania may be common among referred children with severe psychopathology but that it may be difficult to diagnose.
This early work led to systematic studies by Biederman and others which showed that childhood onset bipolar disorder was more common than originally believed, especially among children with attention deficit hyperactivity disorder or conduct disorder.Biederman, Mick, Faraone, Van Patten, Burback and Wozniak (2004) A Prospective Follow Up Study of Pediatric Bipolar Disorder in boys with attention deficit/hyperactivity disorder. Journal of Affective Disorders. 82S S17-S23Chang, Adleman, Dienes, Simeonova, Menon and Reiss (2004) Anomalous prefrontal-subcortical activation in familial pediatric bipolar disorder: a functional magnetic resonance imaging investigation. Arch Gen Psychiatry. 61 781-92Faedda, Baldessarini, Suppes, Tondo, Becker and Lipschitz (1995) Pediatric-onset bipolar disorder: A neglected clinical and public health problem. Harvard Review of Psychiatry. 3 171-195Leibenluft and Rich (2008) Pediatric bipolar disorder. Annu Rev Clin Psychol. 4 163-87 Childhood onset bipolar disorder is now recognized by the American Academy of Child and Adolescent Psychiatry as a valid disorder as indicated by the publication of a practice parameter for diagnosing and treating bipolar disorder in children.(2007) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry. 46 107-125
For many years the secondary prevention of bipolar disorder had been stymied by diagnostic uncertainties, especially its diagnostic criterion overlap with attention deficit hyperactivity disorder (ADHD). These uncertainties made it difficult for clinicians to identify children with the disorder leading to delays and failures to treat the disorder. To deal with this problem, Biederman began a program of research aimed at clarifying the diagnosis and better understanding its etiologic links with other disorders. In an initial study, he and his mentees examined the prevalence and clinical features of childhood onset bipolar disorder in clinically referred children.Wozniak, Biederman, Kiely, Ablon, Faraone, Mundy and Mennin (1995) Mania-like symptoms suggestive of childhood onset bipolar disorder in clinically referred children. Journal of the American Academy of Child and Adolescent Psychiatry. 34 867-876 The sample consisted of all children, 12 years or younger, who had been consecutively referred to Biederman's pediatric psychopharmacology clinic since 1991. Sixteen percent of 262 consecutive referrals met criteria for bipolar disorder. Their bipolar disorder was chronic, severe and impairing in multiple domains of functioning (psychopathology, cognitive impairment and social disability). All but one of the bipolar disorder children had a severe ADHD syndrome prior to the onset of mania. Notably, symptom overlap analyses showed that this high rate of comorbidity was not due to diagnostic criteria shared by the two disorders.
Using the same sample, Biederman evaluated the ability of the Child Behavior Checklist (CBCL) to identify children with bipolar disorder.Biederman, Wozniak, Kiely, Ablon, Faraone, Mick, Mundy and Kraus (1995) CBCL clinical scales discriminate prepubertal children with structured-interview derived diagnosis of mania from those with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry. 34 464-471 His results showed excellent correspondence between the clinical scales of the CBCL and DSM-III-R diagnoses of bipolar disorder. The excellent correspondence between clinical diagnoses and CBCL scales reflecting content congruent dimensions suggests that the CBCL could be a useful screening instrument to help identify mania and its associated comorbid conditions in referred children. Because other research groups replicated his findings,Mick, Biederman, Pandina and Faraone (2003) A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder. Biological Psychiatry. 53 1021-1027 they now provide a simple method for pediatricians and child psychiatrists to screen for bipolar disorder in their practices.