“There’s a tremendous amount of progress in understanding bipolar disorder. It’s a bad illness to have, but a good time to have it.” K. Jamison, Ph.D.
There was a time when a diagnosis of bipolar disorder in a child would be unthinkable. The earliest age of onset for this serious mood disorder was believed to be in the late teens. However beginning in the mid-1990s, more and more children were being diagnosed with bipolar disorder.
In fact, over the past decade the number of children diagnosed with bipolar disorder has increased dramatically, from 25 per 100,000 in the 1990s to 1000 per 100,000 in 2003. (That’s a 40-fold increase)
“A forty-fold increase in the diagnosis of bipolar disorder in children and adolescents is worrisome. We do not know how much of this increase reflects earlier under-diagnosis, current over-diagnosis, possibly a true increase in prevalence of this illness, or some combination of these factors.” Thomas R. Insel, M.D
Some physicians believe that the diagnosis of bipolar in children is being overly applied and have suggested that the label of bipolar has become a “catchall” diagnosis for every explosive, moody, or aggressive child.
To address this issue the American Psychiatric Association is urging that a new, more transient and less-stigmatizing diagnosis, Disruptive Mood Dysregulation Disorder be added to the latest Psychiatric Diagnostic and Statistical Manual. The new condition would apply to children who have chronic irritability, as well as recurrent temper outbursts. As a result, children would be treated with antidepressants as opposed to anti psychotics.
Bipolar disorder, formerly known as manic depression, is a serious life-long brain disorder which manifests as extreme mood swings, from very high (mania) to very low (depression). In children, it is referred to as early-onset bipolar disorder and has been diagnosed in children as young as six years old.
Because the diagnosis is controversial and is currently being debated, it is difficult to assess just how prevalent the disorder actually is. However, it is believed that up to one-third of the 3.5 million children and adolescents with depression in the United States may actually be experiencing early onset bipolar disorder.
Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history. However, most children with a family history of bipolar disorder will not develop the illness.
Bipolar disorder in children generally presents itself differently than in adults, and therefore can be difficult to diagnose. It often mimics the symptoms of ADHD. For this reason, physicians will focus on symptoms that are uncommon in ADHD but are present in bipolar disorder. These are:
- Euphoric or hysterical mood.
- Grandiose or exaggerated behavior.
- Jumping from topic to topic in rapid succession when talking.
- Decreased need for sleep.
- Acting out sexually (acting inappropriately flirtatious, engaging in inappropriate touching, or using explicit sexual language.)
In addition, it is common for children with mania to have multiple mood cycles during a single day that range from giddy and silly to morose and gloomy. These depressed cycles are important to recognize because of the danger of suicide.
Bipolar disorder that starts during childhood or adolescence is called early-onset bipolar disorder, and seems to be more severe than the forms that first appear in adults. Children with bipolar disorder are different from adults with bipolar disorder. Young people with this illness appear to have more frequent mood switches, are sick more often, and have more mixed episodes.
Physicians normally treat children with the same medications that are used in adults. Around half of the children receiving treatment for bipolar disorder are on an anti-psychotic drug, one-third are on a mood-stabilizer or an antidepressant medication, and many are on a combination of psychiatric drugs.
For more information on Bipolar Disorder in Children and to assess your own child for this disorder, please visit The Balanced Mind.
Source Material: APA 2000, DSM-IV, NIMH.gov, R.Comer, U.S. Dept of Health and Human Services