Early Onset Bipolar Disorder
Diagnosing Children who Experience Extreme Mood Changes
In the last decade the diagnosis of bipolar disorder among children has increased fivefold. Bipolar, a disorder of the brain, is typically marked by extreme mood changes from mania (high) to depression (low). Until recently the diagnosis was rarely made in children.
The Bipolar Child
However in 1999 Demitri Papolos, M.D. and Janice Papolos wrote the book, The Bipolar Child, The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder. The book, now in its 3rd edition, literally transformed how psychiatrists and parents alike, view bipolar disorder. Through their research, the Papolos’ found that children with bipolar often have different symptoms and reactions than their adult counterparts.
Typical symptoms of children that have bipolar include, but are not limited to:
- An expansive or irritable mood
- Separation anxiety
- Defiance of authority
- Hyperactivity
- Extreme sadness or lack of interest in play
- Extreme rages
Difference Between Bipolar and ADHD
During a child’s manic phase, behaviors such as extreme irritation, hyperactivity and distractability may be seen as ADHD. The two disorders are very similar and hard to distinguish. As a result the Child and Adolescent Bipolar Foundation (CABF) estimates that a significant number of children who have ADHD may indeed have bipolar or a combination of the two. However, according to the National Alliance on Mental Illness (NAMI), children with bipolar also experience elated behavior, grandiose ideas, flight of ideas and hypersexuality that are uncommon in ADHD patients.
Rapid Cycling
One of the most significant differences the Papolos’ found is that children with the disorder often cycle in and out of depression and mania multiple times a day. This rapid cycling creates a difficult problem when diagnosing bipolar in children.
In order to diagnose a patient with bipolar, symptoms must match the adult criteria of the DSM-IV manual. NAMI says one of the criteria requires a "distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days." For children, if the Papolos’ research is correct, meeting these criteria is hard if not impossible.
Overdiagnosing
However not everyone thinks the Papolos’ are correct. In the article, “Is Early Onset Bipolar Disorder Simply Normal Childhood,” that appeared on PsychCentral’s website on December 12, 2007, John M. Grohol, PSY.D. argues that the Papolos’ definition of what constitutes a bipolar child is simply the terrible two’s. As he says, “Children responding poorly to being told “No” as a toddler? That’s normal and can be diagnostic of absolutely nothing.”
The preponderance of children diagnosed with bipolar in the last decade has led experts to question how safe the diagnosis is. In the article by Andy Coghlan, “Bipolar Children, Is The U.S. Overdiagnosing?,” that appeared May 16, 2007 in NewScientist, strong medications such as Lithium and Valproate are given to children who have this diagnosis. These medications have serious side effects including rapid weight gain and in adolescent girls can trigger polycystic ovarian syndrome.
To help parents navigate the often complicated world of early onset bipolar disorder, many organizations such as Child and Adolescent Bipolar Association and NAMI are available to provide valuable information and support for those families in need.
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