New Hope for Children and Teens with Bipolar Disorder

Random House

Chapter One

Does My Child Have Bipolar Disorder?

Mark is a teen who has been experiencing severe mood swings, fluctuating between extreme sadness and extreme happiness, since early childhood. During periods of sadness, Mark is irritable and gets in frequent arguments with his parents and teachers. He has a hard time concentrating, feels tired, and spends much of his time sulking alone in his room. Often, during these episodes of depression, he feels so miserable that he considers committing suicide.

After several weeks of feeling very down, Mark suddenly, without any warning or apparent reason, becomes exaggeratedly happy for one to two weeks. During periods of an elevated or “high” mood, he becomes very talkative, impulsive, and so energetic that he needs to sleep only a couple hours a night to feel rested the next morning. He usually also feels invincible, to the point of putting himself in dangerous situations such as driving recklessly on the freeway. Like approximately 1 percent of the teenagers in the United States (or about 400,000 teens), Mark is experiencing typical symptoms of bipolar disorder.

Formerly known as manic-depressive illness, bipolar (bi, meaning “two”) indicates that mood cycles or swings between two opposite poles: mania and depression. A child’s mood is like a roller coaster with unpredictable ups and downs or highs and lows. As an analogy, when a child is in the “north pole,” she or he experiences an episode of mania or “high” mood and, in the “south pole,” an episode of depression or “low” mood.

Bipolar disorder is a lifelong illness that affects approximately 1 percent of the world’s adult population of all sexes, ethnic backgrounds, and economical levels. It is most interesting that up to 60 percent of adults with bipolar disorder report experiencing symptoms of the disorder as children. For example, they remember having had long periods of being extremely quiet or isolative, with poor concentration and low motivation. Other times they felt excessively active, outgoing, talkative, and even bossy or very silly. Still, until recently, many professionals did not believe that young people could have bipolar disorder.

Children and teens with bipolar disorder have been frequently misdiagnosed with other psychiatric conditions, such as attention deficit hyperactivity disorder (ADHD) or behavior problems, or parents were blamed for their children’s misbehaviors. However, thanks to the recent interest and research in bipolar disorder in youth, it is now clear that this disorder can affect a person at any age.

Formerly known as manic-depressive illness, bipolar (bi, meaning “two”) indicates that mood cycles or swings between two opposite poles: mania and depression.

The Cost of Bipolar Disorder

Bipolar disorder is very costly to the individual, the family, and society in general. It is ranked among the ten most disabling conditions in the world, but up to 40 percent of adults with bipolar disorder and an even higher percentage of youth go untreated. Moreover, it typically takes approximately 8 to 10 years after the first signs of bipolar disorder to receive the appropriate diagnosis and treatment.

Recent media attention has helped parents and professionals become more knowledgeable about the problem of children and teens with bipolar disorder, but it also has created some alarming misconceptions regarding symptoms and treatment of childhood bipolar disorder. Parents of children with severe behavior and mood problems are bringing their sons and daughters in for evaluation, but at our clinic we are finding that only around 50 percent of all children and teens referred for assessment actually have the disorder. The remainder of the children have other psychiatric disorders that mimic bipolar, such as ADHD, anxiety disorders, oppositional defiant, conduct disorders, or Asperger’s disorder (mild autism). (These will be discussed further in chapter 2.)

Separating the diagnosis of bipolar disorder from these other similar disorders is critical. Unfortunately, laboratory tests and/or specific brain exams for diagnosing bipolar disorder do not yet exist. We can rely only on direct observation of a child’s behavior and moods during clinic visits. But observations during an appointment are limited by time and by the fact that children usually do not show their symptoms in the office unless their disorder is severe.

If your child is misdiagnosed with bipolar disorder, he or she will be treated with medication specific for bipolar management, which will, as expected, fail to help and expose your child to unnecessary medication side effects. Conversely, if your child has bipolar disorder and is not correctly diagnosed, he or she will be treated with inappropriate medications and may suffer needlessly for many years. Therefore, it is crucial that you are aware of and understand the symptoms and subtypes of bipolar disorder discussed in this chapter and become familiar with the controversies regarding its diagnosis. With this information in hand, you can better work closely with your child’s clinicians to accurately assess your child’s symptoms. If untreated or inadequately treated, bipolar disorder can affect the normal cognitive thinking, emotional, and social development of a child, increasing the risk for suicide, legal problems, and abuse of illegal drugs.

Before discussing the symptoms of bipolar disorder in children and teens, it is important that you understand the fact that the severity of symptoms may vary greatly from child to child. The situation is similar to a case of the flu. If your child has mild flu symptoms with no fever, he or she can still run around and enjoy normal activity. On the other hand, a severe case with fever, muscular pain, and chills will keep your child in bed. The same range of symptoms is found in bipolar disorder; they can be mild, moderate, or severe. The decision for treatment depends mainly on whether the symptoms affect the child’s normal development and functioning at home, at school, and with his or her friends.

Although we know that bipolar disorder exists in children and teens, there is controversy regarding the way the symptoms appear in youth. Several studies are ongoing to clarify these diagnostic issues. Until further research, many researchers and clinicians believe that the symptoms of bipolar disorder in young people may be divided in the groups and subgroups described in this chapter and summarized in the sidebar, "Bipolar Disorder Symptoms in Children and Adolescents."

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Excerpted from New Hope for Children and Teens with Bipolar Disorder by Boris Birmaher, M.D. Excerpted by permission.
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