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There has been considerable debate about whether or not children can have true bipolar disorder (BPD) and how they should be treated. However, bipolar disorder, a condition that used to be called “manic depressive disorder” is now known to definitely occur in young children. Even though there have been concerns that the condition is over diagnosed in children, it should still be considered an important impairing disorder in this age group.
Adults with BPD alternate between episodes of euphoria ( Mania) and depression. While “manic,” they may talk too much, spend too much money, often getting themselves and their families into serious financial trouble, and come up with grandiose ideas about their talents and abilities. Their depressive episodes can be completely disabling and can lead to suicide.
Children and youth with BPD do not seem to have classical symptoms of the condition, taking into account their developmental stages, certain behaviours can be viewed as the beginning of a lifelong problem with mood regulation.
In children, euphoria is shown by, for example, giggling or laughing a lot at inappropriate times or places and for no apparent good reason, irritability, Grandiosity (believing you’re a superhero and trying to demonstrate your ability to fly) decreased need for sleep without evidence of daytime fatigue, talking a lot and very quickly, and loud, intrusive, and hard to understand speech. While depressed the child may be sad or tearful, feel hopeless, and have decreased energy. They may have physical symptoms like stomach aches or headaches and difficulty with eating or sleeping. Some children may talk about killing themselves.
Children with BPD often have other problems too. They can have diagnoses of attention deficit disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD) or anxiety disorders at the same time. This makes it difficult to establish the diagnosis of BPD. Some children have serious problems maintaining their mood stability and have a lot of intense mood swings every day at least several days a week. Children often have racing thoughts that interfere with functioning, too.
The American Academy of Child and Adolescent Psychiatry has recommended that a diagnosis of bipolar disorder be made through a comprehensive evaluation including questioning of child, parents, and other informants such as coaches, child care providers, teachers, that is done over a period of weeks or even months. A single interview with information provided by only one person is not sufficient to make an accurate diagnosis. The diagnosis should be based on
- the presence of mood episodes, that is, the behaviours seen, such as sleep disturbances, and anger or irritability, occur together and in a specific time period ( at least 7 days for mania and 4 days for Hypomania) and then change, signalling the end of an episode.
- the presence of symptoms that are not usual to the child, but are characteristic of an episode. For instance if the child is distractible all the time, then ADHD is more likely to be the diagnosis. If, however, the child is distractible only during a specific time period when he/she is also irritable, then the behaviours are likely characteristic symptoms of bipolar disorder.
- the degree of impairment at school, home, and with peers.
Causes
Bipolar disorder tends to run in families, suggesting that there is a genetic component, although environmental factors play a role, too. It is likely that having multiple genes combined with traumatic experiences or chronic stress can trigger an episode. In some people there is no known cause.
Treatment
In a systematic review of studies of treatment of bipolar disorder in children (1), only two medications were found to improve manic symptoms better than a Placebo medication did. The two effective treatments are a combination of quetiepine and valproate, and olanzapine, which reduced ADHD symptoms, aggression and improved global functioning Although lithium, the usual treatment for adults, does not seem to work for children, it does improve global functioning of teenagers with bipolar disorder who also have substance abuse problems.
Sources
- Bipolar Disorder Resource Center, American Academy of Child & Adolescent Psychiatry. FAQs on Bipolar Disorder. http://www.aacap.org/cs/bipolar_disorder_resource_center/faqs_on_bipolar_disorder.
- Kowatch RA, Fristad, Birmaher B, Wagner KD, Findling RL, Hellander M, and the Workgroup members. Treatment Guidelines for Children and Adolescents with Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2005; 44(3): 213-235.
- Bipolar Disorder. Children’s Mental Health Research Quarterly. 2008; 2(3): 1-15. http://www.fhs.sfu.ca/news/news/2008-news/childrens-mental-health-research-quarterly-1
Resources
The Bipolar Child by Papolos D and Papolos J. Broadway Books (2002).
Bipolar Disorders. A Guide to Helping Children & Adolescents by Mitzi Waltz. O’Reilly & Associates, Inc. (1999).
Bipolar Disorder. A Guide for Patients and Families by F.M. Mondimore. The Johns Hopkins University Press (1999).
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