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Children and Bipolar Disorder

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There has been a striking increase in the diagnosis of bipolar disorder in children over the past several years. Pediatric bipolar disorder is being diagnosed at a rate 40 times greater than the recent past!

What this dramatic increase represents, few mental health professionals can agree upon. Some see rampant overdiagnosis, while others believe mental health professionals are identifying and treating a previously unnoticed problem.

Bipolar disorder in adults is difficult to diagnosis and pediatric bipolar disorder is even more complex. Mental health professionals disagree about the diagnostic criteria for bipolar disorder in children and if pediatric bipolar disorder could be a developmental subtype of the adult disorder.

Bipolar disorder for children and adults is a clinical diagnosis, meaning there is no definitive “test” one can take to arrive at the diagnosis.

Bipolar disorder is classified as a mood disorder. It involves extreme changes in mood, energy, thinking and behavior. Persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.

However, bipolar disorder often looks very different in children than in adults. Children’s symptoms rarely follow discrete patterns. Children may have a mix of mania and depression that cycles rapidly and produces a chronic state of irritability. Bipolar disorder in children is especially difficult to distinguish from attention deficit hyperactivity disorder and oppositional defiant disorder, as many of the symptoms are the same.

Management of bipolar disorder typically involves the use of psychotropic medications prescribed by a psychiatrist. However, there is little research on the use of psychotropic medications for children with bipolar disorder (compared to
adult studies) and often adult medications are not appropriate for children.

Identifying a specific diagnosis, especially in the case of pediatric bipolar disorder, does not always imply there is a specific treatment technique or approach that is helpful. In our practice we prefer to describe an individual child’s strengths and weaknesses. We look at behavior problems as an indication that specific skills need to be taught, and we look for triggers or situations where lack of skills is likely to cause significant problems in the child’s life. We might describe a child as having difficulty considering likely outcomes or consequences of her actions, or a child who is having difficulty handling unpredictability, ambiguity and novelty.

So what can you do if your child is experiencing moodiness that causes significant disruption for your child and your family’s life?

First, contact an experienced therapist who works with children. The therapist should take time to carefully gather the family history and a detailed description of the behaviors you are observing and concerned about.

Next, the therapist should spend time with your child establishing a relationship and observing firsthand your child’s behaviors. Be suspicious of a quick diagnosis that is not the result of lengthy observation.

Proceed cautiously if the therapist proposes medication for your child. The types of medications used for bipolar disorder require a child psychiatrist, who specializes in medications for children.

Educate yourself about the diagnosis and the medications. As a parent you are often your child’s best advocate.      

Cary and Tonja Rector are married and live with their children in Manlius. Cary is a licensed mental health counselor and Tonja is a licensed marriage and family therapist. Write to them in care of editorial@familytimes.biz. Consult your own health care provider before making decisions affecting your family’s well-being. To comment on this article, write to editorial@familytimes.biz.

© Family Times: The Parenting Guide of Central New York