The adult presentation of Bipolar Disorder (BD), as it is historically known, begins to appear in mid to late adolescence. In younger children, classical BD is extremely rare. In dealing with literally thousands of children, I have come across only a handful of cases of classic BD. The upsurge in diagnoses has occurred in younger children because these children present with behavior disorders associated with mood changes that are hard to classify using the present diagnostic parameters. However, including them in the BD category might not be the solution. For example:
- In childhood one rarely encounters the above mood episodes (mania/hypomania and depression) as separate, distinct entities. In other words, it is difficult to identify discreet episodes of elevated or irritable mood episodes, intervening normal periods, and than discreet episodes of depression. Thus in children who have mood variability with characteristics of bipolar episodes there is usually no cycling as there is with adults and the course is much more variable. In fact, it is rare to see full blown mania in young children. Keep in mind that there are normal times when children seem to feel great or even overly exuberant as a regularly occurring reaction to an external event or personal achievement.
- Since in adulthood irritability frequently presents as part of a manic episode, the psychiatric community decided to put children with excessive irritability alternating with other mood variations in the category of BD. But this seems more like convenience for the diagnostician than truth. If all these children were, in fact, presenting with some form of BD than they would eventually develop true BD, which they do not.
- Many children classified as Childhood BD really suffer from ADHD, a disruptive behavior disorder other than ADHD, Post Traumatic Stress Disorder (PTSD) with a behavioral disorder, or plain severe anxiety. Even youngsters with hypersexuality (typical of mania) often are sexually abused children acting out.
- It appears to me that behavior disordered children who don’t quite fit the ADHD, Oppositional Defiant Disorder or Conduct Disorder entities have been deposited in the BD category for lack of a better fit. And since some of the medications used for BD help with excessive behaviors, the diagnosis is made.
In summary, truly bipolar children are a rarity in clinical psychiatry, although, on occasion, one does see such a child. More likely, your child who has a severe behavioral disorder, great variation in mood, resistance to medications for ADHD, or anxiety is suffering from a mixed disorder which defies strict diagnosis at this time. The good news is that there is treatment for these children.
DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.