Childhood Bipolar Disorder

Bipolar disorder, also called manic depression, is a mental health disorder characterized by periods of mania and depression.  During the manic periods, a person may experience extreme “highs” with symptoms like feeling indestructible, rapid thoughts, inability to stay still and/or engaging in risky behaviors. During the depressive periods, a person with bipolar disorder may feel very sad, pessimistic, lack energy and/or have changes in sleep or eating habits.

Childhood bipolar disorder differs from adult bipolar disorder because the periods of mania and depression typically come and go at much faster intervals.  In adults, one period may last weeks to years whereas with children an episode may last hours. In some instances both mania and depression can occur simultaneously.  Furthermore, pediatric mania and/or depression symptoms may present themselves in different ways such as irritability or other “masked” symptoms. It is important to note that in order for an adult or child to be diagnosed with bipolar disorder, the mood swings must be interfering with the child’s daily life.

Bipolar Symptoms in Children

Children with manic depression (bipolar disorder) may experience extreme mood swings. In children, it is possible to display both mania and depression at the same time.

During the manic period, children with this disorder may experience:

  • Inflated self esteem
  • Need for little sleep
  • Excessive energy
  • Distracted thoughts and quickly fluctuate between activities
  • Rapid and excessive talking
  • Participation in risky behaviors
  • Increased sexuality
  • Dramatic moods swings  (expressing irritation, continously giggling or behaving in a silly or immature manner)

During the depressive period, children with this disorder may experience:

Childhood Bipolar Disorder

Not enjoying activities they normally would is a depressive symptom of bipolar disorder.

  • Deep, lasting sadness
  • Not enjoying activities which once used to enjoy
  • Withdrawing from social life and interests
  • Sleeping too much or too little
  • Changes in eating habits
  • Lethargy
  • Low self esteem or feeling worthless
  • Thoughts of suicide or harming oneself

Problems with Diagnosing Bipolar Disorder in Children

Diagnosing any mental health disorder can be difficult as signs may manifest themselves in different ways.  In children, it becomes even more difficult to diagnose a mental health disorder such as bipolar disorder because psychological changes and emotional inconsistencies are normal parts of childhood development. Diagnosing bipolar disorder in children can be even more difficult because the symptoms may resemble other disorders like ADHD or oppositional defiance disorder.  Many psychological experts believe that bipolar disorder is common in children whereas others believe that it is being over diagnosed.  Thus, it is a good idea to get a second opinion to confirm a diagnosis of childhood bipolar disorder.

How Common is Bipolar Disorder in Children?

Bipolar disorder is most commonly diagnosed during the teenage or young adult years however there has recently been an increase in the number of children diagnosed with childhood bipolar disorder. It is now suggested that approximately 2% of children, ages 5 to 18, have been diagnosed with manic depression. Some experts believe that a different set of requirements should be made for diagnosing childhood bipolar disorder in order to take into account the emotional and behavioral characteristics of children.

Childhood bipolar disorder was previously considered rare, but there has been an increase (40%) in cases within the last few decades. It is unclear as to whether the increases are the result of societal changes or an increased awareness of the disorder.

What Causes Childhood Bipolar Disorder?

Bipolar disorder is thought to be caused by an imbalance in hormones or neurotransmitters in the brain. Evidence shows that bipolar disorder is genetically inherited with 85% of those diagnosed also having a history of depression or bipolar disorder in the family.  However, it is more difficult to distinguish a cause for bipolar disorder in children.  Children of parents who have depressive symptoms are more likely to be reared in an environment conducive to mental health disorders.  Thus, it is difficult to separate the genetic link from any environmental factors.  Most experts agree that bipolar disorder is likely caused by a combination of genetic, environmental, and social factors.

How is Childhood Bipolar Disorder Treated?

To date, significant studies on treatment for childhood bipolar disorder have been far and few between. Most experts heavily rely on information from adult bipolar disorder studies to develop a treatment plan for children. Treatment typically involves medications such as mood stabilizers and/or antipsychotic medicines. Side effects commonly associated with manic depression medications include weight gain, tardive dyskinesia, movement disorders and/or polycystic ovarian syndrome.

When treating children with bipolar disorder, parents are encouraged to involve their children in the planning and treatment process. If children feel like they are being forced to take medications, they will become resentful, resistant and/ or defiant.

Studies about the effectiveness of therapy in treating childhood bipolar disorder are ongoing.  Cognitive behavioral therapy appears to be a very promising a treatment for adult-onset bipolar disorder, but its effect on children in inconclusive at this time. Therapy is still suggested for children with this disorder.  Counseling can help children cope with the disorder, foster positive relationships, strengthen their support group and improve their self-esteem.

References:

American Psychiatric Association. (2001). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, D.C.

Griswold, K. S. & Pessar, L. (2000). Management of bipolar disorder. American Family Physician. Retrieved from http://www.aafp.org/afp/2000/0915/p1343.html

Van Meter, A., Moreira, A. L., & Youngstrom, E. (2011).  Meta-analysis of epidemiological studies of pediatric bipolar disorder.  Journal of Clinical Psychiatry. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21672501

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