Bipolar Diagnosis in Children
Bipolar Diagnosis in children was the topic in a study conducted by Demitri Papolos, MD, and Janice Papolos, which indicates that over 80% of children who have Bipolar Disorder come from families with a history of mood disorders and/or alcoholism on both sides of the family. And yet, even when a strong family history of this is present, professionals rarely consider early-onset Bipolar Disorder. Many children who actually have Bipolar Disorder have been diagnosed with ADHD. Why? Because the official guidelines for diagnosing Bipolar Disorder found in the
Since 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modifications to adjust for age. Similarly, to diagnose a child or adolescent with bipolar disorder, there need be at least one period of mania that is manifested by a distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least one week or any duration if hospitalization is required. In addition, during the period of mood disturbance the children or adolescents may experience to a significant degree at least three of the following symptoms (or four if their mood is irritable): inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal-directed activity, or excessive involvement in activities with the potential for painful consequences. For a diagnosis of bipolar disorder these symptoms must also produce marked impairment in functioning and be unaccounted for by other psychiatric disorders due to physiologic effects of substances or medical conditions (American Psychiatric Association 1994).
Obstacles in identifying and diagnosing this disorder in children and adolescents include the low base rate of the disorder, the diversity in clinical presentation within and across episodes, the symptomatic overlap of mania with other disorders commonly found in childhood, such as attention-deficit hyperactivity disorder (ADHD), and the constraints placed upon symptom expression due to the developmental stage of the child (Bowring and Kovacs 1992). Developmental factors may confound the presentation of symptoms; for example, normal behavior in children may sometimes resemble hypomanic activity. Therefore, if not viewed within the context of normal behavior, psychopathology may not be recognized.
In young children it is difficult to identify discrete episodes of mania or depression. The clinical presentation of childhood bipolar disorder is variable but includes a waxing and waning course, worsening disruptive behavior, moodiness, irritability, difficulty sleeping, impulsivity, hyperactivity and decreased concentration. Episodically they experience short attention span, low frustration tolerance, explosive anger followed by periods of guilt, depression and declining academic performance (Weller and colleagues).
Dr. Papalos lIists those symptoms common to children who have early-onset Bipolar Disorder.
Very Common
* Separation Anxiety
* Rages & Explosive Temper Tantrums (lasting up to several hours)
* Marked Irritability
* Oppositional Behavior
* Frequent Mood Swings
* Distractibility
* Hyperactivity
* Impulsivity
* Restlessness/ Fidgetiness
* Silliness, Goofiness, Giddiness
* Racing Thoughts
* Aggressive Behavior
* Grandiosity
* Carbohydrate Cravings
* Risk-Taking Behaviors
* Depressed Mood
* Lethargy
* Low Self-Esteem
* Difficulty Getting Up in the Morning
* Social Anxiety
* Oversensitivity to Emotional or Environmental Triggers
Common
* Bed-Wetting (especially in boys)
* Night Terrors
* Rapid or Pressured Speech
* Obsessional Behavior
* Excessive Daydreaming
* Compulsive Behavior
* Motor & Vocal Tics
* Learning Disabilities
* Poor Short-Term Memory
* Lack of Organization
* Fascination with Gore or Morbid Topics
* Hypersexuality
* Manipulative Behavior
* Bossiness
* Lying
* Suicidal Thoughts
* Destruction of Property
* Paranoia
* Hallucinations & Delusions
Less Common
* Migraine Headaches
* Bingeing
* Self-Mutilating Behaviors
* Cruelty to Animals
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Early intervention & treatment offer the best chance for children with emerging bipolar disorder to achieve stability, gain the best possible level of wellness, and grow up to enjoy their gifts and build upon their strengths. Proper treatment can minimize the adverse effects of the illness on their lives and the lives of those who love them.
Families of affected children and adolescents are almost always baffled by early-onset bipolar disorder and are desperate for information and support. You are encouraged to read the additional information here and at other prominant webites, and as always, you should seek professional advice from a doctor about bipolar diagnosis in children.
