Kids with Bipolar Disorder
There is so much controversy and misunderstanding about bipolar kids that it is hard to know where to begin. The first thing you should know is that even the experts cannot agree on how best to diagnose bipolar disorder in young people. There has been many years of debate on whether kids should be diagnosed using the same criteria that is applied to adults, or if bipolar disorder in kids has different symptoms and should therefore be assessed along different lines.1
I have to “come out” at this point and let you all know something about me – I am skeptical about young children and tweenies having bipolar disorder. This is a matter of personal opinion and it is also the reason why there is not more information about bipolar kids on Bipolar-Lives website.
1. A two thousand year history of manic-depressive illness being understood as manifesting in the late teens/early twenties. Research studies consistently show an average age of onset is 25 years old. In fact, age of onset is regarded as in itself an indication of whether it “really is bipolar”. The Bipolarity Index scores patients higher (that is, more likely to genuinely suffer from the illness) is their age of onset is in the late teens or early twenties.
2. The unlikelihood that the dramatic recent increase in diagnosis (4,000% more cases of children with bipolar disorder!!) is plausible as a matter of simple math and common sense. (Ok, sure I accept that growing awareness can cause sudden spikes in diagnosis as the medical profession improves its understanding of a particular illness – but an increase of 4,000 percent?)
3. The exposure of childhood bipolar “expert” Dr Joseph Biederman as acting in collusion with a drug company for financial gain based on phoney bipolar related research.
There is strong argument for using the same diagnostic criteria for both adult and child bipolar.
4. The recent decision by the American Psychiatric Association is that NO EVIDENCE exists to justify bipolar disorder in children who don’t meet the bipolar symptoms criteria for adults. Instead, the latest edition of the diagnostic manual used by mental health experts (the DSM-5) includes a new category, called “temper dysregulation disorder with dysphoria,” (TDD) for children who are aggressive and irritable.
Another important thing to understand is that in children, other conditions such as ADHD can look a lot like bipolar. In fact, some children may have both. You will not be able to make any diagnostic progress via the Internet. A more appropriate approach is to schedule a personal consultation with a board-certified child and adolescent psychiatrist or a licensed psychologist with experience in diagnosing mood disorders.
PLEASE UNDERSTAND – I am NOT saying there is no such thing as bipolar kids – just that they are RARE!
Just please keep in mind that the recent 4000% increase in diagnosing childhood bipolar disorder is largely without foundation. In addition, it is statistically very unlikely that your child has bipolar disorder, especially if they are 14-years old or younger.
Let’s consider bipolar disorder in kids of different age groups – teens (aged 13-18), children (aged 4-12) and toddlers.
Teenage bipolar disorder
Being a teenager is never easy, but bipolar disorder in teens presents special challenges. Obviously the first challenge is an accurate diagnosis given that many typical bipolar disorder symptoms, such as mood swings, impulsivity, disrupted sleep cycles, reckless driving, or poor boundaries around drugs, booze and sex are arguably part and parcel of being a teenager.
So, how can you tell if your teen is just going through “typical teenage stuff” or suffering from a mood disorder such as bipolar? In most cases bipolar disorder is not accurately diagnosed until later in life – sometimes much later. However, it is possible to detect bipolar disorder in teens.
According to the American Academy of Child & Adolescent Psychiatry:
“The diagnosis of Bipolar Disorder in children and teens is complex and involves careful observation over an extended period of time.”
Here is my list of the top 6 clues to an accurate bipolar teen diagnosis:
1. Bipolar disorder has a genetic and therefore a hereditary element. Therefore, if one or both parents have bipolar disorder, there is an increased chance their child may also have it. Also look to other close blood relatives such as siblings, grandparents and aunts/uncles. Any parent with bipolar disorder should be alert for signs and symptoms in their child as early diagnosis and treatment will greatly increase the chances of bipolar kids having a high quality of life with few episodes or relapses.
2. Bipolar disorder has a clear age of onset. What does this mean? It means that episodes of mania (the “highs” of bipolar) may involve symptoms such as anger, excessive talkativeness, mood swings, risky behavior, or grandiosity (exaggerated, unrealistic belief in own importance and ability) that will seem out of character and represent behavior THAT DIFFERS FROM THE TEEN’S “USUAL” OR PREVIOUS PERSONALITY STYLE.
3. Bipolar kids must experience BOTH depression AND mania.
4. The most common symptoms of mania in adolescents are also very similar to what we see in bipolar adults, i.e. pressured speech, euphoria, and hyperactivity.
5. Psychosis is a more prominent feature of teen bipolar mania than it is for adults. Studies indicate one-half to one-third of adolescents with bipolar mania have psychotic symptoms, making this a strong distinguishing feature of bipolar disorder in teens.
6. Just as with adults, bipolar teenagers will usually spend far more time in depression than in mania. Also, bipolar disorder in teens is more likely to begin with a depressive episode.
Also, young people with a history of anxiety are at greater risk for bipolar disorder. Substance abuse also often co-occurs in bipolar kids.
Research has shown that certain features of teen depression tend to be predictive of teenage bipolar:
1. Rapid onset of their depression.
2. Psycho-motor retardation.
3. Psychotic features.
4. Family history of mood disorder.
5. Antidepressant induced mania or hypomania.
Other teen bipolar depression symptoms also linked to bipolar include:2
1. Thoughts of suicide, suicide attempts, preoccupation with death.
2. Illnesses such as irritable bowel syndrome and complaints of stomach aches.
Although there may be serious adverse consequences if teen bipolar disorder is left untreated, the good news is that with medication and therapy it can be well managed.
Even simple lifestyle factors such as:
- a healthy sleep routine
- daily exercise, and
- good nutrition (like The Bipolar Diet)can be extremely effective in maintaining level and healthy moods and keeping episodes of both mania and depression at bay.
Substance abuse and bipolar kids / teens
Substance abuse is a particular concern, given the high proportion of people with bipolar disorder who abuse alcohol and drugs. The high rates of dual diagnosis (for example bipolar AND alcoholism) greatly complicate treatment and lead to much poorer long term outcomes. The National Institute of Mental Health (NIMH) recently published its COBY STUDY (Course and Outcome of Bipolar Youth), and found teen experimentation with alcohol to be the biggest single predictor of subsequent substance abuse. In fact, the lead researcher described experimental alcohol and marijuana use by teenagers with bipolar disorder as literally “playing with fire”.
He also explained things this way:
“we appear to have this window of 2-3 years during which we can attempt to prevent substance abuse in these youth. This study provides some clues regarding the types of preventive strategies that may be useful.”
Important and useful strategies include identifying and treating common co-morbid conditions such as panic attacks, addressing depression, and improving family cohesiveness. Parental substance abuse is also a strong predictor so if you are the parent of a bipolar kid, please get your own house in order.
As noted above, one of the most contentious issues is whether childhood bipolar disorder should be diagnosed according to the same criteria as we use for adults, or does it take a special set of criteria, unique to bipolar kids?
For centuries the accepted wisdom was that manic-depressive illness developed in early adulthood. However, today most experts do agree that there IS such a thing as childhood bipolar disorder.
Doctors Frederick Goodwin and Kay Jamison, in their authoritative text Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, combine a number of the most recent and reliable studies, revealing that the average age of onset is 22.2 years.
However, given the usually lengthy gap between actual diagnosis and the first onset of symptoms, it seems that early symptoms such as unstable moods probably begin before age 20 for many if not most sufferers.
What is clear – as long as the focus remains on clinical studies instead of anecdotes, pop culture fashion victims, and media hype – is that bipolar disorder in CHILDREN is RARE.
Has your child been diagnosed with bipolar disorder? At 18 maybe, but at 8? GET A SECOND OPINION! (Maybe even a third and fourth!)
There is a long way to go before we can arrive at reliable statistics. If we take as our starting point that bipolar disorder occurs in approximately 2% of the population (National Institute of Mental Health or NIMH), and that genuine cases of pediatric bipolar disorder are rare in comparison, then it can probably be safely stated that bipolar in kids younger than 14-years old will be less than 0.01% of the population (possibly much less) and that the frequency of occurrence decreases as age decreases.
In the US today, over a million children have been labelled as “bipolar”. These huge increases in bipolar kids have not been matched in other developed countries such as the UK, Germany, Australia, or Japan. The “bipolar kids” seems to be a uniquely American phenomenon.
Why? Well to start with, a lot of money has been made out of childhood bipolar disorder.
One of the reasons this rash of diagnosis may appear unconvincing is that much of it is based on the work of Dr Joseph Biederman, now disgraced for failing to disclose the millions of dollars he was paid by the manufacturers of bipolar medications. Biederman provided the foundation for a phoney epidemic by broadening the diagnostic criteria for bipolar disorder in children.
Specifically, he speculated that one of the defining characteristics of bipolar disorder – the episodic nature of the fits of mania and depression – took a different form in children. This enabled him to label any child who was aggressive, troubled, irritable, disruptive, uncooperative, or who for any reason would not or could do as he or she was told as “bipolar”.
The approach has led to children as young as age 4 being placed on powerful anti-psychotic drugs. These medications have serious side effects, and may actually exacerbate various emotional problems.
All of this is not to say that there is NO such thing as childhood bipolar – just that it does seem clear that the 4000% rise in diagnosis is misleading and has resulted in harmful or inappropriate treatment, especially in children in the 4-14 age group.
On a more positive note, the heightened interest in childhood bipolar disorder has led to much innovative and quality research which, in time, should help fill in the gaps on our very incomplete understanding. This will be especially helpful in clarifying the overlap and distinctions between bipolar disorder and ADHD and/or severe emotional or behavioral dysregulation. We are also getting better at tailoring treatments for high risk kids such as the children of parents with bipolar disorder.
Is a meaningful diagnosis of bipolar in toddlers even possible?
Think about it. Toddlers are very young children who do not yet walk properly – they “toddle” – hence the term. Folks, we are talking about 1-to-3 year olds!
How could bipolar disorder manifest in such a young child? What would a bipolar 2 or 3 year old even look like? It is important to understand this is a very controversial issue and there is no agreement with the professional community about even the most basic definition of bipolar disorder in such young children. What some describe as “pediatric bipolar disorder” is a new condition only recently defined and with symptoms quite different from the criteria long used to diagnose adults.
Bipolar disorder was first described in the medical literature over 2000 years ago. It is one of the most documented mental illnesses and, usually, one of the most treatable. For most of these 2000 plus years, there was a distinctive pattern of bipolar symptoms first appearing in the early twenties, or sometimes the teenage years. Now a different set of symptoms, emerging in toddlers, is being given a very stigmatizing psychiatric label, along with unproven treatments including drugs.
Do I sound too dismissive of even the possibility of bipolar toddlers? I am not saying that children cannot have a mental health disorder. In fact, there is research indicating that roughly 50% of such illnesses arise before the age of 14. But manic depression? In a two year old? Given that the FDA does not allow for the prescription of any medication recognized as a treatment for bipolar disorder before the age of 10, such a diagnosis is not only far-fetched, it is not helpful to parents looking for actionable solutions.