What is pediatric bipolar disorder?

Bipolar disorder is what we used to refer to as manic depression. People affected by this disorder have distinct periods in which they experience changes in mood, energy, thinking and behavior that interfere with their functioning. When we say someone is manic, his or her mood is up or extra happy, or highly irritable; the person is full of energy, needs little sleep and has a very busy mind. Depression is just the opposite. A depressed person feels sad, cranky and tired, and his or her concentration is off because of slowed thinking.

How common is pediatric bipolar disorder?

It’s been estimated that this disorder affects anywhere from a half million to a million children and adolescents in the United States.

What causes the disorder?

Though the cause of the disorder is still unknown, heredity definitely plays a role. About 60 percent of people with bipolar disorder have a family history of the illness. Studies indicate that if one parent has bipolar disorder, the risk to each child is 15-30 percent. When both parents have bipolar disorder, the risk in each child increases to 50-70 percent. This is obviously much higher than the risk of .5-1.5 percent in the general population. With identical twins, if one twin has bipolar disorder, the risk of the other one having the disorder is approximately 70 percent. This is one clue that bipolar disorder is caused by other factors in addition to genetics. If genetics alone caused bipolar disorder, then one would expect 100 percent of both identical siblings to have the disorder. In reality, bipolar disorder is probably caused by the interaction of more than one gene, as well as factors in a person’s environment.

How does bipolar disorder manifest itself in kids versus adults?

Until the past decade, it was thought that bipolar disorder was rare in children. This is because researchers and clinicians we’re looking for children to have the same symptoms as adults— but children are not miniature grown-ups. If the symptoms we see in adults are present in children, a child’s age and mental development may still influence how the different symptoms appear. For example, in adults the average person in a manic stage is extra amusing, charming, full of energy and sure of himself. He thinks he is superior to most other people, whether there is any truth to this belief or not. The adult in the “up” manic phase can also be angry and irritable, but it is less common. Yet, the manic child’s main mood is generally extra angry and irritable, with the silly, giddy behavior occurring less frequently. Such kids are often incredibly hyper, talk nonstop and appear grandiose and full of themselves.

Why is diagnosing pediatric bipolar important?

The general rule for children is that if they have one mental disorder, they probably have two or more problems at the same time. Frequently, kids at risk of bipolar disorder, or kids who show evidence of bipolarity, exhibit signs of ADHD, obsessive compulsive disorder, separation anxiety disorder or depression. Treatment of many of these disorders includes the use of stimulants or antidepressants. These medications can bring out a bipolar episode in a youngster who is predisposed to the disorder. These medications can also worsen the bipolar child’s illness. This is one reason why it is crucial to identify and treat bipolar disorder, before specifically addressing a child’s other problems. Besides, treatment of the bipolar disorder may lessen the symptoms of the other disorders and make them easier to treat.

How do parents determine if their child has bipolar disorder?

The first step is to have the child in question evaluated by a physician familiar with bipolar disorder and other childhood psychiatric disorders. By evaluating the problems and looking at the family history, as well as examining the child, the diagnosis should become clear. Remember, children are a work in progress. Sometimes observation may be necessary for a long period of time, before the correct diagnosis can be given. It should also be noted that once a child is diagnosed, a successful treatment plan may take some time to be determined— though it’s generally discovered eventually.

What kind of help is available?

A variety of professionals are involved with the treatment of childhood mental health disorders. If parents need a referral, they can ask their child’s pediatrician, the school guidance counselor or friends whose children have undergone treatment. Many communities have local mental health centers that offer diverse treatments. Assessment and treatment may also be available at local hospital outpatient clinics. Treatment is often multifaceted, combining family education, ongoing psychotherapy (in an array of forms), educational intervention and possibly the use of medications.

What can parents do to improve their bipolar child’s future?

There is no question that early intervention is critical. I have been surprised by how many children who have been in treatment for years— struggling to get control of their moods and behavior— become more aware of their mood disorder pattern as they mature physically and emotionally. This awareness can help bipolar children to control their lives. For instance, while in treatment, a high school senior with seasonal affective disorder who gets depressed in the winter may realize he would do much better attending college in Florida than Alaska. Chances of his mood disorder being well-controlled would be good in Florida, where dark gray winters are unusual.

Why a Diagnosis in Kids is Key

A look diagnosing and treating bipolar disorder in children.