Bipolar Children and Teens

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Diagnoses of bipolar disorder in children and teenagers are growing, but experts disagree on the reasons.

Although bipolar disorder is usually diagnosed in early adulthood, it can appear in children and teens. And the incidence seems to be increasing — a 2007 study in the Archives of General Psychiatry showed a 40-fold increase in the number of children treated for bipolar disorder between 1994 and 2003. “We’re seeing it much more in kids and adolescents than in the past,” says Roy Boorady, MD, a bipolar expert at the New York University Child Study Center and assistant professor of adolescent and childhood psychiatry at NYU School of Medicine. The reasons for the increase aren’t known; some experts attribute it to overly aggressive diagnosis, while others believe the increase reflects increasing awareness and more knowledge about the disorder in children. “It was once believed that bipolar only developed later in life, but now we know that’s not the case,” says Michael First, MD, a professor of clinical psychiatry at Columbia University and editor of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the American Psychiatric Association’s diagnostic guidelines.

Bipolar Children: Making the Diagnosis
Diagnosing bipolar disorder in children and teens is not always easy, partly because mania and depression symptoms look different in youngsters than in adults. While adults tend to be elated or euphoric during manic episodes, bipolar children and teens are likely to be irritable and prone to extreme temper tantrums and destructive outbursts during manic periods. When depressed, youngsters may have physical complaints like headaches, muscle aches, stomachaches or tiredness. Additionally, many bipolar children change frequently between mania and depression, sometimes several times in the same day. “Adults with bipolar can have periods in between the mania and depression of looking pretty normal, but with kids the transition between episodes is much more rapid, and it’s often all mixed together,” says Dr. Boorady.

Symptoms of bipolar in kids and teens can vary by individual, but the following red flags are common:

  • Frequent irritability
  • Violent temper tantrums
  • Constant complaining
  • Unexplained crying
  • Headaches, muscle aches, stomachaches, or fatigue
  • Extreme sensitivity to rejection or criticism
  • Talk of running away from home
  • Alcohol or substance abuse (in teens)
  • Preoccupation with death or suicide

Is It Bipolar Disorder or ADD/ADHD?
Many bipolar children also have attention deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD), further complicating the diagnosis. “ADHD can develop as early as age 4, while bipolar usually doesn’t develop until age 10 or later,” says Boorady. One problem is that medications used to treat ADD/ADHD are stimulants, which can worsen mania in children with bipolar disorder. Family history is often helpful in distinguishing between the two conditions, since a child has a greater risk of developing bipolar disorder if a close family member (parent, brother, sister, or grandparent) is bipolar.

Bipolar Children: Getting Help
Because diagnosing bipolar disorder in youngsters is so complex, it’s best to get a referral to a child and adolescent psychiatrist for evaluation and appropriatetreatment. A number of medications can be helpful in managing the disorder. It’s not yet known whether children with bipolar disorder will grow into bipolar adults. However, studies show that the earlier treatment is started, the better the long-term prognosis. Psychotherapy, lifestyle changes, and support groups can also be helpful. “Support groups help kids realize that they’re not alone and also give families practical tips for coping with the disorder from other parents dealing with the same thing,” says Dr. First. The Web site of the Child & Adolescent Bipolar Foundation lists a number of support groups for kids and teens with bipolar disorder, as well as the Depression and Bipolar Support Alliance and the National Alliance for Mental Illness.

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