Children of Rage and Sorrow — More Children are Battling Mental Illness

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Possible causes

It has been discussed but not proven that childhood disorders might be getting worse because of a genetic effect called "anticipation" in which certain genes are magnified down the generations. Each cohort of children born is more susceptible to earlier onset of mood disorders and to a more severe form of it. Some psychiatrists believe these pediatric cases have always been there and better diagnostic tools and more awareness — despite the stigma of mental illness — are bringing more of them forward. But others also cite greater pressures on kids.

"I believe life has become more stressful for young, growing children. Kids are growing up in a much more stressed environment," Anders says. "These are multiple gene disorders and, like diabetes, not everyone with the gene gets diabetes. But if they have the genetic vulnerability to become depressed or anxious or obsessive compulsive, it will express itself in the kind of social pressure cooker we are putting our children in."

These children desperately need treatment, and without it, they can wind up in the juvenile justice system, later adult prisons, or face a lifetime of failure in their personal and work lives. But treatment is fraught with unanswered questions. Fears about an increased risk of suicide led the Food and Drug Administration to issue black box warnings on all antidepressants, which in the absence of large-scale clinical trials in youngsters, are not approved for children. The exception is Prozac, which is FDA approved for children older than 8. Antidepressants are used "off label" by physicians, who look at clinical pediatric experience, extrapolate from adult data and adjust dosages. At this writing, the FDA also is looking at pediatric cardiovascular concerns with widely prescribed Ritalin.

University of Maryland researcher Julie Zito in 2000 found the use of psychotropic medications in children, 2 to 4, had jumped dramatically from 1990 to 1995, when some 150,000 preschoolers were on them. That increase and the dearth of studies on children have raised alarms about both short-term effects and possible long-term consequences for developing bodies.

About 2.3 million Americans have bipolar disorder, but with solid statistics on children lacking, it's not clear how many kids suffer the rapid cycling, sometimes from one hour to the next, of manic and depressive moods marked by irritability, aggression, grandiose beliefs and even thoughts of suicide. The Child and Adolescent Bipolar Foundation cites studies showing about one-third of the children and adolescents who suffer from depression have early onset bipolar without the mania.

The issue is more than academic because early identification and early treatment can ease the severity of manic and depressive episodes in the future. Researcher Joan Luby, an associate professor of child psychiatry at Washington University School of Medicine in St. Louis who has found bipolar disorder in preschoolers, says treatment for the very young doesn't necessarily mean medications. It can start with psychotherapy.

Bipolar disorder diagnosis in 8- or 9-year-olds remains controversial. Critics of psychiatric "labeling" of children and anti-psychiatry groups such as the Church of Scientology oppose the screening and diagnosis of the disorders in children. But even within psychiatry, there are reservations about the bipolar diagnosis, which some say has become almost trendy.

Claudio Cepeda, a child and adolescent psychiatrist at Southwest Mental Health Center, believes the diagnosis of bipolar disorder is being "abused." And child and adolescent psychiatrist Jon McClellan of the University of Washington at Seattle is also critical of the widespread diagnosis in children.

"There's no doubt that there's lots of kids that have trouble regulating their moods or behavior, and they might have explosive and angry outbursts," McClellan allows. "It just never was the case that we used to call that bipolar disorder. Simply by calling it the same name as the adult disorder doesn't mean that it's the same thing or that the same treatments may work or are indicated. I think it (the diagnosis) is being used so broadly now that it has lost a lot of its meaning."

Actually, medications for bipolar disorder do tend to help children with explosive behavior and anger, and McClellan, who heads the state hospital in Lakewood, Wash., says that leads some to think they've made the correct diagnosis.

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The diagnosis may be controversial, but parents like Kim Smith have no doubt. "I've done a lot of research into this, and it all comes back to bipolar disorder."

When you ask her what's the hardest thing about Tyler's illness, her eyes tear up. "He gets to the point where he says, 'I don't want to be like this anymore. I want to get better.' That's the hardest part. Watching him try to deal with it."

Last updated: 3/06

Related Information:

• Course of Bipolar Disorder in Youths Described for the First Time
• Bipolar Disorder in Children: How Common Is it?
• About Early-Onset Bipolar Disorder
• How to Help Your Child
• Treatment and Parent’s Role in Treating Your Bipolar Child
• Addressing Educational Needs of Children with Bipolar Disorder
• Living with Bipolar as a Teen: Dealing with School (for teens)
• Mood Swings and Substance Abuse
• Girls with Bipolar Disorder
• Bipolar Patients Show Differences in MRI
• Brain Damage From Bipolar Disorder
• What Causes Bipolar Disorder?
• Bipolar is a Serious Psychiatric Condition
• APA 2004 Mtg. Report: New Research on Biological Psychiatry and Psychopharmacology
• How To Survive Bipolar Disorder
• Family-Focused Therapy Helps Bipolar Patients Cope

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