Bipolar Disorder on Rise Among Children

(April 4, 2006) -- "I was shocked," said the mother, who requested identifying information be withheld to protect her child. "It broke my heart to think about it."

More than a 25 percent increase in the number of children identified with bipolar disorder was recorded between 2002 and 2004, according to one study. It is present in an estimated 1 percent to 2 percent of youngsters ages 12 and younger.

"Over the past few years, we're seeing kids earlier and earlier," said Dr. Steven L. Pastyrnak, pediatric psychologist at DeVos Children's Hospital. "It used to be diagnosed in the late teenage years, early 20s. Now, we see kids as young as 5 or 6."

Many children with bipolar disorder are bright, creative and curious, but a complex chemical storm in the brain causes huge swings in behavior. They experience classic signs of depression, such as increased sleep and social withdrawal, and then manic episodes, marked by irritability, rage, aggression, self-destructive behavior or hypersexuality. They can experience mood changes several times per day.

Diagnosis controversy

Treating children for what has been, until recently, assumed to be an adult or adolescent disorder is not without controversy. Some question whether childhood bipolar is the diagnosis du jour -- a trend that will be to this decade what Attention Deficit Hyperactivity Disorder (ADHD) was to the 1990s.

One viewpoint holds children should be diagnosed using the same criteria used for adults -- which are the only criteria accepted by the American Psychiatric Association -- thus making it extremely rare. On the other side are those who say better diagnostic tools and a philosophical evolution in the field of psychiatry are allowing these children to be identified and provided with treatment that improves their lives.

The 1999 book, "The Bipolar Child," by New York psychiatry professor Demitri Papolos and his wife, Janice Papolos, pushed early-onset bipolar disorder front and center. It was published in the context of a psychiatry profession starting to set aside Freudian theory that children are beings too incomplete, too dependent on parents, to develop such disorders, said Dr. Emmanuel M. Tendero, a Grand Rapids child and adolescent psychiatrist.

Jean McFadden, a professor of social work at Grand Valley State University, organized a seminar last fall for her students who work with children who have bipolar disorder in their clinical training. "Ten years ago, I was not aware of any kids diagnosed with bipolar. It seems like within the past five or even three years, there's been an explosion of that diagnosis," McFadden said.

Early signs

The suburban Grand Rapids mom knew her baby was extremely sensitive to sensory stimulation and prone to uncontrollable crying for no discernible reason. With guidance from a pediatrician, they started getting help when she was 2.

The mother said she was surprised to hear the word "bipolar" when the child was just 4. Her daughter's treatment for bipolar has only recently begun, as psychiatrists and psychologists have considered anxiety and depression as well.

Diagnosis is the first hurdle, and Pastyrnak said there's no scientifically certain way to make one. "There's not any brain scan or blood test that's truly objective that allows us to make a diagnosis."

Mental health professionals rely on behavior patterns and family history, he said. The Diagnostic and Statistical Manual, used to identify mental illnesses, addresses bipolar in adults only. So the professionals adapt the criteria, and the treatment, to a younger population. They talk to parents, to the child and to school personnel.

Further complicating the diagnosis is some symptoms of bipolar disorder overlap with other childhood disorders, such as depression and ADHD.

Research indicates there may be a relationship between bipolar and ADHD, Tendero said. Studies have found between 11 percent and 75 percent of children with early-onset bipolar disorder also have ADHD, according to Dr. Thomas N. Fluent, a Michigan psychiatrist who presented the GVSU seminar in October.

Similar symptoms

Even some medical conditions can display symptoms similar to bipolar, according to "The Bipolar Child."

"There are some children who do have bipolar, but not as typically presented as in adults," said Dr. Dan Schellenberg, service chief of child psychiatry for Pine Rest Christian Mental Health Services, in Cutlerville.

"Anger or explosiveness can be a sign, but stress, depression or behavior disorder can cause anger and explosiveness."

"The hallmark characteristics are what we see during manic periods," Pastyrnak said.

The suburban mother is familiar with those episodes. "She has a lot of aggression mixed in with manic states. She gets very irritable and agitated during her manic episodes," said the mom, who is concerned about the effect of the stigma society places on people with a mental illness.

"After school, she's running around the house, jumping on beds, climbing on the counters, writing on walls, writing on herself. She's got a lot of physical energy and can't differentiate between appropriate ways of getting rid of that energy. She's being dangerous, reckless and destructive, then she gets agitated and angry."

A kind of relief

Pastyrnak said many parents are relieved to find out their child has a treatable illness.

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"Most parents strive to maintain some semblance of control or predictability in the household," he said. "When a child has bipolar illness, there isn't a rhyme or reason for why the child is irritable, and structure falls by the wayside. Without a clear trigger, parents feel helpless.

"They feel like bad parents because they don't have control and don't have answers for why this is going on."

The suburban Grand Rapids mom whose daughter is just embarking on treatment said she's hungry for information and advice.

"I think I hope what any parent would hope for their child, that she'll be happy, be able to function well, go to school and enjoy things," she said. "She's very creative. I hope that she'll be able to channel that creative energy.

"I am looking forward to getting my child back."

Sources: NIMH

Last updated: 04/06

Related Information:

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