Bipolar Children: Fact or Fad?

(September 3, 2007) -- RALEIGH, N.C. - Judi Sharp's son used to get so depressed he refused to come out of his room. The next moment he would be giggling uncontrollably.

Sharp, who asked that her son not be identified by name, chalked it up to the attention deficit hyperactivity disorder her son was diagnosed with at age 3.

But when Sharp's son had a violent outburst last Thanksgiving Day, a psychiatrist diagnosed bipolar disorder and put the teenager on mood stabilizers. Sharp says the drugs have helped tremendously.

"He's back to being my sweet boy, like he was when he was little," she said.

Twenty years ago, bipolar disorder was considered a disease of adults and a rare one at that. Now psychiatrists are increasingly willing to make the diagnosis - and at younger and younger ages. A study published this month in the journal Archives of General Psychiatry noted a 40-fold increase of bipolar diagnoses in youths up to age 19 since 1994.

That has led some to question whether the brain disorder is over-diagnosed and over-treated, turning the normal behavior of children and adolescents into a disease. Many symptoms of bipolar disorder, such as fanciful thinking or impulsiveness, can look like age-appropriate behavior in children.

Just teen mood swings?

"How many adolescents have mood swings? How many have severe mood swings? A lot," said Paul Brinich, a Chapel Hill, N.C., child psychologist.

Brinich said he believes bipolar disorder has become the latest fad diagnosis for children with behavioral problems. He is particularly concerned about the drugs that almost always accompany such a diagnosis. Many of the newer medicines used to treat bipolar disorder, such as Risperdal, have worrisome side effects in children, such as rapid weight gain that might put them at risk for diabetes and other health problems.

At the same time, however, psychiatrists see hope that people with a major mental illness are finally getting help, and getting it earlier.

The increasing attention to the disorder has prompted University of North Carolina Hospitals in Chapel Hill to establish a center that will study and treat both adults and children. Dr. Jair Soares, its director, became interested in bipolar disorder more than a decade ago while training at a University of Pittsburgh bipolar program. He feels certain that heightened awareness is helping more children get treatment sooner.

"That's a wonderful thing," Soares said, noting that people with bipolar disorder are at increased risk of disability, hospitalization and suicide. "Treatment at the right time can be lifesaving."

Early treatment might lessen the severity of a child's illness over time, Soares said. If bipolar episodes play out unchecked in a child's still-developing brain, the brain wires itself to become more prone to episodes. Soares said proper treatment can break that cycle, protecting the brain.

Diagnoses up

Diagnoses of bipolar disorder among adults nearly doubled from 1994 to 2003, the recent study found. The illness is now seen in 1,679 of every 100,000 adults.

But for children, diagnoses have skyrocketed. In 1994, the disorder was found in 25 of every 100,000 youths under 20. By 2003, it was diagnosed in 1,003 of every 100,000 youths. Experts say it has probably increased since then.

The spike might have come from research showing that most adult bipolar patients had symptoms of the illness by their teen years, if not earlier. Psychiatrists and others treating children's behavioral disorders began to look for the illness.

Researchers who reported the dramatic rise in pediatric diagnoses this month said bipolar is likely being diagnosed inaccurately. About two-thirds of pediatric diagnoses were made in boys. In adults, bipolar is more common in women.

"Any child who is unstable and impulsive can be called bipolar," said Donald Rosenblitt, a psychiatrist and director of the Lucy Daniels Center for Early Childhood in Cary, N.C., a mental health and education center for children.

John March, chief of child and adolescent psychiatry at Duke University Medical Center, thinks many psychiatrists have become too willing to label a child bipolar. Though anxious parents might crave an answer to their child's behavior, the diagnosis is never good news, he said.

"If you tell someone they are bipolar, and you are right, you're telling them that they have a lifelong mental illness," March said. "If you have bipolar disorder, the chances are you are going to be sick the rest of your life, even with the best treatment."

For adults and children, that treatment is usually the same: one or more powerful antipsychotic drugs, many with serious side effects.

"We have no idea what the long-term effects of these things are in children, whose bodies are still developing," said Brinich. "We so much want to have a pill that helps with the ups and downs of life. When someone comes along and says this is going to help you or it's going to help your child, we are not critical enough."

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'Tragic injustice'

Rosenblitt said parents and treating physicians often fail to examine whether behavioral problems might be a normal response to stresses in the child's life.

Calling such behavior bipolar disorder is a "tragic injustice," Rosenblitt said.

"There's something grotesque and dehumanizing about calling it a biological mental disorder," he said.

"It's a denial of their fundamental reality."

By: Jean P. Fisher

Source: MTC News Service

Last updated: 09/07

Related Information:

• Bipolar Disorder Cases Rise Sharply in U.S. Children
• Are Bipolar Drugs Safe For Kids?
• More About Diagnosis and Confusing ADHD with Bipolar in Children
• Bipolar Disorder in Children: How Common Is it?
• Psychiatrist Won't Practice Medicine After Girl's Death
• About Early-Onset Bipolar Disorder
• Diagnosing Bipolar Disorder in Children
• Prognosis Worse with Childhood Bipolar Disorder
• UC Study Finds Just 40% of Teens Rebound After Bipolar Treatment
• Study Looks at Bipolar Youth
• Mood Swings and Substance Abuse in Adolescents
• Toddlers Diagnosed with Bipolar
• Impact of Antidepressant Discontinuation on Relapse, Remission, and Mood Episode Cycling in Bipolar Disorder
• 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

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