Bipolar in Young Children

Bipolar disorder, also known as manic depression, is a severe, chronic mental illness characterized by extreme shifts in mood, thoughts, energy levels and behavior. According to the National Mental Health Information Center, bipolar disorder affects more than 750,000 American children and has been diagnosed in children as young as preschool age. Unfortunately, many cases of pediatric bipolar disorder often go undiagnosed, putting the affected children at risk for difficulties with school and relationships, problems with substance abuse, and suicide.

Causes

• According to the American Academy of Child & Adolescent Psychiatry (AACAP), most researchers agree that bipolar disorder is triggered by a combination of genetic, environmental and neurological factors. Studies conducted on twins, adopted children and family histories have suggested that children who have one or more first-degree relatives with bipolar disorder are at an increased risk for developing the illness. Scientists have also identified changes in brain structure, chemical balance and function that may contribute to the onset of bipolar disorder. Further, stress or trauma may play a part in triggering bipolar disorder in genetically or neurologically vulnerable children.

Signs and Symptoms

• According to the National Mental Health Information Center, bipolar disorder is manifested differently in children than in adults. While the moods of adults typically cycle slowly over weeks or months, children may cycle through varying highs (mania) and lows (depression) very rapidly, often experiencing several shifts within one day. Studies conducted by the Child and Adolescent Bipolar Foundation (CABF) lists the following common symptoms of pediatric bipolar disorder: explosive or destructive tantrums, dangerous or hypersexual behavior, aggression, irritability, bossiness with adults, driven creativity, creating pictures or stories that depict graphic violence, excessive talking, separation anxiety, chronic depression, loss of interest in activities, sleep disturbance, delusions, hallucinations, psychosis, and talk of homicide or suicide.

Diagnosis

• According to the AACAP, bipolar disorder is especially difficult to diagnose in children. Symptoms of pediatric bipolar disorder can closely mimic the symptoms of other childhood disorders such as depression, conduct disorder, oppositional defiance disorder and attention deficit/hyperactivity disorder. Further complicating diagnosis is the fact that pediatric bipolar disorder very often exists in a comorbid state with these disorders and others such as anxiety disorders and autism spectrum disorders. The National Mental Health Information Center has also found that a family's culture, beliefs and language play a part in how symptoms and behaviors are communicated and understood, and thus diagnosed and treated.

Treatment

• Although treatment for adult bipolar disorder has been well-founded, the best course of action for the treatment of bipolar children is still a work in progress. According to the National Alliance on Mental Illness (NAMI), at present, mental health practitioners must treat pediatric bipolar disorder using established adult treatments. Medications such as lithium, atypical neuroleptics and anticonvulsants are helpful, but children must be closely monitored for physical and mental side effects. The AACAP suggests that family and behavioral therapy are as important as drug therapy in helping bipolar children and their families understand and manage bipolar disorder.

Prognosis

• The CABF reports that pediatric bipolar disorder tends to be more dangerous and difficult to manage than adult-onset bipolar disorder, and strongly advocates early treatment and diligent, lifelong management. Even with a good treatment plan, outcomes can vary, but many bipolar children experience a significant abatement of symptoms, and a decline in the frequency and length of episodes. Further, with persistent adherence to drug and behavioral therapies, and a supportive network of family, friends and mental health practitioners, bipolar children can successfully graduate from school, find employment and enjoy independent lives.