Children and Early Onset Bipolar Disorder

Originally thought to be primarily an adult disorder, childhood bipolar disorder diagnosis is becoming more common.

No information on incidence rates of childhood bipolar disorder is currently available. However, adult manic depression rates indicate that one to two percent of the world's adult population suffers from bipolar disorder, so incidence rates could also be high in children.

Early onset, or juvenile, bipolar disorder has symptoms very similar to ADHD (attention deficit hyperactivity disorder). Juvenile bipolar disorder researchers suspect that many children diagnosed with ADHD actually suffer from bipolar disorder, or a combination of bipolar and ADHD.

Early onset bipolar disorder may be mistake for childhood depressionThe American Academy of Child and Adolescent Psychiatry estimate that up to one-third of American children diagnosed with depression actually have juvenile bipolar disorder.

The Child and Adolescent Bipolar Foundation reports that with each generation since WWII rates of both depression and bipolar disorder have increased. It also reports that the average age at onset of bipolar disorder symptoms has gone down an average of 10 years with each successive generation. The reasons remain a mystery.

Early onset bipolar disorder is difficult to detect in children, as symptoms differ markedly in pre-teen children, teenagers, and adults. In general, teens and adults follow a cycle of manic episodes followed by episodes of depression. Periods of high energy, irritability, and high activity are followed by periods of low energy, depression, and social withdrawal.

 

Children with bipolar disorder rarely have clearly defined episodes of mania and depression. Children tend to have an ongoing, generalized mood disturbance that combines symptoms of both mania and depression. Children often cycle rapidly through mania and depression, sometimes several times a day. The instability of mood resulting from early onset bipolar disorders leaves children chronically irritable and upset. Periods of emotional calmness and wellness are few and far between in childhood bipolar disorder.

Symptoms of juvenile bipolar disorder may be detected as early as infancy. Parents of children diagnosed with bipolar disorder describe babies that had great difficulty sleeping and settling. Young children with bipolar disorder often display pronounced separation anxiety.

Emotionally, children with bipolar disorder are very erratic. Periods of intense euphoria and happiness out of proportion to events are quickly followed by episodes of anger, crying, and irritation.

Intense temper tantrums and uncontrollable rages are common. Rages are violent and comparable to an emotional seizure. Screaming, destruction, head banging, and other aggressive behavior are common to bipolar disorder-induced rages. Parents often report that asserting authority and the word "no" trigger rages. Rage symptoms rarely occur out of the house or around strangers, making it difficult to convince others that a problem exists.

No single child exhibits all possible symptoms of bipolar disorder. In addition to the symptoms discussed above, children with bipolar disorder may also experience:

Children with bipolar disorder may also exhibit sexual behavior inappropriate for their age. Some children have "grandiose" beliefs, such as believing they can fly, they are too smart to go to school, or other logic-defying behavior. In severe cases, childhood bipolar disorder can cause severe delusions or hallucinations.

Environmental factors and events can trigger juvenile bipolar disorder, but the root cause of the disorder appears to be genetic. Bipolar disorder runs in families. The disorder may skip a generation or may differ in symptoms from one generation to another.

Family histories of depression, substance abuse, alcoholism, and bipolar disorder increase the risk of childhood depression. Parental bipolar disorder greatly increases this risk. Children with one parent who is bipolar have a 15 to 30 percent chance of developing the disorder. If both parents have a history of manic depression, the risk increases to anywhere between 50 to 70 percent.

Making a diagnosis of bipolar disorder in children is complicated by a number of factors. Current diagnostic criteria for bipolar disorder only apply to adults: No definitive criteria exist as yet for children.

The symptoms of childhood bipolar disorder closely resemble those of attention deficit hyperactivity disorder (ADHD). Eighty percent of children with bipolar disorder have all the symptoms of ADHD. Distinguishing between the two disorders is vital; stimulant medications used to treat ADHD can increase mania symptoms and aggression associated with bipolar disorder.

As medical science is only beginning to recognize childhood bipolar disorder as a serious problem, few medications are approved to treat the disorder. Parents and health providers must weigh the potential risks of using bipolar medications intended for adults against the dangers of leaving bipolar disorder untreated.

 

The consequences of not treating bipolar disorder are grave. Untreated bipolar disorder has a fatality rate of eighteen percent due to suicidal depression. Other complications include substance abuse, failure to achieve full potential in school and impaired social functioning.

Mood stabilizers are the most commonly used bipolar disorder medication. Of these medications, lithium has the best success rate in adult treatment, with an improvement rate of between seventy and ninety percent. Lithium reduces mania symptoms and prevents severe emotional cycling.

Long-term lithium use has effects that must be balanced against it benefits. Thyroid supplements are required with long-term lithium use, and the drug can cause kidney damage in rare cases. The long-term effects of lithium when taken by children are under investigation.

A number of anticonvulsants are also used in treating bipolar disorder in children. Some, such as divalproex sodium (valproic acid), which helps prevent rapid mood cycles, have proven useful when administered to children.

The Food and Drug Administration has approved only one anticonvulsant, tiagabine, for treating bipolar disorder in teenagers. Tiagabine is also increasingly used to treat younger children with bipolar disorder.

Psychotherapy uses cognitive-behavioral therapy, and family therapy to teach children and their families how to deal with bipolar disorder and its symptoms. Medication is usually required in combination with psychotherapy before counseling produces positive results.

Parents of children with bipolar disorder can learn coping strategies, relaxation techniques, and other skills to help their children cope with bipolar symptoms. Possible strategies include

Parents will also need to communicate with the child's school so his or her special needs are accommodated. Symptoms of bipolar disorder often require special handling in the classroom. Regular communication between parents, teachers, school counselors, and health professionals helps facilitate cooperation.

Bipolar disorder is a lifelong illness. The sooner the disorder is detected and treated, however, the better the prognosis. Starting treatment early helps children with bipolar disorder function better socially and academically.

Resources

Child and Adolescent Bipolar Foundation. (updated 2002). About early onset bipolar disorder.

Juvenile Bipolar Research Foundation. (nd). About juvenile bipolar disorder.

National Alliance for the Mentally Ill (NAMI). (updated 2004). Child and adolescent bipolar disorder.