The Bipolar Child – a New Emergence
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The Bipolar Child Ð- A New Emergence
The bipolar child is a relatively neglected childhood diagnosis that is the subject of great controversy in the fields of clinical and child psychiatry and psychology. Diagnosis and treatment of such a devastating disorder is very difficult due to several different factors, including, Childhood-onset Bipolar Disorder (COBPD) does not have its own criteria in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV), published by the American Psychiatric Association, Washington D.C., 1994, the main diagnostic reference of Mental Health professionals in the United States of America, a child shares the same criteria standards as an adult, plus there are several similarities in COBPD and Attention Deficit Hyperactivity Disorder (ADHD), causing some misdiagnosis, and the simple fact that there is little reference to the disorder in a medical and psychiatric field afraid to step into the world of childhood mood disorders.(Papolos NARSAD 2003, Popper 1989, NIMH 2000) Only until recently has more research and development been conducted on COPBD.
According to the DSM-IV diagnostic criteria, a person must have at least five of the following symptoms during the same two week period to qualify as a major depressive episode: a depressed mood lasting most of the day for several days, a significant weight gain or weight loss, a loss of interest in activities, difficulty sleeping or an increased need for sleep, restlessness or slowed pace observable by others, daily fatigue, feelings of guilt or worthlessness, inability to concentrate, or recurrent thoughts of death. For a mixed episode, a person must display symptoms of depression and mania every day during at least a one-week period. A manic episode is described as elevated or abnormally irritable for at least one week, with a least three of the following: personal greatness, decreased need for sleep, extreme talkativeness, “racing” thoughts, distractibility or hypersexuality (excessive sexual activity, or sexual desire). The DSM-IV states that these symptoms must interfere with daily functioning and not be a result of the effects of drugs, medical condition, or temporary results from a traumatic event for all of these; depression, mixed state, and mania.
The Child and Adolescent Bipolar Foundation lists four types of mood disorders in the bipolar window; Bipolar I, Bipolar II, Cyclothymia, and Bipolar NOS (Not Otherwise Specified). Bipolar I can be described as alternating episodes of intense and sometimes psychotic mania and depression. In Bipolar II, episodes of hypomania a markedly elevated or irritable mood accompanied by increased mental and physical energy is experienced between recurrent periods of depression. Periods of less severe, but definite mood swings is defined as Cyclothymia. And finally, Bipolar NOS is used when doctors are not clear of which type of bipolar disorder is emerging (CABF 2002)
Symptoms of Childhood-onset Bipolar Disorder can be found in children as young as two-years old. Parents have been reported as noticing something was different about their child even during infancy, describing their child as having been unusually fidgety, difficult to soothe, extraordinarily clingy, and sleeping erratically (CABF 2002, Kluger & Song 2002). One of the definitive differences in the Childhood and Adult-Onset forms of bipolar is what is known as ultra-ultra rapid or ultradian cycles, (rapid swings of mood and energy multiple times in one day). Parents describe children as alternating between several different mood states, including: unpredictable belligerence, nastiness, hostility, silliness, goofiness, and giddiness. Severe, prolonged temper tantrums with an enormous amount of energy exuded including aggression, violence, and rage can also be described by parents of these children. This is not included in the DSM-IV, and thus it is likely that not more than 25% of children with COBPD are properly diagnosed. New criteria should be developed for children with the inclusion of the ultra-ultra rapid cycling and the tendency towards temper tantrums and extended rages (NARSAD 2003). It can be very difficult to identify episodes of mania or depression in children because of the waxing and waning course they follow (Weller and colleagues 1995). Dimitri Papolos, M.D., research director of the Juvenile Bipolar Research Foundation and co-author of The Bipolar Child, believes he has spotted a pattern in these children through a study of three hundred bipolar children ages four to eighteen years old. Characteristically, in the morning, they are more difficult to wake up, dont want to get dressed or go to school. They are irritable, and can snap and complain or be withdrawn and somber. By the afternoon, the “darkness lifts” and they enjoy a few “clear” hours. Then by mid-afternoon, what is described as “rocket thrusters going off” begins, and wild, giddy, euphoric play begins, stories are made up and they may insist that they have super powers. Efforts to calm them down are resisted and the wild behavior can continue late into the night (Kluger & Song 2002)
Just one description that was outlined in the TIME article, Young and Bipolar, published August 19, 2002, can paint a picture of what living with a bipolar child can be like. Lynn Broman, 37, of Los Angeles, is raising 3 children, two of whom- Kyle, 5, and Mary Emily, 2, are bipolar. Kyle has been expelled from six preschools and two day-care centers and has destroyed a once tidy home. He had been hospitalized for violent outbursts at age four and still has periods where he goes almost completely feral. He has even thrown a butcher knife at his mother. What a scary picture this paints.
Unfortunately, Childhood-onset Bipolar Disorder can include ADHD-like symptoms but they are more severe, and ADHD may actually be a forerunner for full-blown mania (NIMH 2000). In a study listed on the National Alliance for Research on Schizophrenia and Depression (NARSAD 2003) website, in a group of 120 children and adolescents (ages 3-18) diagnosed with bipolar disorder, 93% met the DSM-IV criteria for ADHD. A child may even have ADHD and bipolar disorder simultaneously. There in lies another difficulty in the diagnosis. Charles Popper, M.D. outlines several similarities and differences in ADHD and COBPD. These similarities include; impulsivity, inattention, hyperactivity, increased physical energy, behavior and emotions change often, frequent coexistence of conduct disorder and oppositional-defiant disorder, and learning problems, family histories of mood disorders, treatment with psychostimulants or antidepressants can help in both depending on which phase the bipolar is in. Differences are seen in destructiveness, duration and intensity, regression, triggers, moods, and