Beyond Blue

Beyond Blue

The Bipolar Puzzle: Kids and Bipolar Disorder

posted by Beyond Blue | 9:45am Tuesday September 23, 2008

Writer Jennifer Egan published an excellent, comprehensive article about bipolar disorder among kids in Sunday’s New York Times Magazine. She profiles several different families as well talks to experts in the field, asking doctors how they go about diagnosing a child with bipolar disorder and why the percentage increase among kids.

You can get to her article by clicking here. I have excerpted more of the medical paragraphs. But the descriptions of the kids’ symptoms is worth reading.

The Diagnostic and Statistical Manual of Mental Disorders (the current edition is referred to as D.S.M.-IV) describes bipolar disorder as a condition whose average age of onset is 20, but virtually all the leaders in the field now say they believe it exists in children too. What they don’t agree on is what, exactly, characterizes the disease in kids, or how prevalent it is; some call it rare, while others say it is common. Many clinicians say the illness looks significantly different in children than in adults, but the question of how it differs, or what diagnostic terms like “grandiosity,” “elevated mood” or “flight of ideas” (all potential symptoms of adult bipolar disorder) even mean when you’re talking about kids, leaves room for interpretation. For example, it’s normal for children to pretend that they are superheroes, or believe that they can run faster than cars, whereas in an adult, these convictions would be signs of grandiosity. Equally unclear is whether a child who is identified as having a bipolar disorder will grow up to be a bipolar adult. Work on the D.S.M.-V is under way, and discussions have begun on how to address the issue of bipolar children.

As Ellen Leibenluft, who runs the pediatric bipolar-research program at the National Institute of Mental Health, told me, “There definitely will be — and needs to be — more description of what bipolar disorder looks like in children, how one diagnoses it and some of the challenges.”

A study last fall measured a fortyfold increase in the number of doctor visits between 1994 and 2003 by children and adolescents said to have bipolar disorder, and the number has likely risen further. Most doctors I spoke with found the “fortyfold increase” misleading, since the number of bipolar kids at the beginning of the study was virtually zero and by the end of the study amounted to fewer than 7 percent of all mental-health disorders identified in children. Many also said that because bipolar children are often severely ill, they can proportionately account for more doctors’ visits than children with other psychiatric complaints, like A.D.H.D. or Anxiety Disorder. Still, nearly every clinician I spoke to said that bipolar illness is being overdiagnosed in kids. In Leibenluft’s studies at the National Institute of Mental Health, only 20 percent of children identified with bipolar disorder are found to meet the strict criteria for the disease. Breck Borcherding, a pediatric psychiatrist in private practice in the Washington area, said: “Every time one of my kids goes into the hospital, they come out with a bipolar diagnosis. It’s very frustrating.” 

There are many possible reasons for the sudden frenzy of pediatric bipolar diagnoses. First, a critical shortage of child psychiatrists, especially in rural areas, means that many children are being seen by adult psychiatrists or — more often — by family doctors, who may lack expertise in child psychiatry. Managed care usually pays for a single, brief psychiatric evaluation (and it strictly limits the number of therapy appointments a year) — not nearly enough time, many say, to accurately diagnose a condition in a mentally ill child.

Then there is “The Bipolar Child,” a successful book published by the psychiatrist Demitri Papolos and his wife, Janice, in 1999, and referred to by more than one parent I spoke to as a “bible.” The Papoloses’ description of pediatric bipolar disorder was amassed partly by using responses to an online questionnaire filled out by hundreds of parents on an electronic mailing list, who said they believed their children were bipolar (and who often had strong family histories of the disease). The Papoloses’ diagnostic criteria include some idiosyncratic items — a severe craving for carbohydrates, for example — that are found nowhere in D.S.M.-IV. Nevertheless, many parents walk into doctors’ offices having already read “The Bipolar Child” and concluded that their children are bipolar. Because doctors rely heavily on parental reports when diagnosing disorders in children, these “prediagnoses” may have an impact on the outcome.

And of course, there are pressures and blandishments from the pharmaceutical industry, which stands to profit mightily from the expensive drugs — often used in combination — that are prescribed for bipolar illness, despite the fact that very few of these drugs have been approved for use in children.

For all the possible overdiagnosing of pediatric bipolar disorder, however, many in the field also say that a lot of truly bipolar children who could benefit from therapy are falling through the cracks. This is a critical issue; studies clearly show that the longer bipolar disorder goes untreated, the worse a person’s long-term prognosis. Between 10 and 15 percent of those suffering from bipolar disorder end up committing suicide.

Some studies suggest that bipolar disorder may actually be on the rise among young people. One intriguing hypothesis involves a genetic phenomenon known as “anticipation,” in which genes become more concentrated over generations, bringing a stronger form and earlier onset of an illness with each successive generation. Another theory is “assortative mating,” in which a more mobile and fluid society, like ours, enables the coupling of people whose mutual attraction might be partly due to a shared genetic disposition to something like bipolar disorder, thus concentrating the genetic load in their offspring.

To continue reading the article click here.

To read more Beyond Blue, go to www.beliefnet.com/beyondblue, and to get to Group Beyond Blue, a support group at Beliefnet Community, click here.



Previous Posts

Love Deeply ...
Valentine's Day is a good time to remember all the ways we can be loving, not just to the guy/gal sitting across from you at the kitchen table, but also your boss, your mother, your boss's mother, and her mother. One of my very favorite reflections from Henri Nouwen is "Love Deeply," found in hi

posted 6:00:28am Feb. 13, 2012 | read full post »

Therapy Thursday: Sweat
I have decided to dedicate a post on Thursday to therapy, and offer you the many tips I have learned on the couch. They will be a good reminder for me, as well, of something small I can concentrate on. Many of them are published in my book, "The Pocket Therapist: An Emotional Survival Kit." Work

posted 6:01:57am Feb. 09, 2012 | read full post »

Scrupulosity: What It Is and Why It's Dangerous
If you sprinkle a hefty dose of Catholic (or Jewish) guilt unto a fragile biochemistry headed toward a severe mood disorder, you usually arrive at some kind of a religious nut. Not that there’s anything wrong with that! For I am one. I have said many places that growing up Catholic, for me, was

posted 6:17:35am Feb. 07, 2012 | read full post »

The Treasures of Darkness
We often equate darkness with sorrow, misery, get-me-the-hell-out-of-here reaction. At least I do. That’s why I keep a mammoth Happy Lite on my smallish cubicle at work. But darkness can also be a treasure. Say what? J. R. Miller writes this in “From Streams in the Desert” by L. B. C

posted 6:06:40am Feb. 06, 2012 | read full post »

On Groundhog Day: 12 Winter Depression Busters
Last year on this day, I got fired. That was a real pleasant Groundhog Day. I was so confused by what had happened that I drove around the D.C. beltway twice. I missed my exit, and realized that halfway around the second time. I just thought on this day, you could probably use some winter depres

posted 6:30:47am Feb. 02, 2012 | read full post »

Advertisement
Comments read comments(3)
post a comment
Larry Parker

posted September 23, 2008 at 1:15 pm


You’re aware that other depression-oriented bloggers (Philip Dawdy in particular) are incensed about this piece because it minimizes the significance of giving powerful medications to children that, as we well know, have pretty significant side effects IN ADULTS.
I tend to agree.



report abuse
 

Accidental Expert

posted July 20, 2009 at 12:57 pm


I can only speak for our family, having two children diagnosed with bipolar. When you have extreme raging, have done all the behavioral and CBT work, have gone to numerous professionals and still cannot control the behavior, medication seems like the only solution left. To us we had to decide between institutionalizing them or giving them medications that could cause undetermined harm now and down the road, but possibly gave them a chance. Neither was an good option, but we chose what we felt was the lesser of two evils.
See my post on the subject at http://accidentalexpert.blogspot.com/2009/06/to-medicate-or-not-to-medicate.html



report abuse
 

Scott

posted June 14, 2010 at 3:25 pm


We SOLVED our 4 year old’s bipolar problem by cutting out MILK!!! Many people we have met have found the same result. It sounds so simple BUT PLEASE TRY it…NO MORE MILK or milk protein products. This takes only hours to a couple days to see life changing results.
NO MILK was told to me before but I did not listen until an employee of mine told me how she was bipolar (or extremely moody and imposible to handle) until age 6 when her mother took her off MILK. We saw the difference THAT DAY!!! its been 2 years (2 years of the perfect child, no joke)and we test him out every few months to see if his alergy is gone. Well, not a chance. Tried it 3 days ago and he went into the worst rage ever after having a Smoothie with added MILK protien. Took me over 2 hours to get him down. Its like clock work. Feed him milk and about 3 -6 hours later hold on to your hat.
PLEASE, for God sake just try it for 2-4 days, NO MILK or milk products. FYI my son is fine with cheese products.
Scott



report abuse
 

Post a Comment

By submitting these comments, I agree to the beliefnet.com terms of service, rules of conduct and privacy policy (the "agreements"). I understand and agree that any content I post is licensed to beliefnet.com and may be used by beliefnet.com in accordance with the agreements.

Share this story


About Beliefnet

Our mission is to help people like you find, and walk, a spiritual path that will bring comfort, hope, clarity, strength, and happiness. More about Beliefnet.

Help

Media Kit

Subscribe

Legal

Copyright © Beliefnet, Inc. and/or its licensors. All rights reserved. Use of this site is subject to Terms of Service and to our Privacy Policy. Constructed by Beliefnet.

Advertisement

Report as Inappropriate

You are reporting this content because it violates the Terms of Service.

All reported content is logged for investigation.