Bipolar Disorder in Childhood
The New York Times Magazine recently featured an article called The Bipolar Puzzle. Using the struggles of several children who clearly have severe emotional or behavioral problems as a backdrop, journalist Jennifer Egan investigated the evolution of the diagnosis of bipolar disorder in children. Currently, bipolar disorder is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as having an average age of onset of 20, but now leading psychiatrists are thinking differently. According to a review article published by the Journal of the American Academy of Child and Adolescent Psychiatry, recognition and diagnoses of bipolar disorder in children have increased in the last ten years. According to the Times, one study found that the number of doctor visits between 1994 and 2003 by children and adolescents said to have bipolar disorder had increased 4000 percent.
Many doctors believe that bipolar disorder is now being over-diagnosed in children. There is an intense debate within the medical community as to the symptoms and clinical presentation of this condition, which in turn causes controversy about its diagnosis. As highlighted in the both the Times article and the literature review, the symptoms of bipolar disorder can overlap with those of ADHD, another increasingly common diagnosis in children. Both can be characterized by irritability and explosive rage. However, the treatments for these two conditions differ, and therefore arriving at the right diagnosis is critical. In addition, the current medicinal treatments for bipolar disorder have mixed success. Changing regimens appears common as medications that initially seemed to work no longer do. Higher dosages of drugs, including those that are considered more toxic, may be prescribed when more conservative approaches fail.
Meanwhile, the behavior of children with bipolar disorder can cause enormous stress on the family. Parents struggle to keep their children in school, and find it exceedingly difficult to successfully integrate them into family activities because of their disruptive behaviors. Siblings react with fear, parents are reduced to tears as simple daily tasks become grueling battles. The diagnosis may not be accurate, but the problems remain all too real.
Questions for Discussion:
- What are your experiences with bipolar disorder in children?
- Do you think it is being over-diagnosed, treated as a “trendy” label for aggressive children?
- How do you feel about giving children with emotional or behavioral disorders high levels of pharmaceuticals, some with severe side effects and toxicity?
Your thoughts…
Comments:
 For years my daughter was in and out of hospitals for attempted suicide. She was hospitalized 8 times from the time she was 8 until age 14. She was then diagnosed bipolar, put on lithium, and is doing great. It was a long, tough road with a lot of tough love, but it has worked. Lots of weekly therapy and therapy for my husband and I on how to manage the behaviors. We had a lot of great support and attend NAMI suppport groups twice a month--extremely helpful. I am grateful that my daughter is doing so well today. Persistence pays off. Posted Tuesday, December 16, 2008 by Libby Morissette, Pembroke N.H at 06:58 PM
Good to see another Kentucky person here, in fact I am glad to know it. I hate to see all these labels being given to all these kids when that should not be necessary to get them the help and assistance that they need.*** I still have no answers for these questions: 1. Evidence That Clearly Establishes the validity of "schizophrenia" "depression" or any other "major mental Illnesses" as any biologically-based brain diseases, or anything more then something based on perceptions, differences, and needs.
2. Evidence For A Physical Diagnostic Exam such as a scan or test of the brain, blood, urine, genes, etc that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs or say so from anyone that has already labeled them), from individuals without
these diagnoses.*** As a matter of fact I was labeled mentally retarded at one point when I was five, that would have precluded me from earning a Masters degree as I did had I have lived down to that rather then being me and living up to who I am. These labels have been made up and changed as things have went along in history and I don't think that they actually do a thing to make any thing any different, I think that the laws that go with them after the fact make it so that some people do have to change what they are doing and meet some of the real needs of the kids that they are working with, so I ask why can't that just be done without having to label a child any child in order to set them in some mold?***All people, all kids aren't the exact same, they are not meant to be they are human beings, not machines, so why don't we treat them as such?
Posted Wednesday, October 29, 2008 by Janie Lee, M.Ed. at 10:47 PM
My three children all have various mental health and autism spectrum disorders...my oldest child (boy, now age 9)has bipolar, ADHD, ODD, OCD,Sensory Integrative Disorder (SID),and Aspergers and was diagnosed BP at age 5; my middle child (boy,now age 7)was diagnosed BP at age 6 and also has Pervasive Development Disorder,SID, ODD, Conduct Disorder, and ADHD; my daughter, age 6, is BP R/O, conduct disorder, ADHD, SID.....while i agree that there are many children being diagnosed too quickly, there are also many children who did not get correctly diagnosed at an early enough age who are now paying the price!! All three of my children are exceptionally bright, with my oldest in the near-genius bracket, but it has taken much perseverance to attain access, support, services etc for my children here in good ol' Kentucky!!
Too often, parental concerns are ignored by providers, leading to lack of effective treatment and resultant problems.... Posted Sunday, October 26, 2008 by Amanda from Kentucky at 04:46 PM
I understand the problem with the quick diagnosis of mental conditions but as the parent of a second generation bi-polar patient I am at a loss of what to do. Those of us that know the problem is real are suffering along with the ones that are misdiagnosed. While the amount of help dwindles because the group is so large how do we help the children and parents with the real serious problems. It is not we want to be reconized for our problems we want to know how to function better in public not drawing negative attention to ourselves. With the group so large our care and advice on what to do is limited and the advice becomes too general. What do I do with the highly intellegent child that can't function with his peers and gets in lots of trouble. What do I do if I have all the same problems and can't help him deal because I am alone (don't get along with my peers either) not as smart as him but wish I could help. How do I help him solve the problems I have too and never learned to solve myself. I am told we blame too much on our medical problems but all we want is help (not special attention). It is sad that it took so many years to be diagnosed and then almost as long for my child. Now with all the misdiagnoses we are lost in a shuffel of people with the same BP diagnoses name but diffrent needs. We just want to function like others are blessed with the ability to do with no extra help. Posted Sunday, October 26, 2008 by ebony00101@juno.com at 12:36 PM
I personally believe that every "mental health" worker - needs to visit bpkids.org every day for weeks on end. That's what Dr. Papolos did...
"Dr. Demitri Papolos described why it is necessary to rewrite the official rules doctors use to diagnose BP in youngsters. Bipolar disorder in preadolescent children does not resemble adolescent or adult BP very much, and what's more, young children with BP are overwhelmingly likely to have at least one other disorder as well. This can make diagnosis a very tricky proposition for doctors."
I am currently getting my MSW - I have two kids who were never exposed to violence or neglect. I have a "normal" daughter ( a little anxiety-ridden at age 19 - just like 3 generations of women before her) and a son who came into the world crying and screaming for years until he was put on his 4th SSRI at age 8 - then he wanted to die- That's how he got diagnosed....nobody asked me about all the addicted drinkers in my family - 3 of my grandparents, my father, his two brothers...and the 2 life-long marijuana users....it skipped a generation here - like his blue eyes -- many of these people I beleive - looking back - were/are trying to deal with their underlying mood disorder. My son responded to lithium at age 9 - but after 5 years he got DI -- and had to go off --However, it did not help his Anxiety - never monotherapy... "Luckily" at 15, he was recently, additionally dx with Asperger's -- WOW - this makes sense -- so he is BOTH - and instead of Emotionally Disturbed - he's Developmentally Disabled - AHHH - red carpet rolled out at school - what a shame - The posting above mine describes my son to a T - Minus the disturbing drawings at age 7, suicidal ideation, etc etc --- but I thought it was alllll BP stuff --- many of us parents find online support - because nobody else "gets it". My personal opinion is that it is a genetic mutation that is spreading down family lines - I know nothing of genetics - but they are finding genes for it - that relate to it - someday it will become a physical diagnosis - it's not in the mind - it's in the frontal lobe! The Harvard Brain Bank - a few years back needed normal brains - they had quite enough "abnormal" brains, including BP. Hoping this goes around the world wide web a couple hundred times : )
Posted Thursday, October 23, 2008 by Kimberly C --- Kansas City at 06:26 PM
Thank you Harvey. I am reading a good book called Unlimited Power, by Anthony Robins, 1997, any of the labels used in mental health can replace any of the oppressive words that we find in this book. Although it has some areas that I want to look at futher I think that many points in the book are well worth reading. This book talks about how self-fullfilling prophecy and the state of mind influences people's thoughts, emotions, and behaviors. That is what Eloise is kind of talking about when she is talking about how she has been trained to look for and identify certain things I think? Robbin's book talks about how we hold onto our past experiences and learnings about them, instead of changing our views and how that holds us back instead of allowing us to move on in a better direction. It also talks about reframing things that we think we know in life in a way as to allow those things to lead us in a better direction rather than keeping us stuck. It is very easy to read and well written. I think anyone that reads this board might enjoy reading it. Posted Thursday, October 9, 2008 at 12:50 PM
My nearly 40 years of community mental health practice, the last 14 of which as the Clinical Director of a child & adolescent behavioral healthcare program, have allowed me to experience the comings and goings of new and cutting edge diagnostics, treatments and other aspects of the conceptualization and intervention of emotional, behavioral, "mental" and other issues of childhood. My overall experiences have led me to be at first skeptical of any new findings, trends, increases in occurance rates, etc. Despite the fact that we have had increasing numbers of clinicians treating increasing numbers of children exposed for the most part to the most sophisticated parents of any generation, we continue to find increasing rates of virtually every childhood psychiatric disorder as well as increasing numbers of diagnostic categories for the little ones. My somewhat jaundiced belief at this time is that the proliferation of childhood disorders is necessary to ensure the employment of the ever increasing numbers of mental health providers. Despite the knowledge and expertise in our field more and more kids are getting sicker and sicker!
Fifteen years ago we rarely provided services to kids under 6; the modal age of our clients was 11 to 14. Today about 20% of our admissions are 6 and under (some in the 13-24 month range!) and the modal age has dropped to the 7 to 10 range.
The number of kids entering our program with a previous Dx of Bi-Polar increase every year...while the ages of thes kids decreases. I don't know exactly the reason, but I do not believe it is because the disorder is simply endemic.
I believe that the Dx is being made too quickly by folks who may have ulterior motives..such as perhaps ease in admission of a child into the hospital...or to ensure an adequate number of compensated visits..or even simply to give further evidence to bolster one's belief in this disorder. The result is that we have increasing numbers of children being given a diagnosis that is serious and essentially life long. When I have asked some practioneers if they ever consider what this Dx may mean to this now 3 or 4 year old when at 18 or 21 the indivual wants to join the military, purchase insurance or get into the university to which they aspire, no one has thought of this. Instead of allowing for longer term observations and attempts at various treatments, the need to justify payment often dictates the early diagnosis of and intervention for Bi-Polar disoder., I think we all know that once a youth has received certain diagnostic labels there is a tendency for such to remain at least at some level for years, even in the absence of overt syptoms.
I do not see folks as puposely trying to do bad things to kids in order to make a reputation or command a higher salary. I do however think that there has been an all too quick jumping on the diagnostic bandwagon of the explosion of Bi-Polar, not to mention ADHD, PTSD,PDD and I'm sure some other letter combinations as well.
In my opinion some of the real "victims" of some of our possibly misguided attempts to pathologize and then treat virtual all kids are the truly impaired children who are lost because so many other carry the same diagnosis. We really crossed the line when a well defined disorder turned into a "spectrum" of disorders. Posted Wednesday, October 8, 2008 by Harvey Kayne, Ph.D. Ohio at 11:45 AM
I have had several years of experience treating children as a therapist and I have found many who were diagnosed with bi polar to exhibit symptoms consistant with those kids on the autism spectrum. Some were HFA and some had mild forms of Autism. Whenever I'd investigate the family and developmental history, I was confident in what I observed but psychiatrists I teamed with tended to disagree. In my experience, not all kids on the spectrum will lack eye contact. This deficit may have been overcome by social inclusion early on. Others that did present with lack of eye contact made it difficult to observe because it was only obvious during angry episodes. I learned to look for lack of eye contact when the kids were angry and I would then read and investigate other developmental quirks and patterns such as eating the same foods, wanting to watch the same things over agian, starring off, sensitivity to light, sounds (esp noise) and texture, and other patterns of rigfidity. I have also observed that not all these kids will fall below 70 IQ and that when presented material in a way that is understandable to them, using a lot of nurturing, they learn well. Posted Wednesday, October 8, 2008 by Eloise V. Lewis-Performance Ma at 11:00 AM
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