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Bipolar's Alarming Increase

Is it real, or is there just better recognition and diagnosis?

Diagnosed cases of bipolar disorder in children and adolescents have increased by 40 times in the last decade, according to studies done by the National Institutes of Health. The reasons for this surge are unclear.

Geetha Kumar, MD, a child psychiatrist practicing in Cherry Hill, NJ, believes that in recent years, more physicians recognize bipolar in children. Among other clues, doctors now know there is a genetic factor. When a parent or grandparent has bipolar, it’s more likely that a child can have the disorder. Dr. Kumar says parents are also more aware of bipolar and seek treatment.

Overlapping Symptoms

It is widely believed that bipolar may have been misdiagnosed as other conditions in the past. It is also possible that some of the recent increase represents other conditions being mislabeled as bipolar.

One reason for wrong diagnoses is that bipolar symptoms overlap with several other psychiatric disorders, says J. Jordan Storlazzi, Jr. MD, director of the ADHD Behavioral Learning Disabilities Center in Wilmington, DE. Among the disorders with symptoms similar to bipolar disorder are ADHD, conduct disorder, oppositional defiant disorder and reactive attachment
disorder.

Two symptoms that particularly distinguish bipolar disorder in kids — hyper-sexuality and grandiosity — are usually not present until adolescence. “More typically, bipolar disorder is diagnosed in mid teens, around the age of 15 or 16, while ADHD is typically diagnosed much younger,” says Dr. Strolazzi. “Kids with ADHD are hyperactive, disorganized and have difficulty concentrating, much like bipolar kids.”

The biggest distinguishing factor is that bipolar is an episodic disorder, with a phase of depressive behavior and a phase of manic behavior. In both adults and children, these episodes can last for days at a time.

Recognizing Bipolar in Children

“All children have some type of mood swings and temper tantrums,” says Jieun Kim, MD, a Bucks County, PA child and adolescent psychiatrist. But with bipolar’s episodes of depression, “we’re talking about major depression, not just feeling sad.”

Prolonged temper tantrums are the most common early symptom of childhood bipolar disorder. According to Dr. Kim, an abnormal temper tantrum is an aggressive outburst that last more than 30 minutes. In addition, bipolar children can be very difficult to calm down.

In teens, external circumstances often cause mood swings, and moody teens are still able to focus on friends, school and day-to-day activities. Normal teen moodiness usually only lasts a couple of hours, says Dr. Kumar. By contrast, bipolar’s episode swings don’t necessarily have a precipitating factor.

With bipolar disorder, kids are not able to function normally and are unable to control the mood swings. Bipolar episodes can last days, says Dr. Kim, rather than from one hour to the next.

Depressive bipolar symptoms in children can include:

  • Flat and apathetic appearance
  • Nothing seems fun
  • Feeling down with crying spells
  • Not wanting to be bothered, irritability
  • Anger and rage
  • Aggressive behavior like hitting and fighting
  • Possible suicidal thoughts

Manic bipolar symptoms in kids can include:

  • High energy
  • Talking a lot
  • Racing thoughts
  • Decreased need for sleep
  • Impulsive behavior
  • Grandiose ideas
  • Hyper-sexuality

Treatment options

Many medications are available to treat adult bipolar disorder. Some are approved for use in children. “It’s very much a trial and error process until you get the right combination that works,” says Dr. Storlazzi. If your child takes medication for bipolar, keep regular appointments with the prescribing physician to monitor the medication’s effects.

Several types of behavioral therapies treat bipolar disorder, including cognitive behavioral therapy, group therapy to help the child improve socialization and family therapy to help the family learn how to deal with bipolar.

Medication and therapy may be required for life. Although bipolar is a chronic illness with ups and downs, “A full productive life is certainly not out of the question,” says Dr. Kumar.

Suzanne Koup-Larsen is a contributing writer to MetroKids.

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