Bipolar Diagnosis In Children: What Should Doctors Pay Special Attention To? | Mental Health articles | Emotional & Mental Health center

Bipolar disorder is most likely to strike during a person's late teens and early twenties. Still, it’s possible for the symptoms show up in early childhood. Data reveals that having one parent who lives with bipolar disorder dramatically boosts your odds of developing it, too — such people have a 15 to 30 percent risk. The odds jump to a whopping 70 percent when both parent have the disease, which is luckily rare.

Researchers in Denmark found that cases of pediatric bipolar disorder have doubled during the study period, from 1995 to 2014, but they’re still not sure whether the increase is real, or due to more diagnostic attention.

Difficulties in diagnosing bipolar disorder in children

According to studies conducted by the American Academy of Child and Adolescent Psychiatry, almost a third of all child depression diagnoses — which would be more than three million children — are wrong. Instead of unipolar depression, these children would be experiencing is the early onset of bipolar disorder. This happens because it’s really hard to recognize mania in children; it often manifests as agitation and hostility rather than extreme euphoria characteristic to adults.

During depressive periods, children often experience symptoms such as tiredness, headaches, digestion problems, irritability, detachment from their peers and surroundings, bad grades, and they handle defeat and rejection badly. These are some characteristics that all physicians should pay special attention to when handling children suspected of having a mental disorder.

Can bipolar disorder symptoms overlap with other disorders?

When it comes to diagnosing bipolar disorder in children, doctors should pay special attention to the symptoms. It’s possible that symptoms of some other condition overlap with bipolar disorder, such as attention deficit hyperactivity disorder (ADHD), but also attention deficit disorder without hyperactivity (ADD).

Studies suggest that up to 80 percent of children diagnosed with ADHD meet the diagnostic criteria for other mental disorders, such as oppositional defiant disorder (ODD), conduct disorder (CD), and yes – bipolar disorder.

ADHD

With ADHD and ADD, a child tends to speak fast, breathes heavily, is often restless, and has difficulties concentrating. These children often do badly at school due to a lack of attention. You’ll notice that some of these symptoms could be assigned to manic behavior, but the main difference is that ADHD affects mostly behavior, while bipolar disorder affects mood.

It can be dangerous to confuse bipolar with ADHD because stimulants that are commonly prescribed for ADHD can make bipolar disorder – especially the manic part of it – much worse.

Oppositional Defiant Disorder

While being oppositional at times is a normal characteristic of children while developing personality and independence, children with oppositional defiant disorder are defiant (hence the name) most of the time, refuse to cooperate, and are hostile towards most people, including their teachers and parents. The condition is mostly diagnosed sometime during early to middle childhood. These children detest authority, and are more troubling to those surrounding them than they are to themselves.

The main difference between mania and ODD is that ODD occurs chronically, and mania periodically.

Conduct Disorder

Experts group conduct disorder into four categories based on patients’ behavior:

Aggression – fighting with peers, cruelty to animals…
Deceitful behavior – lying, stealing…
Destructive conduct – acts of vandalism, arson…
Breaking the rules – ditching school, running away from home…

Studies have shown 69 percent of cases of conduct disorder occur in combination with bipolar disorder, which can confuse the clinical presentation of bipolar disorder and make its detection more difficult. Also, it’s obvious how someone could mix these behaviors with bipolar disorder, because people tend to do a lot of these things while manic.

How to treat bipolar disorder in children

Children can get moody and unpredictable for no reason; it’s in their nature. But if it occurs often and within a certain pattern, it requires an expert’s attention and evaluation.

Many long-term studies have shown that antidepressants are not effective in the treatment of bipolar disorder, and some observational data suggests that antidepressants can be connected with making the symptoms (mainly rapid-cycling) worse in one-third of the bipolar patients that were tested.

It was a common practice in the past to treat bipolar disorder with antidepressants (some doctors still do it), but this practice is controversial because bipolar disorder requires mood stabilizers, and antidepressants have mood-destabilizing effect. Even if antidepressants are prescribed together with mood stabilizers, it will eventually lead to not responding to the treatment with mood-stabilizers.

There’s a relatively new treatment for bipolar disorder in children made of a combination of Omega-3 fatty acids and a natural plant-based supplement called inositol. According to the person who discovered it, Dr Joseph Biederman, director of the Pediatric Psychopharmacology Unit at Massachusetts General Hospital in Boston, this side-effect free supplement treats bipolar disorder in children between the ages six and 12. According to research, it can even help with lithium-precipitated psoriasis in adults with bipolar disorder. You can read more about this supplement here.

Be careful

Irritability, being easily distracted, aggression, as well as defiance can be connected with many psychiatric, but also developmental, disorders. What children with these behaviors need is careful evaluation by a mental health specialist. This will help better interpret and understand the symptoms and their mechanisms of action. Bipolar disorder can be an explanation for these symptoms, but conditions such as ADHD, behavior problems, and even trauma can also explain these symptoms in some cases.