Part of the problem in diagnosing Bipolar disorder in children is that research has shown us that we, as clinicians, are not very good at it. On the one hand, research suggests that youth who are referred for psychiatric treatment as children or adolescents at increased risk of developing bipolar disorder as adults. Other prospective studies have shown that as we follow youth with a bipolar disorder diagnosis into adulthood, the vast majority of them will not meet criteria for bipolar disorder. So, we are seeing the youth at greatest risk for bipolar disorder, but we are not very good at identifying which youth will actually have adult bipolar disorder.
Current treatments for youth identified as bipolar disorder also suggest we are missing the mark.Treatment of adults with bipolar disorder is successful in reducing symptoms about 70 percent of the time. Children diagnosed with bipolar disorder who are given similar treatment regimens do not respond as well.
The standard for a diagnosis of bipolar disorder is the presence of a manic episode, though the vast majority will experience depression as part of the disorder:
A manic episode is a sustained period of “abnormally and persistently elevated, expansive, or irritable mood” in a distinct shift from normal functioning—not just “10 minutes of feeling super-good,” as one clinician puts it, but a pattern of behavior. Some of the following symptoms are also usually present: grandiosity; decreased need for sleep; increased talkativeness; racing thoughts; scattered attention; drive to achieve goals; and risk-taking behavior. The behaviors must significantly interfere with normal activities—social life, school, work—or a psychotic episode must be present.
A teenager in a major depressive episode will display either depressed or irritable mood most of the time, or lose interest or pleasure in things he once enjoyed. In addition, he’ll show some of the following symptoms: marked weight loss or gain; sleeping too much or too little; restlessness or lethargy; fatigue; feelings of hopelessness, helplessness, worthlessness, or excessive or inappropriate guilt; cloudy or indecisive thinking; and a preoccupation with death, plans of suicide, or an actual suicide attempt.
- Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.Symptoms of mania include:
- elevated, expansive or irritable mood
- decreased need for sleep
- racing speech and pressure to keep talking
- grandiose delusions
- excessive involvement in pleasurable but risky activities
- increased physical and mental activity
- poor judgment
- in severe cases, hallucinations
Symptoms of depression include:
- pervasive sadness and crying spells
- sleeping too much or inability to sleep
- agitation and irritability
- withdrawal from activities formerly enjoyed
- drop in grades and inability to concentrate
- thoughts of death and suicide
- low energy
- significant change in appetite
Periods of relative or complete wellness occur between the episodes.
- No one symptom indicates bipolar disorder, however if a child has number of symptoms listed above, and they are interfering with functions at home, school, and friends, have them evaluated by a professional.
Bipolar disorder is not the easiest diagnosis to make, particularly in young children. Many of the symptoms are similar to those associated with other disorders, including attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, depression, and conduct disorder. Children and adolescents with bipolar disorder can also have signs and symptoms of a second disorder, such as substance abuse or anxiety disorders. This is why it’s particularly important to get a comprehensive evaluation by a mental health professional who has specific training and expertise in the diagnosis and treatment of complex child psychiatric disorders.