Unmask Bipolar Disorder in Your Child
August 1, 2007 by Contributor
Filed under Health
By David H. Averbach, MD, MSIA and Audra Ann Averbach, MSW of Oakland Behavioral Health
Bipolar Disorder, also known as Manic Depressive Disorder, is a chronic condition effecting 1 to 2 percent of adults. Very often, symptoms begin in childhood and can cause significant problems with social, developmental, and academic functioning. Children who display symptoms such as irritability, agitation, hyperactivity, sleep disturbance, and mood swings may fit criteria for a bipolar spectrum condition. However, the diagnosis is difficult and many other conditions in children have symptoms that mimic bipolar symptoms. Therefore, it is very important that an evaluation by a child psychiatrist trained in Bipolar Disorder be undertaken in order to arrive at the correct diagnosis.
It is very common for children to be irritable, emotional, and irrational. However, when these symptoms begin to cause problems with functioning, the parents should consider seeking a trained professional’s opinion. Many conditions, such as Attention Deficit Hyperactivity Disorder, depression, and substance abuse, may also be present or may be the primary condition affecting the child. All possibilities need to be explored before the diagnosis of Bipolar Disorder is made.
Bipolar Disorder is displayed differently in various age groups. In younger children, moods cycling from irritability to anger, followed by normal moods may be present in Bipolar Disorder. These children usually overreact to minute issues and carry on for an extended period of time. Parents note this as a “Jekyll and Hyde” personality. In adolescents, moods are more classically either depressive or “manic.” Mania is a state of hyperactivity, racing thoughts, irrational thinking or actions, and a distinct change in personality. This more closely resembles the adult form of Bipolar Disorder.
Many children are misdiagnosed with other conditions when in fact they are more closely on the bipolar spectrum. One of the most difficult conditions to sort out is Attention Deficit Hyperactivity Disorder (ADHD) and Bipolar Disorder. ADHD does not come and go, although symptoms may be worse or lessened depending on the environment or treatment. Children with ADHD usually do not exhibit rapid cycling mood swings and usually do not get irritable and angry to the point where they become out of control and explosive. They do become frustrated, bored, and impatient, but it is not to the degree of Bipolar Disorder.
In addition, children and adolescents with Bipolar Disorder tend to exhibit moods that are more unpredictable and dysfunctional than children with ADHD. Parents know their children best – when in doubt, an evaluation by a child psychiatrist who will look at the symptoms and come up with a reasonable diagnosis and comprehensive plan is imperative.
A comprehensive evaluation consists of input from the parents and the child or adolescent. It is important that this be in their own words describing their problems. Interviewing the family about symptoms present in the child, as well as getting a detailed family history, is also very important. Many families seek out a child psychiatrist after their child has been diagnosed with multiple conditions by doctors or therapists with varying levels of expertise. Sorting out past diagnoses is usually very difficult and takes a trained child psychiatrist who has extensive experience in children with Bipolar Disorder and has seen their share of kids with bipolar and other conditions. They also can determine if the child’s current treatment is adequate and appropriate.
Other families present to the child psychiatrist with no history of evaluation or treatment. As with all evaluations, making the family feel comfortable and able to talk about difficult topics is of the utmost importance. There is usually one chance to develop a trusting relationship between the psychiatrist and the family, and this opportunity should not be wasted. The importance of ensuring the family that every effort will be made to interview, diagnose, and educate cannot be understated.
Bipolar Disorder is treatable. Depending on the functioning issues and the severity of the illness, treatment may take the form of therapy, medication, or both. Psychotherapy focusing on the importance of regular and quality sleep, good nutrition and meal planning, the need for exercise and being active, and exposure to sunlight, is essential for all families effected by Bipolar Disorder. Therapy also must involve the different parts of the family unit – the parents, extended family members, the siblings, the child/adolescent, and possibly friends. The child’s academic setting should also be considered at an evaluation. Without the help of these people, it is impossible to determine when a child is cycling and in a bad state versus when they are stable and functional.
A comprehensive review of medication for Bipolar Disorder is outside the scope of this article. However, if medication is needed, the classic family of medications used to treat this condition is the mood stabilizers. A good child psychiatrist skilled in the medication treatment of Bipolar Disorder in children and adolescents is invaluable and can save years of misdiagnosis, functioning decline, and suboptimal treatment.
Seek out resources that provide information about Bipolar Disorder in children and adolescents. Going to your local bookstore and browsing is one way to familiarize yourself with this condition. Going online to sites sponsored by the National Institute of Mental Health (NIMH) or specialty sites such as www.bpkids.org provide information from a research and health administration perspective, and from a member-driven foundation consisting of family members and concerned individuals, respectively. Choose your favorite method of educating yourself on Bipolar Disorder in kids. Make sure the information you gather is reputable. If you are concerned about you or your child, pursue an evaluation from a highly skilled and reputable child psychiatrist.
Dr. David Averbach is board certified in psychiatry and neurology. He received his medical degree from University of Pittsburgh School of Medicine, and completed his M.S.I.A. in business from Carnegie Mellon University, Graduate School of Industrial Administration. He is a member of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.
Audra Ann Averbach, M.S.W., received her Master’s in Social Work from the University of Pittsburgh. She is a member of the National Association of Social Workers. She completed her undergraduate work in psychology at the University of Michigan, and completed her College of Education, MAT candidate at Wayne State University, Detroit, MI.
