Diagnosing Childhood-Onset Bipolar Disorder

Bipolar disorder, once called manic-depression, because of its symptomatic behaviors with periods of both manic and depressive behaviors (extreme mood swings) was once thought to be a mental illness just among adults. In fact, the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) which is the comprehensive classification of officially recognized psychiatric disorders doesn't even include a bipolar classification system for children. And since the DSM-IV is the primary tool used to determine bipolar disorder by the medical profession, this causes problems for recognizing symptoms of bipolar disorder in children. When the last edition of the DSM-IV was written, not a lot was known about the symptoms of childhood bipolar disorder which explains why information on childhood bipolar disorder wasn't included. The problems caused by this lack in the DSM-IV have lead to confusion and misdiagnoses in mental illnesses in children which unfortunately can negatively affect a child for their entire lifetime.

Since the DSM-IV is the officially recognized manual of psychiatric disorders that is used in diagnosing patients with bipolar disorder, children are held to the same classification system in diagnosing their illness as adults are. The biggest problem with this is that children cycle through both their manic and depressive behaviors much more often than adults do, often many times EACH day while adults generally cycle through their manic and depressive episodes with less frequency (perhaps only every month or so).

Childhood-onset bipolar disorder (COBPD) is known by several names, Pediatric Bipolar Disorder; Early Onset Bipolar (EOBP) and Childhood Onset Bipolar (COBP) but for the purposes of this article, I will be referring to it as childhood-onset bipolar disorder. I have put together this brief guide that I hope will be helpful in diagnosing childhood-onset bipolar disorder.

Researchers are still gathering information on childhood-onset bipolar disorder with more information being added all the time. And as time goes by, studies are showing more and more cases of children being diagnosed with childhood-onset bipolar disorder. Studies are showing that childhood-onset bipolar disorder has some basis in genetics. If the parent of a bipolar child is bipolar or there is a family history of other mental illnesses or alcoholism, the chances are much higher for the child to become bipolar. Unfortunately, stress and other environmental factors also play a part.

Another problem with diagnosing childhood-onset bipolar disorder is that some of the symptoms can mimic those of other illnesses such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), oppositional defiant disorder, conduct disorder, and schizophrenia. Sometimes childhood-onset bipolar disorder is made even more difficult to diagnose because it can be accompanied by one or more of the previous illnesses I listed especially attention deficit hyperactivity disorder. The medications that are given to a child with ADHD can have a strong negative side effect on a child's bipolar disorder so that makes it even more important in making a correct diagnosis for either attention deficit hyperactivity disorder or childhood-onset bipolar disorder or both. There is also some evidence that suggests that certain ADHD medications may even bring out or worsen the rapid cycling manic/depressive episodes in bipolar children.

The following list of symptoms for childhood-onset bipolar disorder appears to be the most commonly seen symptoms among the majority of bipolar children: irritability, hyperactivity, easily distracted, trouble concentrating, fidgety, extremely giddy, separation anxiety, impulsiveness, easily annoyed, depression, poor self-esteem, compulsive behavior, learning disabilities, poor short-term memory, bossiness, lying, paranoia, hallucinations, delusions, over-responsive to sensory stimuli, have bad dreams that can be quite morbid and gory, gets easily frustrated, has difficulties making changes, mood changes, complaining, unexplained crying, extreme sensitivity to rejection or failure, child acts as if rules don't apply to them, jump from one topic to another rapidly while talking, difficulty sleeping (sleeping only a few hours at night but doesn't seem tired the next day), hypersexuality even without any evidence of physical or sexual abuse (may be extremely flirtatious beyond their age level, interested in others genitalia plus may use explicit sexual language), prolonged and violent temper tantrums, suicidal thoughts, high risk-taking behavior, loss of enjoyment in favorite activities, lack of motivation, feelings of guilt and worthlessness, carbohydrate cravings, hard time getting up in the morning, social anxiety, wetting the bed, obsessive behavior, excessive daydreaming, lack of organization, manipulative behavior, and destruction of property.

There may also be numerous physical complaints about headaches, muscle aches, stomach aches, and migraine headaches. Behaviors that are not quite as common but have been found in bipolar children are bingeing, self-mutilating, and cruelty to animals. Please keep in mind that not all bipolar children will exhibit all of the symptoms listed here.

The symptoms of childhood onset bipolar disorder can cause great difficulty in the life of a child and in the lives of their parents and siblings, and in the life of their school teachers. The child can be cycling through manic and depressive episodes many times each day or even having mixed episodes (a combination of both manic and depressive episodes) and displaying some of the symptoms I've listed in this article. One huge problem for the younger bipolar child will be school. Because of the symptoms of childhood onset bipolar disorder, sitting still in school and paying attention can be impossible for a child which makes the chances for academic success extremely slim. Add in frequent absences from school due to possible violent and aggressive behavior, suicidal thoughts or illnesses and the child may feel isolated and have difficulties making friends. The bipolar child may get an undeserved reputation for being a "bad seed," a stigma that may well follow him/her for the rest of their lives. One thing a parent with a bipolar child can do to help them at school is to request a Functional Behavior Assessment (FBA) to find out what triggers the child's behavior. Once the Functional Behavior Assessment is done, a Behavioral Intervention Plan (BIP) can be done. A Behavioral Intervention Plan outlines the steps that school personnel need to take in disciplining your child appropriately according to their mental disorder. It's one way to help raise the school's awareness of children with legitimate mental problems. You can find out more information about Functional Behavior Assessments at The Center for Effective Collaboration and Practice(CECP)

Once the bipolar child is older, the possibilities increase for some form of alcohol, drug or substance abuse. There is also the fear of them running away or even committing suicide (although young children can be suicidal and must be watched as well). The bipolar child may have difficulty with relationships and communicating and become sexual promiscuous. There is also the very real possibility that the bipolar child may commit a crime during one of their manic episodes and end up in jail.

Since there is no one specific age that a child can become bipolar and there is no one specific test that can be done to find out if a child is bipolar, that leaves the parent completely responsible for keeping track of their child's behavior. If you, the parent, suspect that your child may have childhood onset bipolar disorder, then it is very important to learn as much as you can about the disease and to keep a behavior diary on your child and his/her mood swings. Write down everything about your child's behavior and take the information with you to both your doctor and your psychiatrist. Your child will need both so find one you can work with and who will help your child. Build up a support group, ask for help, and don't fall into the trap of thinking that your child is just "bad." Your child has a legitimate mental disorder and can not control his or her actions. There is plenty of help out there for childhood onset bipolar disorder; you just need to look for it.

The Juvenile Bipolar Research Foundation (JBRF) has a Child Bipolar Questionnaire (CBQ) available FREE at their website. You can take the questionnaire in English, Spanish, Portuguese, Polish, or French. It's designed to help you and your doctor in making a diagnosis for childhood onset bipolar disorder. Once you fill out the questionnaire, you print it out and take it along with you to your doctor and psychiatrist.

Another help for parents and families of children with childhood onset bipolar disorder is a program with a series of classes called Visions for Tomorrow, developed by the Texas National Alliance on Mental Illness (NAMI). The Texas NAMI website says "Visions for Tomorrow classes provide information on specific brain disorders such as: Hyperactivity Disorder (ADHD); Conduct Disorder; Bipolar Disorder; Depressive Disorder; Eating Disorders; Anxiety Disorders; Schizophrenia; Post-Traumatic Stress; Autism; Obsessive-Compulsive Disorder and others....The classes also build skills and knowledge in the following areas: Brain Biology; Communication; Coping and Self-Care; Problem Management; Rehabilitation/Transition; Advocacy and Stigma; Organization/Record-Keeping; Types of Therapies; Juvenile Judicial System." The classes are taught by people who are familiar with brain disorders and they are available for free. You can find out more information by visiting the Texas NAMI website.

A couple of books that I highly recommend for parents with bipolar children are The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder by Demitri Papolos MD and Janice Papolos (available at Amazon.com) and The Everything Parent's Guide to Children with Bipolar Disorder: Professional, Reassuring Advice to Help You Understand and Cope by William Stillman and Jeffery Naser (also available at Amazon.com). You might also check at your local library to see if they have copies that you can check out for free.

The process of diagnosing childhood-onset bipolar disorder may seem to be quite complicated but for the parent of a bipolar child, it is of utmost importance. Especially since the symptoms of untreated and misdiagnosed childhood-onset bipolar disorder can affect the child negatively for their entire lifetime. That's why it is so important for us as parents to learn as much as possible about our child's problem and find out if it really is childhood onset bipolar disorder. Because once the diagnosis, childhood-onset bipolar disorder, has been made, then the treatment can begin.

Resources:
About.com: Bipolar Disorder. Red Flags: Symptoms of Bipolar Disorder in Children Bipolar Child Basics, June 2006 By Kimberly Read & Marcia Purse.
About.com: K-6 Children. Childhood-Onset Bipolar Disorder By Kimberly L. Keith.
BNET. Is Your Child More Than A Handful? Pediatrics for Parents, Nov, 1999 by Kathy Jimenez.
Brainstorm: Your Pediatric Bipolar InfoSource. Frequently Asked Questions about Pediatric Bipolar Disorder.
Caregiver.com. Childhood Onset.
Child & Adolescent Bipolar Foundation. About Pediatric Bipolar Disorder.
Healthier You. Facts About Childhood-Onset Bipolar Disorder.
iParenting Media. Preteen & Teen. The Bipolar Child - Early Onset Bipolar Disorder By Gwen Morrison.
National Alliance on Mental Illness (NAMI). Child and Adolescent Bipolar Disorder. Reviewed by Barbara Geller, M.D., January 2004