Children who are diagnosed with ADHD, anxiety or behavior issues may actually have early-onset bipolar disorder. But with early diagnosis and treatment, success in school and at home is possible.
For many years, children who were moody, depressed, hyper or had behavior problems were diagnosed with ADHD, anxiety disorders or behavior disorders. But now studies show that in many cases, these children actually have early-onset bipolar disorder.
What is Early-Onset Bipolar Disorder?
Bipolar disorder used to be called manic-depression. In adults, it presents as extreme mood swings, often over weeks or months. But in children, the swings are even more extreme, often occurring within days, or even hours. Bipolar can start very early in children as young as toddlers. Or symptoms may not show up until the teenage years or young adulthood. Over the past few years, doctors have been more willing to diagnose a child or toddler with bipolar disorder, although many doctors still refuse to believe that a child that young can have manic-depression (even when their symptoms react positively to drugs traditionally given for the disorder). Exact numbers of bipolar children are not available. But the Child and Adolescent Bipolar Foundation estimates that of the 3.4 million children and teens with depression in the United States, a significant proportion may be experiencing the early onset of bipolar disorder.
Childhood Bipolar: Not ADHD or Anxiety
The manic phase of pediatric bipolar disorder is often misdiagnosed as ADHD due to the hyperactive and agitated part of mania. The depressed phase of the disease is sometimes written off as anxiety, extreme sensitivity, irritability or aggressive behavior. Doctors often use adult bipolar diagnosis criteria to diagnose children, which may work for teenagers, but is difficult to apply to toddlers and young children.Here are some common behaviors in children diagnosed with bipolar disorder, as compiled by the Child and Adolescent Bipolar Foundation. Note that many of these behaviors mimic other psychiatric disorders, which makes diagnosis even harder:
expansive or irritable mood
extreme sadness or lack of interest in play
rapidly changing moods
explosive, lengthy, destructive rages
separation anxiety
defiance of authority· hyperactivity, agitation and distractibility
sleeping too little or too much
bed wetting and night terrors
strong and frequent cravings, usually for carbohydrates and sweets
impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
dare-devil behaviors
inappropriate or precocious sexual behavior
delusions and hallucinations· belief in abilities that defy logic (ability to fly, for example)
There is a sad-but-true joke among parents of children with bipolar disorder; you know you have a bipolar child if you have prevented them from jumping out of a moving car at least once. That kind of dangerous impulsivity is a hallmark of the disorder in children.
Bipolar symptoms even show up in infancy. Children with bipolar disorder often were infants who slept badly, were more clingy, and often had uncontrollable rages that were different than the usual childhood tantrums.
Bipolar: All In the Family?
Bipolar disorder has a strong genetic component. That means if a child’s family has a history of bipolar disorder, the child is more likely to suffer from it. But in the case of adopted children, that family history may not be available, making misdiagnosis even more possible. Experts say that in every generation since World War II, the age that symptoms of bipolar disorder show up is earlier and earlier. For example, children with bipolar disorder seem to experience their first symptoms 10 years earlier than their parents did.
Bipolar disorder is often mistaken for other disorders, such as depression, conduct disorder, ADHD and anxiety. But it’s also common for these disorders to be partnered with, or “co-morbid,” with bipolar disorder. In some kids, treatments for the others conditions can make the bipolar disorder worse. In others, treating the bipolar disorder first makes the other conditions less severe.
Diagnosing Bipolar Disorder in Children
Parents who suspect that their young child has bipolar disorder should keep a chart of moods, sleep patterns, tantrums and anything the child says that may be cause for concern (such as violent or suicidal statements). Take these notes with you to your pediatrician and ask them to refer you to a board-certified child psychiatrist who specializes in bipolar disorder. Do not let the pediatrician prescribe medication for this disorder; while pediatricians are excellent resources for regular childhood illnesses, they are not generally qualified to treat psychiatric illnesses other than ADHD or mild anxiety. If you don’t live near a child psychiatrist, try an adult psychiatrist with an extensive background in mood disorders.
Treating Early-Onset Bipolar Disorder
As with adults, there is no cure for early-onset bipolar disorder. But medication and counseling can stabilize mood swings and help your child live a relatively normal life. Treatment of childhood bipolar disorder often includes a combination of drugs, usually a mood-stabilizer (Lithium, Trileptal and Depakote are examples) and an antipsychotic (such as Abilify, Risperdal, Seroquel or Zyprexa). A mood-stabilizer removes the highs and lows of the mood swings, while the antipsychotic evens out aggressive and compulsive behavior. In the past, children with bipolar disorder were not prescribed Lithium until they were older, but now more doctors are finding that it works well in young children too.
There are drugs that do not fall under either of these classifications that are sometimes used as well. Some children need to try different combinations of these drugs to figure out what will work best for them, with the fewest side-effects. Unfortunately, few of these medications are approved by the Food and Drug Administration for use in children… so side-effects in children can be different than what adults may experience using these drugs.
Under no circumstances let your child’s doctor initially prescribe a stimulant medication (Ritalin, Concerta, etc) or antidepressant (Prozac, Zoloft, etc) to treat bipolar disorder. Studies show that stimulant medications and antidepressants can trigger rapid cycling and mania in bipolar children. If co-morbid ADHD exists after bipolar symptoms are successfully treated, some bipolar children are able to tolerate low doses of stimulant medications.
The Bipolar Child’s Education
Bipolar children can have a lot of problems in school. The trial-and-error process of determining the right medication mix can create even more behavior problems. And anxiety over learning and socialization with other children can trigger mood swings in otherwise stable children. Bipolar disorder is covered under federal laws requiring appropriate education and accomodations for children with behavioral or physical handicaps. So parents of bipolar children should meet with their school’s special education team and develop an IEP, or Individualized Education Plan, to make sure their child has the right resources and support in school.
Early Treatment is the Key
Early-onset bipolar disorder does not have to make your child’s life miserable. With early diagnosis and proper treatment, a bipolar child can lead a relatively normal life.