Diagnosing Bipolar Disease in Kids
A: Only in the past few years of family counseling has the question "Is she/he bipolar?" begun being asked when children have mood problems. The question indicates how much more this diagnosis is being made, with adults as well. It seems to be the diagnosis du jour. How many times have we heard people referred to as "bipolar" when they are just moody?
Bipolar disorder used to be known as manic depression, described as "a chronic brain disorder marked by bouts of extreme and impairing changes in mood, energy, thinking and behavior." The Diagnostic Statistical Manual (the American Psychiatric Association-approved manual for basing diagnoses) describes in detail four types of bipolar disorder, and the youngest people it mentions are adolescents.
This is a controversial issue, because some in the profession do believe there is an early onset of the disorder starting in childhood. The problem is that there has not been enough research on children to be definitive. The information comes from adult studies that have led to many improvements in treatment as we learn more about how the brain works. However, we do know that children's and adults' brains are not the same; there is a need to research the age groups separately.
Families bring children with a variety of concerns to counseling, and some professionals see many of the following symptoms reported as bipolar disorder: temper outbursts, sudden mood changes, sleep problems, poor judgment, irritability and hostility, incessant arguing, excessive distractibility, involvement in risky behaviors, racing thoughts, many physical complaints, extreme sadness, guilt and worthlessness, loss of interests in activities, school failure, and peer problems. Parents and other close family members begin to feel as if the family revolves around the child's moods, problems, and expressions of fear and anxiety.
If your child is having these symptoms, he or she should be evaluated first by a medical doctor to make sure there are no physical causes. If the child is cleared medically, he or she should be referred for a psychiatric evaluation, which may include meeting with a child psychiatrist or a therapist who specializes in children and families. The important thing to realize is that these symptoms can stem from many areas, such as a chaotic home situation, an anxiety disorder, depression, a traumatic event, temperament differences that are in conflict with the parent, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, divorce, death of a parent or sibling, unidentified learning problems, and even substance abuse. It is common to see substance abuse with teens, but unfortunately this issue now involves younger children.
There are many possibilities to explain a child's mood problem, and doing so takes careful evaluation and treatment. If you jump to the diagnosis of bipolar disorder, you are using serious medications and labeling your child with a serious mental illness at an early age. One recommendation is that if your child is diagnosed with bipolar disorder, you should get a second opinion.
Judy Bell, MSW, LCSW, is a children, adolescent and adult counselor for Moses Cone Behavioral Health in Kernersville. Please submit your questions to "Is My Kid OK?" by e-mailing firstname.lastname@example.org.