Redefining Childhood Bipolar Disorder

Demitri Papolos Speaks at Ohadi Conference

by Marcia Purse

In his presentation "Childhood-Onset Bipolar Disorder: Up-Ending Diagnostic Boundaries; An Emerging New Paradigm," Dr. Demitri Papolos described why it is necessary to rewrite the official rules doctors use to diagnose BP in youngsters. Bipolar disorder in preadolescent children does not resemble adolescent or adult BP very much, and what's more, young children with BP are overwhelmingly likely to have at least one other disorder as well. This can make diagnosis a very tricky proposition for doctors.

What percentage of bipolar children also have other disorders? The numbers were startling:

• ODD - Oppositional Defiant Disorder - more than 90%
• ADD - Attention Deficit Disorder - more than 90%
• CD - Conduct Disorder - more than 90%
• Separation Anxiety Disorder - 50-60%
• OCD - Obsessive-Compulsive Disorder - 15-20%

Because multiple coexisting or "comorbid" disorders are so common in bipolar children, Dr. Papolos suggested that it may be time to look at "new diagnostic entities." In other words, perhaps the common combination of COBPD + ADD should be given its own name. He also commented that there may be no genetic basis for ODD as a separate condition, and it more likely is part and parcel of COBPD.

Proposed Research Diagnostic Criteria Dr. Papolos listed several categories to be examined for redefining childhood BP.

1. Arousal disorders - such as sleep/wake disturbances, overreaction to both positive and negative events, and being easily made anxious or fearful.
2. Mood dysregulation - rapid and sharp mood shifts, and/or ultra-ultra-rapid cycling.
3. Poor impulse regulation - especially aggression, rage attacks and sexual impulses.
4. "Fight or flight" behaviors:
   • At one end, aggressive, defiant or grandiose;
   • At the other extreme, fearful or even phobic, withdrawn, and prone to self-anger.
5. Temperament features - such as hypersensitivity, boredom, domineering behavior.
6. Neuropsychological deficits in areas such as attention, memory, motor skills, etc.

Other characteristics mentioned included a heightened "startle response," and that bipolar children are easily humiliated.

Dr. Papolos concluded with a look at the suspected causes of childhood bipolar disorder, including a discussion of how the amygdala - the "alarm center" of the brain - is involved. He noted, too, that the youngest diagnosed children almost always have a family history of both alcoholism and BP.

New official definitions of various forms of COBPD will likely not be released soon, so the more parents and doctors can educate themselves while the "new paradigm" emerges, the better off bipolar youngsters will be in the meantime.