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Bipolar Disorder in Children

Not the Same as Adult Bipolar Disorder - And That's the Problem

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Updated March 16, 2013

History and Controversy of the Bipolar Disorder Diagnosis in Children

Bipolar disorder in children was described long ago, says Dr. Demetri Papolos, one of the most respected researchers in the field, "[b]ut in the 1930s, the myth developed in this country that it didn't exist." That myth persisted for decades; then the diagnosis of childhood bipolar disorder began to crop up again - rarely - in the 1970s.

It was the publication of the first edition of The Bipolar Child in 1999 that brought childhood onset bipolar disorder (COBPD) out of myth and into reality again. This book, by Dr. Papolos and his wife, Janice Papolos, de-mystified the symptoms of children who did not properly fit into existing diagnoses such as Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD). Suddenly it was "okay" to diagnose children with bipolar disorder. Indeed, from 1999 to 2000 the number of COBPD diagnoses increased 400%.

But the controversy remained. Many psychiatrists refused to accept that such an illness existed. Some worried that pediatric bipolar disorder had become a "fashionable" diagnosis. Others worried - with some cause - about the effects of bipolar medications on children. Still others argued - and are still arguing - about the earliest age when bipolar disorder can be diagnosed.

More on the Controversy About Childhood Bipolar Disorder

Symptoms of Bipolar Disorder in Children

There are many possible symptoms of COBPD, but the ones common to most children with this diagnosis are:
  • Rages and explosive temper tantrums that may last for hours
  • Very rapid mood changes - can occur many times in a single day
  • Difficulty sleeping, nightmares, and night terrors
  • Difficulty getting up in the morning
  • Aggressive, oppositional or defiant behavior
  • Periods of being fearful, anxious and/or withdrawn
  • Hyperactivity
More on Symptoms of COBPD

Differences Between Adult and Childhood Bipolar Disorder

One of the problems with diagnosing bipolar disorder in children has been that there were no official criteria for the diagnosis. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), published in 1994, only contains the criteria for adults, and there are major differences from those criteria in the way COBPD presents itself. A child may cycle between moods over and over again in a single day, something very rare in adults. Most children with bipolar disorder have prolonged rages and tantrums, and these are not mentioned in the adult bipolar disorder criteria, nor are aggressive, oppositional or defiant behavior.

The depressive symptoms of bipolar in children are much more in line with the adult symptoms, except that they don't have to last as long in children as in adults. And while racing thoughts, grandiosity, suicidal thinking or behavior, and psychotic symptoms are common to both adults and children with bipolar disorder, there are enough differences to make using the DSM-IV-TR criteria to diagnose a child as bipolar is just not realistic.

More on Adult Criteria for Bipolar Disorder:

Changing the Diagnosis - the DSM-V

For some years now members of the American Psychiatric Association (APA) have been working to create the next edition of its diagnostic reference - the DSM-V. Given the advances in psychiatry and diagnostic techniques since the DSM-IV was published, the new edition, scheduled for publication in 2013, is already long overdue. There was no question that pediatric bipolar disorder would be included in the new edition. What may surprise many is that the APA is proposing to create a new diagnosis for this illness: Temper Dysregulation Disorder With Dysphoria (TDD).

Whether this is basically a name change from childhood bipolar disorder or will turn out to have broader implications is yet to be seen. The DSM-V is a work in progress, and undoubtedly the proposed criteria for TDD will be scrutinized, criticized, praised and debated for some time to come. Given that the term dysphoria is not well-understood by the public, and indeed has many different definitions depending on the source, the name of this proposed disorder could be a lot harder for people to understand than is childhood bipolar disorder.

Sources:

"Childhood-Onset Bipolar Disorder: The Danger of Misdiagnosis - An interview with Demitri Papolos, MD." National Public Radio. June 2000.

Temper Dysregulation Disorder with Dysphoria - Proposed Revision. American Psychiatric Association DSM-V Development. 2010.

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