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Childhood Onset Bipolar Disorder – Beyond Obscurity

By Kimberly Read

Updated February 27, 2010

A number of years ago, I introduced a 5-year-old child named Randy in an article called "Red Flags: Symptoms of Bipolar Disorder in Children." His parents had been to the moon and back trying to get to the bottom of the difficulties Randy was having. His symptoms seemed to be those of bipolar disorder, but no one would even consider this possibility. Barbara Geller, a psychiatrist and professor at Washington University, notes that until a few years ago, “It was considered quackery to talk about bipolar disorder in children” (Groopman, 2007). Ironically there was an article published in 1845 that described mania in pre-teens (Esquirol in McNicholas & Baird, 2000). This reference, however, is by far the exception. Only in very rare cases did the medical community even consider this diagnosis in teens, let alone in children.

During the last few years, the picture has been rapidly changing. Childhood onset bipolar disorder (COBPD) -- also known as early onset bipolar disorder or pediatric bipolar disorder -- has emerged from obscurity.

Brady Case and Anthony Russo, researchers at New York University, reported that the number of children under 18 who had been diagnosed with bipolar disorder increased fourfold between 1999 and 2000 (Groopman, 2007). Another report shows up to a 600% increase in children under the age of 13 diagnosed with bipolar disorder in the past 10 years (Groopman, 2007). The 2008 Annual Review of Clinical Psychology has a chapter dedicated to the discussion of pediatric bipolar disorder, written by Ellen Leibenluft and Brendan A. Rich. It is interesting to note here that the very inclusion of this topic in the Annual Review gives evidence of the importance researchers are now placing on this specific field of study. These researchers report that in the past five years there has been twice as many research articles published than in the previous decade (Leibenluft & Rich, 2008).

Why this sudden upsurge in interest? Leibenluft and Rich note three contributing factors: First, of interest to researchers is the possibility that children may present different types of symptoms from the adult course of the disorder. Also, the media has greatly increased the awareness of the struggles and impairment of children with this disorder as well as those with other mental illnesses. Finally, there are now a number of safe, noninvasive ways to study the brains and neurology of those with this disorder.

A discussion of the ever-increasing attention being given to this disorder in children would not be complete without noting the book The Bipolar Child, by Demitri Papolos, MD, and Janice Papolos. This work has been a significant -- probably the most significant -- contributing factor to the gains in awareness about pediatric bipolar disorder in the last decade or so. This book, now in its third and expanded edition, was originally published in 1999. The authors presented a groundbreaking premise that not only do children and adolescents actually develop bipolar disorder in childhood, but much more commonly than anyone had conceived. They also strongly supported the hypothesis that the symptoms of bipolar disorder in children are different than those seen in adults. The Papolos’ were hardly the first authors to suggest or even publish this idea. Their book -- geared to parents and everyday folks instead of researchers and clinicians -- however, propelled this discussion in to the mainstream media, raising the awareness of many parents who were baffled or even tormented by the lack of understanding and help needed in handling their children’s over-the-top behavior issues. Parents were now demanding answers to questions they never thought to ask.

So this should be good news for Randy and his parents, right? Everyone is talking about early onset bipolar disorder, and research has taken on the questions with a vengeance, so he can easily be able to get the support he needs. He now has a clear diagnosis and treatment plan, right? No, Randy is now fifteen and his diagnosis is as much up in the air as it was ten years ago. Why?

While many more researchers are now looking at early onset bipolar disorder, there still remains a library of unanswered questions and enough controversy to make the staunchest of debaters envious over the abundance of material. There is a lot of controversy over what to diagnose, when to diagnose and how to treat the illness in children. The good news is that due to the last few years, experts in this field, with a few old-school holdouts, now agree that bipolar disorder can and does occur in children.

Sources:

Groopman, J. (2007, April 9). What’s normal? The New Yorker.

Leibenluft, E. & Rich, B.A. (2008). Pediatric bipolar disorder. Annual Review of Clinical Psychology, 4, 163-187.

McNicholas, F. & Baird, G. (2000). Early-onset bipolar disorder and ADHD: Diagnostic confusion due to co-morbidity? Clinical Child Psychology and Psychiatry, 5(4), 595-605.

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