Distinguishing between normal behaviors as well as those that may indicate bipolar disorder instead of another mental illness in your youngster is difficult (see Challenges in Diagnosing Children's Bipolar Disorder. Therefore, doctors at Washington University recommend an emphasis on cardinal symptoms found in children to help overcome these hurdles.
What Are the Cardinal Symptoms?
The premise of this approach is to again start with the formal criteria defined in the DSM-IV (see Diagnosing a Child Using the Standard DSM-IV Criteria). Your doctor will then look for several specific or cardinal symptoms your child may be experiencing. These are the key problems that indicate to your doctor that yes, your child likely has bipolar disorder. These include: extended, ultradian cycling and the presence of elevated mood or grandiosity during mania.
Ultradian Cycling
For adults who have bipolar disorder, there are specific periods -- known as episodes -- in which a patient has symptoms of depression or mania, followed by clear periods of no mood problems. However, in their research and clinical practice, the Washington University team noted that kids tend to switch quickly and frequently between types of mood episodes. Your teen or kid may experience both depression and mania in the course of one day -- or even cycle between these extremes of mood several times in one day, a condition known as ultradian cycling. It is also unfortunately common for many kids to go for months or even years with no let-up of symptoms. This is not recognized in the DSM-IV, but increasingly experts believe it should be included in the assessment of a child’s diagnosis of bipolar disorder.
Elevated Mood and/or Grandiosity
For a manic episode, the DSM-IV has a checklist of symptoms. If you are an adult, you need to have any three of these in order for the episode to be considered manic. However, the Washington researchers believe a bipolar child should specifically experience an elevated mood (happiness, giddiness or silliness for no specific reason) and/or grandiosity. They feel this is important because the other symptoms on the list are also common in children with attention deficit hyperactivity disorder (ADHD). So if your kid specifically has one of these two symptoms (or both), your doctor can more accurately diagnose bipolar disorder and rule out ADHD.
Theories in Diagnosing Children with Bipolar Disorder
Source:
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR).
Leibenluft, E. & Rich, B.A. (2008). Pediatric bipolar disorder. Annual Review of Clinical Psychology, 4, 163-187.
