WASHINGTON, April 23, 2012 - If the incidence of a childhood illness increased 4,000% in 9 years, you would think more people would be alarmed. The diagnosis of Pediatric Bipolar Disorder (PBD) did increase that much from 1994 to 2003, and is still on the rise. There is more buzz in the media about it the past few years, and research has been (and continues being) done.
PBD is not in the current version of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR ), which is the current guide to mental disorders; approved by the American Psychiatric Association in 2000. However, PBD is an accepted diagnosis by many psychiatrists and doctors who cite studies validating the need for it.
If a child or adolescent demonstrates “more than a few” of the behaviors below, and the parent or caregiver realizes there is definitely something wrong, it is possible the child could be diagnosed as bipolar.
- Extreme, recurring depression, and sadness; disinterest in playing, talking about wanting to die or kill someone else.
- Explosive anger (esp. after four); extreme hostility, irritability, and dangerous or risky behavior.
- Intense separation anxiety, trouble sleeping, racing thoughts, and rapid, pressured speech; also unusual silliness.
- Grandiosity, delusions or hallucinations, bossing authority figures, and age inappropriate sexual behaviors, hearing voices that speak of harming others.
- Compulsive creativity, cravings for particular objects or food, excessive multi-tasking, and creative projects that depict graphic, over-the-top violence.
PBD can be confused with ADHD, borderline personality disorder, substance abuse, post traumatic stress disorder, or depression. In order for the symptoms to constitute PBD, experts look for distinct episodes of mania and depression with specified durations. Patterns of sleep, energy, and activity levels are considered, also family history.
Family History and Research
Children with PBD often have family histories that include mood disorders or substance abuse (or both). Should one parent have bipolar disorder, their children’s chance of onset increases 15% to 30%. When both parents are diagnosed the incidence rises 50% to 75%. However, to put this in perspective, most children with bipolar disorder nestled in their family tree do not develop PBD.
Research has shown that with onset of bipolar disorder in childhood or adolescence, symptoms are severer than with later onset. Children tend to have more intense symptoms and to cycle between mania and depression more frequently. They are generally sicker than adults who are bipolar, and not as likely to recover.
Another studied revealed one-third of the PBD participants had made at least one suicide attempt.
The reluctance of physicians to diagnosis PBD prior to the mid 1990s is thought to be one reason why incidence used to be lower. The increased occurrence fits with a survey showing that two-thirds of adults with bipolar disorder believe their symptoms started in adolescence or childhood.
Therapy is often recommended for PBD, and children are also prescribed mood stabilizing and psychotropic medications. Anyone who has worked with adults using these medications knows first-hand their insidious side effects. Most adults take them only when their symptoms become more of a hell than their reaction to the drug.
It is not within the scope of this article to say whether giving these drugs to kids is right or wrong, necessary, or not. It is, however, downright scary.
These heavy-duty medications present long-term health risks. Many facilitate substantial weight gain, and some are linked to later onset of diabetes, and metabolic problems. Another possible side-effect, tardive dyskinesia, is permanent. It involves involuntary, repetitive muscle movements that interfere with normal daily functioning.
PBD proponents highly recommend early treatment for best results, but no one knows the medication’s effect on children beyond the immediate reduction of symptoms.
The PBD diagnosis has its opponents. “The proponents of pediatric bipolar often rely on rhetorical sleights of hand to bolster their case by strategically framing the terms of the debate. They conflate facts with value judgments and wield these facts in an attempt to short-circuit and shut down all debate. They cite neurotransmitter activity, brain imaging, and heredity as proof that patients are “sick” when, at its best, this evidence signifies difference and diversity.” (Bossewitch)
Opponents also find it a stretch of the imagination that so many more children are thought to be mentally ill than ten or fifteen years ago. They point out that 80% of the world’s prescriptions for Ritalin are written in the United States, and over 200,000 of our children are now taking anti-psychotic medications (2010).
Environmental toxins and diets heavy in sugary and processed foods are cited as viable reasons for children’s mood swings or problematic behavior. One could argue that no child should be given any medication until they have been eating nutritious meals (and no junk food) for a few weeks.
State Your Case
There is more than one therapist in the U.S. that thinks the PBD diagnosis smells fishy. However, any parents who have children with this diagnosis, or professionals that see children with these symptoms and are convinced the diagnosis and treatment are valid; I invite you to share your story, experience, or thoughts about PBD.
National Institute of Mental Health (NIMH). http://www.nimh.nih.gov/science-news/2006/largest-study-to-date-on-pediatric-bipolar-disorder-describes-disease-characteristics-and-short-term-outcomes.shtml
Bossewitch, Jonah. (2010) Pediatric Bipolar and the Media of Madness. Ethical Human Psychology and Psychiatry. 123(3), 254+.
Geller B, Tillman R, Craney JL, Bolhofner K. (May, 2004) Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry. 61(5):459-67
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