How is bipolar disorder diagnosed in children

These experts argue for a narrower definition of bipolar disorder which includes episodic mood swings, elevated or expansive mood—not just irritable mood—and grandiosity or inappropriate euphoria extreme joyfulness.

These experts clearly recognize that this definition excludes a number of children with episodes of mood instability, explosive rage episodes, extreme irritability and agitation. There is no disagreement that children with these symptoms are impaired.

However, experts differ on whether or not such children should be diagnosed with bipolar disorder. Experts also differ on what would be the most appropriate and effective treatment for them.

There are also other factors that can seriously complicate the diagnosis of bipolar disorder in children. A history of severe emotional trauma such as physical or sexual abuse can lead to mood swings, emotional outbursts, hallucinations, and extremely severe behavioral problems, including sexualized behaviors that can resemble bipolar disorder.

Improving our understanding of all of these issues depends on further research into these disorders as they appear in children and adolescents. Fortunately, some of this research is currently underway and holds the promise of better answers to these important questions in the future. In adults, bipolar disorder commonly involves separate episodes of major depression, alternating with separate episodes of mania. In children mixed states a mix of mania and depression and rapid cycling mood swings may be much more common.

This can make the diagnosis of bipolar disorder much more challenging in these age groups. Many clinicians have observed that the symptoms of bipolar disorder appear to change as children develop, though these observations have not been confirmed by long-term studies. In younger children chronic irritability and mood instability without classic mood swings may predominate.

These symptoms most closely resemble a mixed state of the disorder. In older children and adolescents, episodes including euphoria, grandiosity and paranoia may predominate. In all age groups hyperactivity, distractibility and pressured speech are seen.

In general, the older the individual, the more the symptoms may resemble those seen in adults. As any parent of a child with ADHD has probably already noted, there is a significant overlap in the symptoms of mania, and to a lesser extent depression, and the symptoms of ADHD. ADHD, mania and depression may all involve inability to concentrate and problems with distractibility. Mania and ADHD may both involve hyperactivity and impulsivity. Though the symptom overlap is significant there are several factors that can help to distinguish these disorders.

ADHD in children usually does not involve mood symptoms such as depression and euphoria to the extent seen in bipolar disorder.

ADHD symptoms usually first appear early in childhood while the onset of bipolar disorder appears to occur later in childhood or adolescence 4. ADHD also usually involves normal sleep, at least once a child has settled down in bed and is ready for sleep. The family history can be helpful, as both disorders appear to run in families.

People who suffer from depression, including those who suffer from major depressive disorder, may also eventually exhibit symptoms of bipolar disorder. It is harder to tell the difference between depression and bipolar disorder in children than in adults.

Children with depression more often appear irritable than sad. This presents another overlap with the irritability seen in bipolar disorder. During a depressive phase they might have more physical complaints such as headaches, muscle aches, stomach aches or tiredness. Parents may be aware that something is wrong when their child is experiencing these symptoms but may not be able to tie it to a mental illness like bipolar disorder because it may not look like depression or mania.

A psychiatrist who specializes in childhood mental health may be able to identify the symptoms if they have experience with early onset bipolar disorder. Kids who are treated early for their mental illness are likely to fare better later in life and live more functionally with their disorder. Kids might find it hard to express what they are experiencing and adults may not understand a complicated disorder like manic depression.

However there are certain signs which may indicate that a child is beginning to develop bipolar disorder and needs to receive psychiatric attention.

Manic symptoms can differ greatly from depression so it is important to know the difference. Children with bipolar disorder may struggle in school, performing poorly or taking frequent absences because of their symptoms. They may also be socially isolated from their peers, have conflict in their family life and talk about running away from home. In their teenage years, kids might start to use alcohol or drugs to self-medicate and help them cope with the disorder.

Since most people are diagnosed with bipolar disorder later in life, children who exhibit symptoms of the illness are thought to have a more severe form of the disorder. Before the introduction of DMDD as a diagnosis, many doctors were describing these children as being manic.

Children with bipolar disorder may be irritable and angry, but they will also show depressive symptoms. In DMDD, the symptoms are constant. Treatment for bipolar disorder in children should involve a combination of medication and talk therapy. There are a number of different prescription medications that may help your child manage their symptoms. Children should take the lowest dose and fewest number of medications as possible to manage their symptoms.

Your child may need to try a few medications and doses before finding the right treatment. Stopping medications suddenly can be dangerous. A number of talk therapy options are available. These are often used in combination with medication. Therapy can help parents and caregivers learn about what their child is going through and can be helpful for the whole family. Use these pointers to choose the right therapist for you and your family.

The outlook is more favorable:. Bipolar disorder in children is a serious condition. It can have a major impact on other family members and on parental relationships. More and more, families are being incorporated into therapy. Ask your doctor for a referral to a therapist who can provide support and treatment to the entire family. Rather, they are dealing with issues that are out of their control. Patience, understanding, and a listening ear can go a long way.

Bipolar disorder, formerly called manic depression, causes extreme mood shifts ranging from mania to depression. We explain the symptoms, diagnosis…. Childhood depression affects millions of children. Knowing the signs can help you find the help a child needs to fight depression and to feel better….