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Mental Health: Pediatric Bipolar Disorder???

Updated on August 21, 2019
abbykorinnelee profile image

Bachelors Degree in Organizational Behavioral Psychology with a background in Autism, Mental Health, Business Psychology

What do we know?

What is Pediatric Bipolar Disorder?

Pediatric Bipolar is simply the bipolar disorder that is diagnosed in a child. There is a lot of academic debate and disagreement as to whether this disorder is valid or exists or not, but with the amount of evidence and studies done,, it looks as if the existence of bipolar in children is not unheard of.

The symptoms of Bipolar in children differs from that in an adult. Children will experience very abrupt mood swings, high levels of frustration, excessive defiant behavior, rapid and severe crying cycles, be really hyperactive than its followed with extreme lethargic behavior, over the top temper tantrums and would have chronic (not episodic like adults) irritability.

The Diagnostic and Statistical Manual (DSM-4) does not have criteria for diagnosing pediatric versions of bipolar disorder. Hopefully this will soon be rectified as the DSM-5 will be the new edition soon, and rumored to have reconstructed the Autism criteria. So, diagnostic measures were created by researchers and professionals and they used the adult criteria as their baseline to determine the best criteria possible.

Pediatric Bipolar Disorder

Source

Bipolar Increased Diagnosis in Children

Children with Bipolar Disorder manifest the disorder in a severe form from the adult that sufferers from the illness. Recently, the National Institute of Mental Health disclosed that there has been a 40-fold increase in childhood cases of the illness. The concern has been that children that have been diagnosed and medicated are taking anti-psychotic and anti-convulsants drugs that work very well in children that indeed have the disorder. Problem is a high percentage of cases may have a different disorder that have different treatment methods. The mediation they are taking would be unnecessary. There wasn't any reported reason that was known, to be the cause of such a drastic rate of diagnosis. We saw this and are still seeing drastic increases in the area of neuro-developmental disorders such as Autism Spectrum Disorders.

It's important to realize that not only are these children being diagnosed with a disorder that thirty years ago was most likely unheard of in a child, but they are being diagnosed with a co-existing condition such as Attention Deficit Hyperactivity Disorder (ADHD). ADHD has levels of anxiety and irritability (especially when medicated on stimulants), but is this actually symptomatic of mania in bipolar? Or is the mania in a child diagnosed with bipolar really only the symptom of an undiagnosed ADD?

Already controversial is the fact bipolar has ever been diagnosed in children as the average rate of onset is mid to late teens into their late twenties.

The NIMH has been actively working on what assessment tools should be used in diagnosing bipolar, tightening up the technical criteria for the disorder in the first place, encouraging researchers to do the same when assessing and defining bipolar in adolescence or childhood. There have been some cross-cutting studies that have looked at the area of irritability that might help in clarification of any boundaries between disorders like Bipolar and ADD.

What I found very influential in the advances for diagnosing more accurately and also making the psychological field more scientific based to the public; is that there are now functional brain imaging studies that show circuitry differences. There are other studies showing new techniques that also measure brain circuits; such as, magnetoencephalography (MEG).

Clinical neuroscience may be able to aide in the problem of disentangling the disorders so they no longer overlap each other.

This issue is very important to address and has been one for many years. I was talking to a child clinical psychologist in Fon Du Lac, Wisconsin last month about this very thing. There was a women I knew that had two female family members that were diagnosed with Bipolar as adults. One had simplex 1 and the other had simplex 2. She had been noticing for years that she had some symptoms that manifested in a pattern and that they interfered a little in her functioning. She knew she had been diagnosed in the early 80s with ADHD and her parents didn't believe in this disorder so she was never treated. When she sought out a psychiatrist and gave him her symptoms he immediately put her on Bipolar medication. Problem with her was that he never gave her questionnaires or testing and never watched her over a course of time to verify he was identifying a valid disorder.

When she had been on the medication she ended up in the ER with some bizarre symptoms and the doctor told her to get off the medication immediately and that she was probably misdiagnosed. She sought a second opinion and the psychiatrist quickly tossed out her diagnosis and choose to observe her for three months and after was diagnosed with ADD. According to him, bipolar and ADD manifest the same symptoms and behaviors and it was more common to be Bipolar and actually be diagnosed ADD. Not the other way around.

The psychiatrist made it clear that no one can have both disorders. Even if it was possible, the medication used to treat ADD couldn't be used on someone that has Bipolar as stimulant medication will force a mania episode and the episode would be a lot more intense and probably dangerous than the normal cycles of mania. I was surprised that he said this to her and did a little digging and from what I could see at the time he was pretty accurate in this situation. Now things change but I always wondered about it and at one time I saw someone with Bipolar take a 30mg Adderall XR and they were off the wall and up for four days. I won't go into what they did but lets just say Drew Barrymore could have played her character in a movie.

DIAGNOSTIC CRITERIA FOR PEDIATRIC BIPOLAR

(click column header to sort results)
Symptom's of Bipolar: 4 or more  
Frequency  
Severity  
Irriatability that Affects Daily Mood
 
Chronic and Extreme
Extreme Sadness
 
Extreme
Lacks Interest in Play
 
 
Rapid Cycling Moods
A few hours to a few days
 
Explosive, Lengthy, Destructive Rages
 
Extreme
Seperation Anxiety
 
 
Defies Authority
 
 
Hyperactivity and Agitation
 
 
Sleep Disturbances
Sleeps too much or too little
Night Terrors
Wets the Bed
 
 
Cravings for carbohydrates and Sugar
Frequent
Strong
Involvement in Several Projects or Activities at the Same Time
Multiple Activities
Frequent
Judgement, Impulsive, Racing Thoughts
 
Impaired
"Dare Devil" Behaviors
 
 
Believes that they can do Things That Defy Logic
 
(Think they can fly) Severe
Child must present four or more manifestations of these symptoms with marked impairment in functioning in more than one setting

Normal vs Abnormal Behaviors

Many of the symptoms on the list are behaviors that are normal during child development, for example, bed-wetting can be common at night time when child is learning to potty train. Separation Anxiety is normal during development as well. The key thing to remember is they must have at least four of these listed as well as taking into account family history of mental illness and the severity and frequency of the behaviors. Also, some of these are indicitive of another disorder like Autistic kids have violent and prolonged tantrums and ADHD kids have irritability and hyperactivity ( that lasts for at least two weeks ).

Remember that the diagnosis' validity is being challenged and until its been validated by the scientific and psychological communities, the criteria won't be in the DSM-4. That means that insurance companies may deny coverage for things like treatments, services, and medication. On top of that if you change doctors or relocate for any reason, many professionals still don't recognize it as a mental illness and thus would misdiagnose your child and either he wouldn't get any help or he would be re-diagnosed with something else that may not be accurate and the treatment not affective.

Childhood Bipolar is several intertwining symptoms and behaviors that are marked by rapid mood swings and irritability. On top of that they must have a marked impairment in functioning in normal life in more than one setting. ADD kids have mainly problems in school for instance, just one setting.

Neurotransmitters in Human Brain

Neurotransmiter
What area it Affects
Serotonin
Mood (happy, sad, euthymic)
Dopamine
Pleasure
Norepinephrine
Alertness and Energy Levels
Acetylcholine
Memory and Cognition (thinking)
Gamma-aminobutyric acid (GABA)
Neurons in the Central Nervous System and Inhibition
Six Neurotransmitters that help regulate the functioning in different regions of a human brain

Pediatric Neuropsychology

Pediatric Neuropsychology has to do with the diagnosis and treatment of a wide range of brain-related and emotional disturbances among children and teens
Pediatric Neuropsychology has to do with the diagnosis and treatment of a wide range of brain-related and emotional disturbances among children and teens | Source

What Causes Bipolar?

CHEMICAL IMBALANCES/NEUROTRANSMITTERS

Bipolar Disorder is caused by neurochemical imbalances in a person's brain. The hypothesis (that is close to being brought to light as being validated through research studies that are currently being conducted) is that the part of the brain affected is emotional processing and that the brain isn't functioning the way it should be in a normal individual. This would be true in children and also in adults.

Neurotransmitters in your brain are in several different regions in a human brain. It is supposed to help regulate the brain's activity. There are six different neurotransmitters that have been identified and their affiliation to things like mood and emotion. ( Described in table above this capsule).

An imbalance of three neurotransmitters is most common (dopamine, serotonin and nor epinephrine) are the ones that affect things like mood and a person's cognition. Medication usage is said to regulate the neurotransmitters and the sensitivity receptors as well that are located in the brain.

ROLE OF GENETICS

Genetics play a significant role in the development of Bipolar Disorder. Those that have family members that are considered "first degree" (mother, siblings, father) its more predictive they would manifest symptoms in childhood. When you are diagnosed as a child, its likely they will be less responsive to medications than older teenagers and adults, like Lithium.

If a child has a biological parent with Bipolar Disorder 1/2, 15% of the children of these parents had a childhood form of bipolar while 28% had ADHD.

The risk of having a child with bipolar if one parent has the disorder is at 30-35%.The risk of having a child with bipolar if both parents have the disorder is as high as 75%.

The younger you are the more likely you will manifest psychotic symptoms than an adult.

When studying bipolar in teenagers, there was a trend for the teens to misuse and even abuse psychoactive drugs. It is also more likely you will see parent and child relationship difficulties when a teenager is diagnosed with bipolar over the children that aren't.

As I stated earlier, but found evidence of my claim when researching, its a huge concern that when a child is presenting with extreme mania, that first they are misdiagnosed with ADHD. Also, there seem to be neurodevelopmental delays in the teenagers that had early onset bipolar.

ENVIRONMENTAL FACTORS

Here comes the nurture side of the nature vs nurture debate. Environmental factors play a role in everything from development of speech and language to developing a mental illness. These factors can include behavioral, family related, educational, toxicity, and even substance abuse.

When a study is being conducted, they go in trying to find a cause and affect. Sometimes you are unable to construct and perform a scientific study due to ethical reasons. You can't give them a bunch of heavy metals to increase toxicity in their blood to see if they develop bipolar. I would hope no one would want to do that. So, when you are unable to manipulate a variable to prove cause and affect you can still find out if there is a causal correlation between the two and that is what they did with smoking tobacco, there is a correlation between bipolar and smoking.






Factors Associated with the Risk of Suicide

Source

Risk Factors For Early Onset Bipolar

There are already risk factors associated with Bipolar Disorder when in adults, however when manifested in growing children who experience all sorts of hormonal, emotional, and brain changes wouldn't the risk factors associated with the illness be more severe? I detail below what risk factors are associated with pediatric and early onset bipolar. I have seen first hand what bipolar does to an individual and I have watched someone struggle with it as well as it affecting family and friends. I couldn't imagine watching it with someone not able to even care for oneself and that the won't know what normal ever truly is.

  • Suicide - Adolescents are at higher risks when diagnosed with Bipolar than in comparison to the average adolescent boy or girl. They are also at a higher risk of suicide in comparison to the adolescents that have another behavioral disorder. Suicide risk increases even more if their are family problems or substance abuse issues.
  • Boys are at a higher risk of committing suicide than teenage girls.
  • From the ones that did attempt suicide, girls being the smaller percentage than boys, girls that did try to kill themselves were more likely to be unsuccessful and have tried more often than there male counterparts.
  • The reason that the males rates may be higher than the females is that the boys are suicide "complete rs" and the girls are often not successful in completing it but both should be treated equally as serious.
  • Legal Problems - 24 percent of teenagers that had been diagnosed with this illness AND attempted suicide were previously in some legal problem or charge that occurred within a year of the suicide attempt.
  • Incarceraton- its highly prevalent in a youth facility of mental illness among inmates.

© 2012 Abigayle Korinne

Comments

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  • thewritingowl profile image

    Mary Kelly Godley 

    6 years ago from Ireland

    Thanks Abbykorinnelee, we have meds in this country just no Doctors, Pediatricians or Geneticists who are really willing to help kids like my son either through lack of interest in all the issues involved or most likely because its all a very long i.e. a Political Quagmire. I agree too that medication is certainly not always the answer and you need to be very careful I know that from my own experience too. But you just need to talk to someone who is fully aware of all the issues, the facts, all the options and weigh up what might be best for your child. Such people are very rare here in Ireland. Take Care.

  • abbykorinnelee profile imageAUTHOR

    Abigayle Korinne 

    6 years ago from Plymouth WI

    You know its so sad to me that you can't get medicaton and Iknow a family member of mine that refuses t take it...if I was still talking to her I would tell her that her insurance company should just ship her meds to your countryl

  • abbykorinnelee profile imageAUTHOR

    Abigayle Korinne 

    6 years ago from Plymouth WI

    CBT is a great therapy. Anything in the behaviorism category is for what they use it for. We started the token economy here and that even snapped my kid out of depression. The medicaiton issue is hot and cold with me. I think in Bipolar it is so necessary but that they overmedicae in others. I just did a hub about ADD meds and found out doctors are giving them to kids to get better grades knowing they don't have the disorder. I want to go to Ireland. Is it peaceful there? I need some peace.

    I have an Autistic son too. He actually mimcs bipolar so close its scary...but the doctor in germany we had doesn't believe the disorder exists. I have to run and pick up my son but I wanted to let you know I am so greatful for your responses. On days like today when I feel really alone and think I lost a friend I have had for my lifetime...this is comfort for me right now. Thank you so much for showing interest in what I wrote.

  • thewritingowl profile image

    Mary Kelly Godley 

    6 years ago from Ireland

    Here in Ireland it is very hard to get depression or Bi Polar medication even if you have a diagnosis but getting that to begin with is also extremely difficult. Having depression myself I think Cognitive Behavioral Therapy really is very important too and unfortunately here in Ireland where we have a very high rate of suicide (again especially among young men) Mental Health Services are seriously lacking.

    I worry too about my autistic son developing depression too and even felt that is what he had over the last six months but as he is non-verbal nobody thought it was a possibility. But as there is a definite genetic risk here too as I have suffered from it, I thought differently so I found your article very interesting. I too think children can suffer from depression (and certainly I feel I did as a child but it was not believed in those days in Ireland that children could have any psychological illnesses), that's why i think articles like this are very important to raise some awareness around these little discussed issues. Voted Up .

  • abbykorinnelee profile imageAUTHOR

    Abigayle Korinne 

    6 years ago from Plymouth WI

    That is a very difficult situation for me, because I believe that mental health is an issue world wide. I am somewhat of a humanitarian I suppose but in countries like yours, where you really need it you can't get it...but in this country there are doctors that give children the medication for ADHD for instance that dont need it just so that the kid gets good grades. (That one I am going to post shortly because its insane what I found and it made my stomach hurt).

    I wish I knew of someway that your country could be helped. Has anyone petitioned mental health non-profit organizations in the United States? Because that would probably be a place to start.

  • geetbhim profile image

    sangeeta verma 

    6 years ago from Ludhiana India

    Hi abby1

    you are right what I wanted to know you answer that.But still I do feel country like India were this kind of disorder persist but rarely or very few people accept this and they go to doctors. In most cases disorder goes unnoticed. I have seen many people suffering from mental illness and they don't accept it.

  • abbykorinnelee profile imageAUTHOR

    Abigayle Korinne 

    6 years ago from Plymouth WI

    geetbhim, teenage suicide rates are on the rise for many different reasons. One being the increase in the bullying and types of bullying and how the laws haven't caught up to technology. Suicide is a risk factor for someone with bipolar. It doesn't mean that if you are suicidal you are bipolar though. I hope that is what you wanted to know.

    Illegal drug use or misuse of prescription medication is a contributing factor in their suicial thoughts. With bipolar using illegal drugs makes the symptoms a lot worse than naturally they are.

    As for if drugs are the only way to fix it I don't believe every person is the same and that we respond to different things and those should be tried before administoring antipsychotics to a human being. When it comes down to the science of it, there is evidence that it is an imbalance of many chemicals in your brain and to balance those out medications are known to work. Although in American culture we have processed foods and contaimnated foods and all that...just in my case I have ended up with some weird arthritic condtion because a certain acid level was too high in blood and it was from eating processed foods. When you are in pain like I was it alters your moods and can lead to things like depression so taking care of your body isn't held to high enough esteem here and it should.

    Our culture thrusts medications at us left and right and for everything and they have to make stronger ones because we become immune to them. I can't take a whole lot of antibiotics because I was so sick as a kid my body just doesn't react to it. Its a question of when is the point a line needs to be drawn that we medicate.

    You would be surprised what a quiet and calm atmosphere and classical music while doing yoga can do. A psychiatrist told me to try it and I did and its better than all the Xanax in the world

  • abbykorinnelee profile imageAUTHOR

    Abigayle Korinne 

    6 years ago from Plymouth WI

    I agree with you on the fact our brains develop with influences from other things. I don't agree with medicating almost all of the time. I didn't put my personal opinion in this hub much. I wanted the information to be available and I didn't want it to be a back and forth thing because someone didn't like my views. I am pretty adamant in my views when it pertains to psychology related topics because I have somewhat of a passion for it as I have studied it on and off for fifteen years and I have a knack for it and have worked voluntarily alongside doctors in psychiatry and psychologists.. Medications are very dangerous in my opinion and I am actually going to do a few hubs on using stimulants in kids with attention difficulties. I myself kept my Autistic son off until recently but had a good reason and its a really long story but I wanted him to know how to function off of it, be able to tell if the medication wasn't doing what it was supposed to, and he does and he will when or if he ever gets off of it. I also self educate on these things. I don't want you to think this is my view. If you are interested in mine, I am always open to discuss anything.

    I even have talked in text to one hubber during hte election because of the things we talked about and I didn't understand and all that.

    Luckily the brain imaging is finally going to be something available ot make this more scientifc as to the theory side. We will be able to know when chemicals are out of whack, blood tests are being researched and studied as well. There are biologically based problems that are linked to mental illness.

    Thing is I agree that people put kids on medicatons because they don't want to put in the effort that is extra from what a normal child would so they want them to be good and controlled and I have fought years with a school as they tried to force me to medicate. I have seen first hand what too much or the wrong medication does to a child. Its sometimes needed as bipolar is one of those disorders and one of the few I will adamantly tell an adult with a severe case of bipolar that they not only need all the seperate therapies they also need the medication. But we don't iknow what htese meds will do to our children in the long term because they haven't been tested for children. One bipolar medication can actually mess you up so bad you go psychotic and lose time and have amnesia.

    I am grateful that you had some thought to share and I am glad that you weren't afraid to tell me a view that might be opposite mine. If you have any further questions or want to know what I think about aspects of this feel free to ask me anything I don't have boundaries with it.

    I wish more people were like you the only way for people to know whats going on is to actively participate. Even in topics they don't have interest in...I did during the election and I have a strong view about self educating and not letting someone tell you what to think.

  • geetbhim profile image

    sangeeta verma 

    6 years ago from Ludhiana India

    Suicide rate is high among the teenagers, do that mean all teenager's who commit suicide are diagnosed with AND? When there is severe problem than drugs only can help us in solving our problem, but if the symptoms are minor than the little change can work wonder , for instance by providing cozy atmosphere to the teenage -what they want to do and how they want to live , by not interfering in their matter that's what most of them need to live their own live.

  • vrbmft profile image

    Vernon Bradley 

    6 years ago from Yucaipa, California

    Whatever the label one puts on a disorder, ultimately we go back to

    our brains and what makes the brain grow and develop in the first place? The relationships we have. There are all kinds of ways to soothe the brain centers without using toxic medications which we really do know little about for the long haul. I have been a mental health professional for a VERY LONG TIME. 47 YEARS. And there is nothing like human touch not just once, not just when someone has already "lost it," but constant.

    As a society, we need to look at how we choose to live our lives and our children are no longer a priority. They are in the way and we live crazy, stressful, and addicted lifestyles and we lose our ability to think wisely and to feel and process our emotions. Well, I could go on and on, but I am not in favor of giving children medications and no one will ever be able to convince me and I think adults can find all kinds of way to take care of their brains without soaking them in pharmeceuticals.

    Aside from my strong thoughts and opinions, you did write a fine hub, well researched with lots of information. But I think we all need to start going in some other direction than DRUGS.

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