Special Report – Bipolar Disorder In Kids

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Bipolar Disorder In Kids About 1% of children in the U.S. have suicide, or self-destructive behavior.

Many of these symptoms can be indicative of conditions other than bipolar disorder, but it’s important to have the child evaluated to reach the right diagnosis, says Tim Lesaka, MD, child psychiatrist with The Staunton Clinic in suburban Pittsburgh. Many cases previously thought to be attention deficit hyperactive disorder (ADHD) may, in fact, be bipolar disorder, he says.

“With kids with bipolar disorder, it’s a matter of extremes,” says Lesaka. “With an ADHD kid, there’s a five-minute tantrum and then an apology. With the bipolar child, it can be eight hours of rage with no apology. There is an explosiveness … followed by a super-depression.”

Treatment for bipolar disorder — in kids as well as in adults — usually consists of a combination of medications that may include one or more of the following: mood stabilizer, antipsychotic drug, antidepressant, or antiseizure drug. Medication does work, Kowatch says, but there’s always the problem of getting kids to stay with the program. “It’s a real pain for them,” he says. “The drugs have side effects … but the alternative is to wind up in the hospital.”

Researchers at Ohio State University are looking into other treatment options in two new studies, one funded by the National Institute of Mental Health and the other by the Ohio Department of Mental Health.

The researchers are studying a promising new treatment called psychoeducation that they believe can help children with early-onset bipolar disorder and their families.

Though there have been a few studies evaluating medication in children, none has examined psychosocial treatments, says Mary Fristad, PhD, leader of the studies and a professor of psychiatry and psychology at Ohio State.

“Medications are vital for helping children with bipolar disorder, but they can’t do everything,” says Fristad.

“If you have your first mood disorder as an adult, you have already learned a lot of coping skills that can help you, such as how to hold a conversation and how to treat friends,” says Fristad. “But when you get a mood disorder as a child, you often have never had a chance to develop these interpersonal skills. We help kids ‘catch up’ with these skills, which in turn helps them manage their symptoms.”

While acknowledging that bipolar disorder in children does indeed exist, Barry Cohn Markell, PsyD, a licensed clinical psychologist in Park Ridge, Ill., adds a note of restraint. “It’s talked about more, but it’s still very rare.” (According to Kowatch of Cincinnati Children’s Hospital Medical Center, approximately 1% of children in the general population suffer from bipolar disorder.)

Cohn Markell is concerned that an inaccurate diagnosis of bipolar disorder can “label” a kid for life. “Many of the symptoms that are listed for bipolar disorder can be caused by other things from abuse and neglect to physical illnesses such as epilepsy, , brain tumor, or head injury.”

When parents bring a child with severe mood swings to him, Cohn Markell learns about the child’s environment — by observing the child himself and/or by giving the parents and teachers an observational scale (“If the behavior isn’t the same at home and at school, then something else might be going on,” he says). He also takes a history to determine how long the symptoms have been present and refers the child to a pediatrician to rule out physical illness.

If a child is diagnosed with bipolar disorder, says Cohn Markell, he recommends counseling, special classes or schools, and support services for the child and family.

Judith Lederman agrees. “There’s so much to know and so much to deal with,” she says. But it’s important to know that you’re not alone. There is support out there. But you have to seek it out.”

Reviewed by Michael W. Smith, MD, August 22, 2002.