In recent years, mental health clinicians have become aware that many adults who develop the condition known as Bipolar Disorder have had some symptoms during their childhood. The challenge for mental health clinicians and researchers has been to connect the dots between behavioral or emotional difficulties in childhood and Bipolar Disorder. There is much controversy in the field about how best to connect these dots. Lucy Daniels Center clinicians are among the many professionals who feel that the field may have diagnosed many children with Bipolar Disorder on the basis of symptoms that might develop into a Bipolar Disorder, but also may well not develop in that direction. More explanation is in order.
What is Bipolar Disorder?: Bipolar Disorder, also known as manic-depression, is a serious mental condition that manifests with symptoms affecting mood, energy, thought processes, judgment and behavior. The symptoms may be those of depression or those of mania, a condition of elevated mood, impaired judgment and thought, and diminished impulse control. Although most individuals with depression do not have Bipolar Disorder, the diagnosis applies to some individuals with repeated periods of depression and to most individuals with even one episode of mania with or without a separate period of depression. Sometimes, but not always, symptoms begin in childhood or adolescence. Researchers in the field estimate that between approximately 2 percent of all adults have Bipolar Disorder.
What are the symptoms of Bipolar Disorder?: Bipolar Disorder usually manifests differently in childhood than in adulthood. For example, many affected adults have periods of well being between episodes of illness, whereas affected children tend to be more chronically troubled and irritable.
Possible symptoms of childhood Bipolar Disorder are:
· Infants have difficulty being comforted and do not settle into stable rhythms such as the sleeping and waking cycle;
· An expansive or irritable mood;
· Rapidly changing basic moods lasting a few hours to a few days;
· Explosive, lengthy and often destructive rages;
· Separation anxiety;
· Defiance of authority;
· Hyperactivity, agitation, distractibility;
· Sleeping little or, alternatively, sleeping too much;
· Bed wetting and night terrors;
· Strong and frequent cravings, often for carbohydrates and sweets;
· Excessive involvement in multiple projects and activities;
· Dare-devil behaviors;
· Inappropriate or precocious sexual behavior;
· Impaired judgment, impulsivity, racing thoughts and pressure to keep talking;
· Changes in Appetite
· Depressive feelings, often reaching suicidal levels;
· Delusions and hallucinations;
· Grandiose belief in own abilities that defy the laws of logic (the ability to fly, for example).
This list is a slightly modified version of a list compiled by the Child and Adolescent Bipolar Foundation (www.bpkids.org).
How Is Bipolar Disorder diagnosed?: Early diagnosis and treatment should make a positive difference in both the present adjustment and future mental health of a child with Bipolar Disorder. The Lucy Daniels Center recommends that the evaluation of a child for any problem should always involve a comprehensive assessment of the child's symptoms, genetic background, medical and developmental history, and life experience.
The results of the assessment may be clear enough that an experienced clinician can either diagnose or rule out the presence of Bipolar Disorder. However, the information derived from an evaluation does not always permit clinicians to form an opinion as to the presence or absence of Bipolar Disorder.
The reason that Lucy Daniels Center clinicians, and many others, believe that it is usually difficult to decide with confidence, one way or the other, whether a child is developing a Bipolar Disorder may be evident from the list above; most of the symptoms are non-specific. In our view, Bipolar Disorder is often difficult to pinpoint because many of the symptoms associated with its manifestations in childhood can appear for other reasons and are often even present in a fully typical and healthy development. Some symptoms, however, are much more suggestive of an early Bipolar condition, such as the last three on the list above. Because of the ambiguities involved, Lucy Daniels Center clinicians generally recommend caution - unless the situation is clear - when affixing a psychiatric diagnosis to a child, especially when the label being considered is a serious one. Furthermore, sometimes a child is experiencing extra emotional challenges, but their difficulties do not fit neatly into any a psychiatric category. Finally, it is especially difficult to make a definitive diagnosis in children under 6 years old because children at this age demonstrate great variability in their development.
What causes Bipolar Disorder?: Bipolar Disorder results from a problem with brain function, the nature of which is currently unknown. Heredity clearly plays an important role for many and possibly all individuals with Bipolar Disorder. However, a person's brain development and function is determined by much more than heredity and other biological factors. Genes establish the potential range of what a person can become, but relationships, experience and the child's own interpretation of his or her life all help determine how a particular child develops within the range of potential provided by his or her genetic endowment.
How are Bipolar Children treated?: Bipolar Disorder can be treated, but it is a life-long condition. Effective treatment should follow a careful diagnosis and development of an individualized and comprehensive treatment plan. Lucy Daniels Center clinicians recommend a focus on immediate relief and stabilization and emphasize the importance of helping develop the inner strength and coping resources the child requires to face and overcome the effects of the Bipolar Disorder throughout his or her life.
With the guidance of a psychiatrist, parents must weigh the potential benefits and risks and make a decision about use of medication for a child with Bipolar Disorder - and sometimes for a child with extreme symptoms but an uncertain diagnosis. The medications to be considered will depend upon the individual situation, and may include antidepressants (specifically Prozac in situations of significant depressive symptomatology), mood stabilizers, such as Lithium or various anti-convulsants, and neuroleptics, also known as major tranquilizers or anti-psychotics.
The Lucy Daniels Center believes that children with Bipolar Disorder require and profoundly benefit from a comprehensive approach to their care. Parent counseling, psychotherapy for the child, and assistance to teachers generally have a place in the appropriate care of a child with Bipolar Disorder. The goal of such measures is to enable a child to fulfill his or her potential and perhaps even minimize the extent to which the Bipolar Disorder manifests itself over time.
Bipolar Disorder should be approached as a chronic condition requiring an ongoing relationship with trusted mental health professionals. With such an orientation, flexible and appropriate interventions throughout childhood and adolescence, and likely future scientific advances, children with Bipolar Disorder and their parents can look forward to a promising future.
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