Consider this scenario: At 8 a.m. your 12-year-old is so irritable and hard to wake you nearly have to drag her out of bed, dress her and roll her on a skateboard to make the bus. By 11 she’s a prodigy, delivering the most poignant speech her sociology teacher has ever heard on the civil rights movement. At 2, though, her English teacher claims she’s the class clown, refusing to sit still and focus on her assignments. And by bedtime she often acts as if she’s downed a gallon of espresso.
As a parent, do you chalk this up to normal prepubescent moodiness? If so, you may be right. Then again, warns Dr. Kelly Botteron, you could be in denial.
“Parents sometimes try to explain away a psychological problem,” notes Botteron, an associate professor of psychiatry at Washington University School of Medicine in St. Louis, who specializes in juvenile mood disorders.
“They’ll say, oh, kids can be erratic and kids can be moody and difficult," she says. "But in fact they aren’t as moody and difficult and erratic as their reputation. Most studies show that they aren’t as unusual and strange as they sort of have this cultural myth as being.”
Indeed, at times most children can go from irritable, easily annoyed, angry moods to silly, goofy, giddy elation but, says Botteron, there’s an easy way to determine if you have a problem: persistent trouble-making.
“If you have a child who is moody to the point of causing problems in school, at home or with friends, that’s usually not a normal thing,” she says.
One possible explanation is drug use. Another is that the child is suffering from a serious psychological illness, and one that's woefully underdiagnosed: bipolar disorder.
Much more common than thought
Also called manic-depression, bipolar disorder is a mental illness that causes a person to cycle through abnormally high and low moods. It was once thought to be rare in children, so little attention was paid to the issue. But the latest research shows that not only can bipolar disorder begin very early in life -- as early as age 5, though it typically manifests in kids around the onset of puberty -- it’s much more common than ever imagined. In fact, according to the Juvenile Bipolar Research Foundation, the condition is now diagnosed in close to 1 million children and adolescents in the United States each year.
The most shocking revelation, however, is that because many healthcare professionals haven’t been trained in childhood bipolar, kids afflicted with this illness may be misdiagnosed and given medication that actually worsens their symptoms or doesn't help them at all.
“At least 20 percent of kids initially diagnosed with [attention deficit hyperactivity disorder] actually turn out to have bipolar disorder,” says Dr. David Fassler, a child and adolescent psychiatrist in Burlington, Vt., and a clinical associate professor of psychiatry at the University of Vermont College of Medicine.
In addition, between 20 percent and 40 percent of kids diagnosed with depression ultimately turn out to have bipolar disorder, he says.
It’s a situation Dr. Demitri Papolos, an associate professor of psychiatry at Albert Einstein College of Medicine in New York City and director of research for the Juvenile Bipolar Research Foundation, says amounts to a national healthcare nightmare.
Prescriptions for stimulants, which are used to treat ADHD, and antidepressants are increasing in children, "and you have these kids who are undiagnosed as bipolar but diagnosed with everything else being treated with these drugs,” says Papolos, who is co-author with Janice Papolos of "The Bipolar Child."
The wrong medications, he says, can be dire, causing increased cycling that spells rapid and profound mood fluctuations, increased aggression and often psychosis.
“This is the sort of thing that really makes life horrible for these kids," he says. "It’s clear to me, although we don’t have data to support this, that it’s much, much harder to stabilize kids with the usual mood stabilizers after they’ve been through these trials of [antidepressants and stimulants].”
Left untreated or mistreated, bipolar children and teens can face a lifetime of trouble. They have an increased likelihood of failing in school, alienating friends, developing substance abuse problems, getting in trouble with the law, becoming pregnant and even committing suicide.
Getting the right help
With the correct diagnosis and treatment, bipolar children can have a bright future even though the illness is chronic and requires a lifetime of treatment.
Papolos calls bipolar children “national resource treasures” because of their creativity, intelligence and drive. American explorer Meriwether Lewis, in fact, is thought now to have suffered from bipolar disorder. “If you channel it in the right direction perhaps it can pay off, which is what we try to help parents do with these kids. But they have very little control over their impulses and it can become a horrendous scene [if untreated],” he warns.
Talk therapy may be used to help bipolar children and their families deal with the illness and its fallout, but mood-stabilizing medications such as lithium and tegretol are the cornerstones of treatment.
Botteron, who does brain imaging research, says parents shouldn’t be fearful of the proper medications. Her research has found that untreated psychological illnesses can reduce gray matter in certain areas of the brain but proper medication can help counter this damage. The sooner treatment starts, the better, she says. “It looks like some of the damage may be able to be prevented or is less the more treatment and the longer treatment you’ve had.”
The first step is for parents to recognize the potential problem and seek proper medical attention.
While a trip to the pediatrician or family practitioner may be the first stop, parents should realize that he or she probably isn’t trained to pick up on the symptoms of bipolar disorder, many of which mimic other more common disorders. Since bipolar has a strong genetic link, they should ask for a referral to a child psychiatrist or a psychiatrist who specializes in bipolar disorder, particularly if they know the illness is present in their family.
Victoria Clayton is a freelance writer based in California.