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What is bipolar disorder in children?

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Diagnosis

"My friend today, I told her I had bipolar, and she kind of backed off away and said, 'Oh my god, is it contagious?' and I was like, 'No!'" - Athena

"I've had friends who've been diagnosed and have refused to believe it. And then there's parents who say, 'Oh yeah, it doesn't really exist. It's just them acting out. You know, they need to learn to control their temper.'" - Erin

"Kids with bipolar gotta know that they're not that different. They have bigger mood swings than other people. There's probably kids that don't have bipolar that are a lot weirder than they are." - Eric

Eric Rancke, 16, (left) with his father.
photo by Steve Schapiro

An estimated one in five children has a diagnosable mental illness, but many go untreated. That's not surprising if you consider the roots of child psychiatry. Freud and his followers believed children were born with a clean mental slate and that only damage during childhood could lead to psychological problems later in life. In the 1970s, doctors began to diagnose children with depression. But until the early 90s, calling children "bipolar" was only for the true renegades of psychiatry. Even today, childhood bipolar disorder isn't mentioned in the standard manual of psychiatry.

"I regard it as a public health crisis. It's an epidemic, if you will," says Martha Hellander, research director for the Child and Adolescent Bipolar Foundation. "If this many kids had some other strange illness that was causing them to not be able to go to school, and want to kill themselves, and so on, you know there would be attention focused on it."

Hellander's group advocates for better research, treatment, and awareness about the disorder.

"What we hear is a long story of going from one doctor to another begging for help, describing horrendous symptoms that the child has at home, and being told that 'It's your fault. You're not disciplining enough. You're too strict. You're too lenient.' And the last place the doctors have wanted to go is to say, 'Is there something going on in this child's brain from within that's causing this behavior that we see?'," says Hellander.

That's a critical distinction, says Dr. David Miklowitz. For one, the causes are believed to be genetic, and researchers think the bipolar brain works differently.

"I would say there are certain chemical imbalances in the brain," says Miklowitz, "and certain structures in the brain that may be either overactive or underactive. And the point is that because of the biology of this condition, not all the behavior in this condition is controllable by the person."

In adults, bipolar disorder has distinct periods of highs and lows. Each extreme can last days, weeks, or months. In children, moods can flip-flop several times a day or even hour, and in some cases, Miklowitz says, they're simultaneous.

"These kids have what we call 'mixed disorders,'" says Miklowitz, "which means you're manic and depressive at the same time. If you can imagine having your thoughts race, feeling a sped up feeling like you can't sleep and don't want to sleep, but at the same time feeling suicidal, feeling hopeless about the future."

But if the symptoms in children are distinct from adults, is it truly bipolar disorder?

"Bipolar disorder is the flavor of the month in the diagnosis of children," says Dr. Rachel Klein, a professor of psychiatry at New York University. "The children who are described as bipolar are reported to have chronic mania. They're always irritable, impulsive, difficult, etc.. And as a result, people say, 'It's different in children. It's chronic.' Then by definition, we're not talking about the same disorder."

"The problem is, across the country, different criteria are being used," says Dr. David Miklowitz. He says the symptoms of bipolar illness often look like attention deficit hyperactivity disorder. "What's one person's ADHD kid is another person's bipolar kid. And as a result, there's a lot of confusion and disagreement."

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