A significant challenge facing psychiatrists is accurately diagnosing bipolar in children. Aside from the controversies of its existence, the array of symptoms, how they present and the complexities of age all pose a problem. Experts weigh in on why it’s so difficult to diagnose bipolar disorder in children.
What is normal?
Symptoms of pediatric bipolar disorder can be initially mistaken for normal behaviors and emotions of children and adolescents. A child’s constant motion, lack of impulse control, vivid imagination and difficulty dealing with frustration could describe any child on any day of the week. Distinguishing between pathological and normal behaviors in a young child is even more challenging since there’s an insufficient time span to establish a course of illness.
No lab tests in psychiatry
Demitri Papolos, MD, says that each person “experiencing a psychiatric illness” does so through a unique filter of mind. Diagnosis in psychiatry is a problem, he says. “After all, there are no lab tests in psychiatry that can conclusively pinpoint a diagnosis and there are a host of overlapping symptoms, especially in children’s disorders.”
Many bipolar disorder symptoms can resemble or “co-occur” with other mental disorders, such as Attention Deficit Hyperactivity Disorder (ADHD.) A diagnosis of ADHD has traditionally depended on the presence of particular behavioral traits—mainly hyperactivity, impulsivity and inattention—but these traits can differ at different ages and can be different in boys and girls, says Rachel G. Klein PhD, a founding member of the Brain & Behavior Research Foundation Scientific Council. “Without specific biological markers, diagnosing mental illness in children is difficult.”
A young and changing brain
The brain is plastic by design so it develops and changes, explains Papolos. The changes that children undergo, both in the biology of their development and in the “need to adapt to changes in environment, at home and at school—interactions with parents, siblings, and other children—all can trigger behaviors with rapid and wild swings of mood.”
Different than adults
Clinical investigators are beginning to realize, says Papolos, that the “classical cycles” of mania and depression in childhood presents differently than in adulthood. “For instance, children have more irritable moods with explosive outbursts, and their cycles of mania, hypomania and depression are far more rapid than the typical adult presentation. Yet the DSM-IV specifies that a mood episode must last for a specified period of time.”
Questions still need to be resolved
For Paopolos, clarification is still needed from research in order to make diagnosing childhood bipolar less ambiguous. He asks: 1. Does bipolar occur simultaneously with other psychiatric disorders, making it possible to have three, four, or more diagnoses? 2. Are these clusters of symptoms that suggest distinct disorders merely early precursors that’ll eventually express itself as full-blown bipolar?
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