Why is Bipolar Disorder Often Misdiagnosed in Children?

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Until the last ten years, Bipolar Disorder, also known as Manic-Depressive Disorder or Mania,was largely considered an adult health problem.

However, research has shown that approximately 7% of children attended by physicians at psychiatric facilities can be categorized as bipolar. According to the American Academy of Child and Adolescent Psychiatry, up to 30% of the 3.4 million children and adolescents with depression in the United States may actually be experiencing early onset of Bipolar Mania.

Research also shows that a patient with bipolar disorder faces up to ten years of coping with bipolar disorder symptoms before he or she can get an accurate diagnosis. Even then only one in four patients receives an accurate diagnosis in fewer than three years.

One reason for the misdiagnosis is the nature of the condition itself; bipolar disorder is characterized by hypomania or wide, unpredictable mood swings between manic and depressive episodes.Periods of manic elation and hyperactivity alternate with periods of intense depression, often self-consuming and sometimes suicidal.

In adults, the swings are more noticeable signs of abnormal behavior. In children and adolescents, however, such swings are often interpreted as part of the emotional instability of the age group.

Bipolar Disorder is often misdiagnosed as other behavioral issues like ADHD because both illnesses present with similar symptoms--irritable, hyperactive and distracting behavior.

There is as well a spectrum of behavior symptoms shared between Manic Depressive Disorder and Anxiety,Psychosis and some Learning Disorders. Often, Mania is misdiagnosed as Oppositional Defiant Disorder or O.D.D. when children present with defiant, angry and explosive episodes.In fact, anger is a common symptom of Mania.

Anger and aggression occur in 40-60% of the bipolar population. Stress triggers often contribute to manic and violent outbursts.In contrast to adults, children and adolescents experiencing manic episodes, are more prone to destructive outbursts than elation or euphoria.

There is no way we can identify aggressive outbursts in children as bipolar or oppositional. Only a specially trained doctor or psychologist has the expertise to do so.

What Distinguishes Bipolar Disorder from A.D.H.D. and O.D.D.?

There are key differences between Mania and other behavioral problems.

While hyperactivity may exist in all three conditions, intense mood swings are more indicative of manic-depressive syndromes. Bipolar children seem to be in a chronic state of alternation between abnormal behavior and normalcy. This kind of mood and behavior changes is not present in other behavioral issues.

Another difference is a decreased need for sleep in bipolar children.They are usually insomniacs requiring fewer than 5 hours of sleep. They also do not seem to suffer from consequences of sleep deprivation. When manic, their energy level seems unquenchable.

A third difference is the presence of manic elation which often takes the form of uncontrollable and hysterical laughter for no apparent reason. Episodes of elation can also appear as unusually risky behavior undertaken because of a grandiose concept of an invincible self.

A fourth presiding symptom is rapid and incessant talking without listening to what others have to say.

What are the Causes of Bipolar Disorder?

A precise cause has not been located. However, there are several factors that may contribute to the disease.

Genes: A genetic component to the disease has been shown.According to the National Institute of Mental Health,a person who has a parent with Mania has a 15-30 % chance of developing this condition.The risk increases to 50 to 75% when both parents have bipolar disorder.Other studies show that the disease is polygenic, that is, it is a disease not carried by one specific gene, but caused by an interaction of genes in several different locations in the body.

Researchers have recently created the first comprehensive map of genetic pathways identified with bipolar disorder. This accomplishment may lead to more effective diagnosis and treatment of the disease.

Neurotransmitters: An abnormal neurotransmitter system seems to be partially the cause of Manic disorder. When neurotransmitters like serotonin are imbalanced, the mood stabilizing function of the brain is in jeopardy.

More About Mood Disorder in this Video.

Stress: Stressful life events such as deaths in the family, parents' divorce or traumatic occurrences can also trigger the onset of manic depressive episodes.Even the process of going through puberty can be a trigger.

Can Bipolar Disorder Be Treated?

At present,there is no cure for Manic Depression. However, the use of mood stabilizing drugs and anti-convulsants has been successful in preventing manic or depressive episodes. Because each child interacts differently with these medications, it is important that a consistent dialogue between patient and doctor be maintained until the right combination/dosage is attained.

Other treatments like psychotherapy and family therapy used in conjunction with medication have proved helpful.These include

a) problem solving therapy to help the child find immediate solutions to problems;

b)interpersonal therapy to help the child deal with personal relationships;

c)cognitive behavior therapy to help the child change certain thinking and behavior patterns.

On the home front, there is a great deal that we as parents can do for the bipolar child.

a)We can help him or her develop consistent exercise routines and relaxation techniques for stress release.

b)We can ensure that the child eats a balanced diet rich in omega 3 fatty acids, whole grains and antioxidants.

c)We can provide the child with a strong and consistent sense of love and support.

d)We can help him or her understand that these treatment processes(medication, therapy, exercise and diet)are lifelong choices he or she needs to make on an ongoing basis.

e) Nutrition and Lifestyle changes provide effective help when used with medical prescriptions.

f)Learning Ways to transform anger is also helpful.One way is through creative expression. There seems to be a direct correlation between manic depression and creativity. Creative expression can be a viable way to contain the energy generated by manic episodes.

g) Check out Bipolar Disorder Symptoms Network for comprehensive and up to date information.

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Disclaimer: The above information is meant only to inform and should never displace professional consultation.

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