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Kid Companions- Chewelry: May 12, 2010

May 12, 2010

The Depressing Facts About Juvenile Bipolar Disorder

Derryck Smith, head of psychiatry at the Children's and Women's Health Centre of British Columbia, wrote in the Canadian Journal of Psychiatry last July: "There is no greater controversy in child and adolescent psychiatry than that related to the diagnosis, treatment and increasing prevalence of childhood-onset bipolar disorder."

While the debate rages on, parents and children struggle on. The following facts do not paint a pretty picture of the situation. Doctors, researchers and experts at children's hospitals, mental-health support groups and referral services must push for answers and programs to help families crippled by Juvenile Bipolar Disorder.

The Depressing Facts:

*Some psychiatrists suspect that under broad definitions, childhood bipolar disorder may be more prevalent than autism - affecting between 1 and 2 per cent of all children.

*Bipolar disorder was thought to be the result of chemical imbalances in the brain, now researchers can also identify specific areas of the brain that are affected by the illness.

*According to the Child and Adolescent Bipolar Foundation, 15% of children diagnosed with ADHD may actually be bipolar.

*Many of the frustrating or objectionable behaviors displayed by students with bipolar disorder are actually symptoms of neurological instability in the brain rather than willful misconduct.

* The disorder is often suspected by a knowledgeable parent, psychiatrist, pediatrician, psychologist, therapist, or social worker based on information and observations from the patient, family members, and others who know the child well.

*A correct and thorough evaluation as early as possible is critical since psycho stimulant medications, often prescribed for ADHD, may worsen manic symptoms of juvenile bipolar disorder.

*According to the Child and Adolescent Bipolar Foundation (CABF), children with bipolar disorder can be charming and charismatic during an appointment. They initially may appear to a professional to be functioning well. Therefore, CABF suggests you take daily notes of your child's mood, behavior, sleep patterns, unusual events and statements made by your child that cause you concern. Share these notes with the child and adolescent psychiatrist who you choose to evaluate your child.

*Bipolar disorder tends to run in families. When one parent has bipolar disorder, the risk to each child is estimated to be l5-30%. When both parents have bipolar disorder, the risk increases to 50-75%.

* Juvenile Bipolar disorder has always stood out as one of the toughest psychiatric disorders to diagnose, manage and monitor because of the ultra-ultra rapid mood swings of mania and depression and the other comorbid conditions.

*Health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development.

*Research suggests the earlier the disease strikes, the more severe the illness will become.

*Bipolar children are at risk for failing grades and drug abuse. Prone to suicide, reckless behaviour and delusions of grandeur, no mental illness results in more premature deaths than bipolar depression.

An Educator's Guide to Pediatric Bipolar Disorder February 5, 2010, on the Child and Adolescent Bipolar Foundation website gives this advice:
"A child with bipolar disorder needs medical treatment, but medication is just one element of an effective treatment plan. It is equally important for the child to be surrounded as much as possible by supportive people in settings that minimize daily stress.
 An effective treatment plan for bipolar disorder requires three essential elements:
Lifestyle and environmental changes
School accommodations

Bipolar disorder is a chronic, lifelong condition. However, medications can help alleviate and reduce symptoms so they are less intrusive, smooth out mood fluctuations, reduce anxiety and distractibility, and increase frustration tolerance. Because stress is a trigger that intensifies bipolar symptoms and causes a decline in overall level of functioning, lifestyle and school changes should be made to reduce stress."

As grim as all this sounds, focus on the big picture. Create opportunities for your bipolar child to shine and feel good about him/herself…this little star has talents, gifts and a whole life ahead that you are instrumental in making  happier and brighter. "If you think you are too small to be effective, you have never been in the dark with a mosquito”

Leave us a comment telling us the support or services in your area for families affected by Juvenile Bipolar Disorder.

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What Are Some Symptoms of Juvenile Bipolar Disorder?

When Bipolar Disorder is finally diagnosed in an individual, parents will most often confess that since their child was a toddler, they KNEW something was not just right.  Since toddlerhood, their child had had a very difficult time to settle for the night, had extreme difficulty sleeping through the night, experienced severe separation anxiety and had always had lots of sensory issues.

The visits to their professional support had probably been in vain as all the above complaints could be attributed to many causes. These parents are not alone because it is a fact that Bipolar Disorder is often misdiagnosed or overlooked.

The Juvenile Bipolar Research Foundation website states that Bipolar disorder (manic-depressive illness) affects close to 1 million children and adolescents in the United States at any given time. Recent studies have found that from the time of initial manifestation of symptoms, it takes an average of ten years before a diagnosis is made. This is due in part because its symptoms overlap those of other disorders, including ADHD, depression, or obsessive-compulsive disorder.

What is different between adult and juvenile bipolar disorder?
In adults, the mood cycles of mania and depression can last several days or weeks. In children, the cycling pattern is called ultra-ultra rapid. Their moods fluctuate multiple times in a day. These children seem to have problems getting going in the morning and have more active moods in the afternoon and evening.

The following are other Red Flag signs of juvenile bipolar disorder:

*Children appear hyperactive, fidgety, frustrated, inattentive, restless …these symptoms are much like ADHD but add to this the following symptoms.

*Children have decreased need for sleep, will sleep only 4-6 hours and are not tired the next day. Bipolar kids tend to experience a range of sleep disturbances that include night terrors and nightmares - often with images of gore and mutilation and themes of bodily threat and parental abandonment - sleep-walking, teeth-grinding, and bed-wetting.
*Children have grandiose behaviors ~an inflated self-esteem or think they have special powers, like Superman. Children act as if rules were not made for them and take unbelievable, dangerous risks.

*Children will suffer high levels of frustration. The word “NO” will make them throw a temper tantrum that lasts a long time. These tantrums may even be accompanied with aggression. All these negative behaviors may never be shown outside the home. Or for some children, it is the exact opposite where parents see their good sides and the school sees their violent side.

*Children have flight of ideas and jump from topic to topic becoming unusually talkative and talk faster than usual.

*Children may be unreasonably silly, giddy or happy.

* Children have sudden shifts in mood making them bored, withdrawn, wishing they were never born. And yes, children can even be suicidal.

*Children may be bossy to their peers and even to adults. Some children can be insolent but other children are well-liked and want to make friends. Some will have difficulty making transitions and become argumentative.

*Children develop social phobia and want to be alone. They loose interest or pleasure in activities they normally enjoyed. They feel tired, worthless and guilty about unreasonable things.

*Some children even have hallucinations, they see insects or snakes, hear voices, or hear satanic figures. Some have delusions (irrational fears or beliefs).

In another post I will tell you about the Fear-of-Harm phenotype (FOH). This group of children have a more severe form of pediatric bipolar disorder with higher frequency and severity of manic and depressive symptoms, greater rates of hospitalization and greater likelihood of school performance difficulties.

If any of these RED FLAGS make you think your child has bipolar disorder DO NOT WAIT. Seek professional help immediately and do not stop until the right care has been found for your child. The first line of treatment is usually to stabilize the child's mood and to treat sleep disturbances and psychotic symptoms if present.

The following sites are a wealth of information for parents…use them, arm yourself with knowledge to advocate for your child. When my child was struggling through undiagnosed bipolar disorder, none of this was available.


National Alliance for the Mentally Ill (NAMI)

Mental Health America a change of name from (National Mental Health Association (NMHA)

Child & Adolescent Bipolar Foundation (CABF)

Juvenile Bipolar Research Foundation (JBRF)

Depressive & Bipolar Support Alliance (DBSA)

Bipolar Children Newsletter

Parenting Bipolars: A Survival Guide for Parents

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