Excerpt from Chapter 1: Understanding Childhood Bipolar Disorder
Q. What is childhood bipolar disorder?
A. Childhood bipolar disorder is a chronic illness that affects the most complex organ of the body: the brain. The impact of bipolar disorder on the brain is thought to include abnormal structures, abnormal levels of neurotransmitters (the chemical messengers of the brain), abnormal cellular function, and abnormal metabolic function. Thoughts, memories, movements, moods, energy, behaviors, learning, and sensory processing are all based in the brain's amazing network of interconnected cells and neurons. It is not surprising, then, that when an illness impacts such a complex organ in multiple ways, it can have far-reaching consequences. Such is the case with bipolar disorder in children. There is little in their lives that is not touched by their illness.
Children with bipolar disorder are subject to extreme mood swings, ranging from the highs of mania to the depths of depression and despair. They suffer from extreme irritability, abrupt changes in energy levels, low tolerance for frustration, sudden changes in thinking, and odd or oppositional behaviors. Children with bipolar disorder also have some perceptual differences. Studies have shown that they incorrectly process facial expressions and may misinterpret social cues as a result. It is also common for executive functioning, sensory processing, attentional abilities, and cognitive functioning to be impaired. At the same time, these unique children may be gifted, articulate, engaging, artistic, poetic, and precocious for their age.
Bipolar disorder was once thought to be an "adult" illness, meaning that people thought it could not express itself in children. Studies are now showing that half of the patients who suffer from bipolar disorder had their onset before the age of eighteen. The misconception about its prevalence in childhood led to long delays in treatment that resulted in decades of suffering for those affected. The good news is that the illness is treatable. Identifying the symptoms early and providing treatment can give children who suffer from bipolar disorder a better quality of life.
Q. How does it differ from adult onset?
A. The onset of bipolar disorder can come at any age, but when it occurs during childhood, it presents some unusual difficulties that differ from its adult counterpart. Children are still growing and reaching developmental milestones. They are establishing their identity and discovering their place in the world. When bipolar disorder strikes during this time period, it interrupts this normal developmental process. They face difficulties unique to the pediatric population as they attend school and try to make social connections and to handle the already difficult transition to puberty. Their illness can turn all these steps into monumental tasks.
Children with bipolar disorder are generally more volatile in their mood swings than their adult-onset counterparts. Adults with bipolar disorder may spend weeks or months in one mood phase before switching to another; they also experience periods of wellness in between. However, children with bipolar disorder experience very few periods of wellness, and their moods swing rapidly between the extremes. The pediatric population is much more likely to experience chronic irritability than the "high" feelings of euphoria that accompany mania. Children spend more time in a "mixed" state, meaning that they are experiencing symptoms of both mania and depression at the same time. They are also more prone to experiencing a co-occurring condition, such as an anxiety disorder, attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, learning disabilities, and so on.
Not unlike other illnesses that onset during youth, childhood bipolar disorder is considered more chronic and more ever-present than its adult counterpart. Some believe these differences constitute a completely different illness altogether. Hopefully, current ongoing research will clarify the degree of difference in the expression of the illness between adults and children.
Q. How is onset in late teens different?
A. No matter when the onset of bipolar disorder occurs, it can be devastating to the individual suffering the ill effects, but when the first symptoms of the disorder occur in late adolescence, they can differ somewhat from a younger childhood onset. The late-teen onset is more likely to mimic the adult onset characteristics of the disorder, including longer periods of time spent in one mood state before switching to another. The development of older teens may be less affected by the symptoms of the illness simply because they have already reached certain developmental milestones before the onset of symptoms.
At the same time, these teens may be overlooked and undiagnosed-the symptoms of their illness may be attributed to "teenage rebelliousness." If undiagnosed and untreated, this age group is at particular risk for abusing drugs, dropping out of school, and attempting suicide. Many parents may feel that these adolescents are simply struggling to get through the difficult teen years and may not even consider the possibility that the onset of an illness has occurred. Normal teenage events such as breaking up with a girlfriend, moving into a new apartment, starting a job, or going away to college may be blamed for an increase in mood symptoms. While these factors should not be dismissed, they also should not be used to excuse extreme behavior that may indicate bipolar disorder. Parents should know that these normal, stressful events can trigger an onset of the illness in those who are at risk for the development of the disorder. It should also be noted that drug use may unmask symptoms of the illness, while, conversely, symptoms of the illness may drive the teen to experiment with self-medication through drugs.
If you suspect your teenager may be suffering from bipolar disorder-even if you are not 100 percent sure-it is important to take him to a doctor for an evaluation. It could prevent your teen from getting into some serious trouble.
