Bipolar Disorder in Children:Neglected Health Problem or Trendy Diagnosis?

Bipolar disorder is being diagnosed with increasing frequency in children. Some psychiatrists claim that the symptoms of early onset in children differ from the symptoms in adults. But other medical experts hesitate to acknowledge a diagnosis of bipolar disorder in children. And both sides worry about the unintended consequences of medication on children with an improper diagnosis.

Learn to recognize the symptoms of bipolar disorder in children.

Michael Klein, a San Francisco boy a couple months shy of his 12th birthday, had a very disturbing day at school. When his mother, Valerie (whose name, along with Michael's, has been changed at her request), arrived to pick him up, the teachers at his therapeutic day school reported that he had been uncontrollable all day, kicking, yelling and screaming.

At their insistence, Michael was taken to the emergency room at Stanford Hospital where it took five adults and an injection of Depakote, a mood stabilizer, to restrain him. Five days later, he returned to his mother's house in Mountain View. But that weekend, he again lost control. He threatened his mother with a baseball bat, kicked her and pushed her out of his bedroom, nearly breaking her hand when he slammed the door.

For the first time since her son was diagnosed with bipolar disorder at age 6, Valerie was scared of him. This time, he was taken to the acute adult psychiatric unit at Valley Medical Center in San Jose, where the examining psychiatrist informed her of the obvious: her son's behavior was "not age-appropriate."

"I said, of course not. He's been diagnosed with bipolar disorder. And the doctor said, `No, we're not going to call this bipolar.' He refused to accept the diagnosis." In fact, there are many medical personnel who hesitate to diagnose or even acknowledge the existence of bipolar disorder in children. They say that the hallmarks of the disease (periods of depression followed by bursts of energy, prolonged wakefulness, and sharp, focused thinking) are nonexistent in childhood. The cynics among them disdain it as the diagnosis du jour.

And yet in other circles, bipolar disorder is being diagnosed with increasing frequency in children. Researchers and clinicians at Stanford University and other teaching hospitals are seeing a dramatic rise in the diagnosis of mood disorders in children and adolescents, including bipolar disorder. They say that the increase is not yet fully understood, but can be attributed to more media attention and perhaps an actual increase in the prevalence of the disorder.

Dr. Kiki Chang, director of the Pediatric Mood Disorders Clinic at the Stanford University School of Medicine, explains that children present with symptoms which are complex and different from the typical pattern of symptoms seen in adults. "It can be difficult to diagnose if you don't specialize in the disorder," Chang says. For example, while a bipolar adult cycles back and forth between mania and depression every few months, a child may cycle back and forth several times a day. He estimates that it may affect up to 1 percent or more of children and adolescents.