Your child may not be crazy after all: bipolar diagnosis not for children

The question of whether or not bipolar disorder can develop in children has been hotly debated within the mental health community for years. Traditionally, it has been believed that the onset of bipolar disorder does not occur until adolescence at the earliest.

The main problem with diagnosing bipolar disorder in children is that symptoms commonly considered to fall under the description of a manic episode are often either common, to varying degrees, in children, similar to the symptoms of other childhood disorders such as ADHD, or completely absent from what might be known as a childhood manic episode altogether. Grandiose thinking and flight of ideas are generally considered somewhat normal for children, and overly sexual behavior in children is more often associated with sexual abuse than a bipolar manic episode.

In recent years, though, mental health professionals have begun to diagnose bipolar disorder in children more frequently, bringing up the question once again. Of course, mental health professionals are diagnosing all manner of mental disorders more frequently, which could also call into question the medical establishment’s apparent desire to take any negative emotion or behavior as a sign of mental illness. Still, the question remains. Can children be diagnosed with bipolar disorder, or is this doing them a disservice because of misdiagnosis?

According to the National Institute of Mental Health, children are most often diagnosed with bipolar disorder when they’re given an antidepressant and it sends them into a manic episode, or they’re given a medication for ADHD, sending them into a depressive episode. While bipolar disorder is often detected initially much the same way in adults, the adults then generally display a certain set of symptoms to back up the diagnosis. With children, the set of symptoms is different and could be linked to some other form of emotional issue.

A recent review of previous research bipolar research questions this rising trend of diagnosing bipolar disorder in children. The studies reviewed were performed on adult bipolar patients. While the onset of the first bipolar episode across those studied could happen in mid to late adolescence, none reported experiencing a full-blown major depressive or manic episode in childhood. Some did report mood disturbances or predisposing temperaments, pointing to the possible biological factors that contribute to bipolar disorder.

The study takes a look at the possible factors contributing to the upswing in childhood bipolar diagnosis. The use of psychotropic drugs may trigger earlier onset, or it may create a set of symptoms that mimic bipolar disorder. Still, researchers concluded that there is not enough evidence to support diagnosing children with bipolar disorder. First-time episodes are extremely rare before the age of twelve when external circumstances don’t mitigate an episode. The study warns that even children who are irritable, labile, or behaviorally dysregulated cannot be conclusively diagnosed.

Why would the mental health community want to begin diagnosing bipolar disorder earlier? The possible reasons vary from an increasing need for the “perfect” child and a growing desire to get a handle on mental illness as early as possible, and all reasons presented would be pure speculation. It stands to reason, though, that children are a highly volatile group of individuals in general, and personalities are subject to serious change at all points before adulthood. Diagnosing children with mental illnesses such as bipolar disorder may actually do them harm because it takes their developing personalities and puts them into the box of “sick,” allowing very little room for growth and stunting their ability to explore themselves freely. While the jury is still out on childhood diagnosis, it may be best to let them develop before making such big decisions.

© Copyright 2007 Insight Journal Online Magazine.

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