Difficult to distinguish bipolar symptoms in children

At least one-third of the time, the symptoms of bipolar disorder first appear in childhood or adolescence.

However, in children, it can be difficult to distinguish bipolar symptoms from those of other disorders, notes the May 2007 issue of the Harvard Mental Health Letter.

Children, especially young children, usually do not show the adult cycle of distinct mood episodes of mania and depression. Also, many symptoms that may stem from bipolar disorder also occur in other childhood disorders: moods fluctuating in very rapid cycles, sometimes from hour to hour; irritability and agitation; or bursts of rage. Bipolar disorder in children is especially difficult to distinguish from ADHD, since they share a number of symptoms—impulsiveness, distractibility, and hyperactivity. Up to 30% of children originally diagnosed with ADHD eventually receive a diagnosis of bipolar disorder.

Research suggests that some children diagnosed with bipolar disorder have a different condition, recently labeled “severe mood dysregulation.” Although both conditions involve periodic irritability and hyperactivity, electrical signals in the brains of children thought to have severe mood dysregulation are different from brain signals in children with bipolar disorder.

It is important to treat diagnosed bipolar disorder. In adults, that means the use of mood stabilizers—frequently several drugs in combination. The same drugs are increasingly prescribed for children. Psychotherapy can also help. “In coming years we are likely to develop better ways to define the mood problems of children. Nonetheless, childhood bipolar disorder is a real and serious illness that should be recognized and treated as early as possible,” says Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter.

Also in this issue:

• Thyroid deficiency and mental health
• Depression in China
• Williams syndrome in Japan and America
• Readiness for addiction treatment
• A doctor discusses: The importance of breakfast for children

The Harvard Mental Health Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School, for $59 per year. Subscribe at www.health.harvard.edu/mental or by calling 1-877-649-9457 (toll free).