I want to start an interesting discussion with you guys. I think you're all very bright individuals and I think it would be cool to pick your brains!

I've read a bit on childhood/adolescent bipolar disorder. Some doctors and psychologists refuse to diagnose bipolar disorder until the adolescent is at least 16 or 18. (Or whatever age threshold you can think of... 14, 15, 16, 17...) Do you agree or disagree with having an age "threshold"? Why?

Sometimes if one or both parents has bipolar disorder, a psychiatrist or psychologist might be more inclined to diagnose the child with bipolar disorder. But if it the genetic linkage is not obvious, the psychiatrist or psychologist may not give out the Dx.

[xRavenx]

I have mixed opinions on this. I definitely think doctors need to be extra careful when diagnosing at such a young age, because there is evidence the brain is not fully developed until at least 20, sometimes up to 25! Because of this, young people tend to be more impulsive, which is more 'the norm.' However, there's impulsive behavior that goes way beyond being the average risk taking teenager, and when that's combined with other Bipolar symptoms...well, that needs to be taken into account as an issue that needs to be assessed.

The DSM now includes a new diagnosis with some parallels to Bipolar called "Disrupted Mood Dysregulation Disoder" for children, which eliminates diagnosing someone too early with Bipolar, which is interesting to read about.

I am convinced though that adolescents can certainly experience Bipolar episodes for the first time. The hypomania felt good at age 15-16 when I first experienced it, but it unraveled into something terrible. I became clearly manic. Paranoia set in, which definitely doesn't fall under the norm for a teenager. The behavioral change was huge. I couldn't sit in class. I spent every day at the Child Study Team, needing to speak to a counselor. I had pressured speech, extreme anxiety, off-the-wall ideas, and ended up in a Mixed Manic state that was terrifying to me. I had no clue what was wrong with me until I was "labeled" and read about my problem. Counselors were afraid to label me early on, but I wish they had, because it took multiple recurrent episodes to finally learn. I went without adequate care during that dark time.

So to sum it up, yes, I believe Bipolar episodes can first occur in teenage years. I believe children can have features of it, but I think it's too early to label it. Besides, there's such a broad spectrum for these symptoms. One thing that bothers me though is that people (a lot of mothers) throw around the term too loosely to label a kid as Bipolar at times when there could be environmental and other physical problems going on. Some kids do grow out of stuff, like hormonal mood swings.

[Victoria'smom]

My son was dx. PDD/ ADHD/ possible bipolar. His pdoc wasn't going to stick him with the label until he had to be hospitalized. He was treated and medicated as having bipolar. He did fairly well. Then we moved. He got labeled with impulse control disorder which I liked the name better. Not as much stigma. Problem is the changed all his meds. They weren't working so we dropped them.

I think broader labels should be used on kids.

[usehername]

My daughter was hospitalized and still had to wait over a year for someone to call it what it clearly was WITH family history. She's 14 now, and only recently got a mood stabilizer and is doing SO much better with it. She still has psychosis regularly, but at least she sleeps and wakes almost normally now, and her rages have subsided.

[Guess7131]

I see why some doctors will diagnose it and why some wont. I think as long as the symptoms are being treated then there is no immediate rush to diagnose it. I've had this happen to me when i was 17, Was extremely manic etc but i wasn't diagnosed then, although i was put on medication used to treat bipolar. Anyway thats just my opinion.

[scatterbrained04]

I kind of have mixed feelings about it. On one hand, a diagnoses could help get a handle on it young. I probably could have been diagnosed around 17. My symptoms started at 13-14. But on the other hand, children and adolescents change so much that it could be hard to differentiate what is normal and what is not. Also, not sure meds at a young age is that great unless the problems are very severe. My son is showing some signs he could have issues in this department. He's 11. Has had issues since he was 6. But how they displayed at 6 is not the same as now. Time will tell, I guess. I don't think I'd want him diagnosed with it this young, if he even is bipolar. He's already been diagnosed with ADHD.

[Travelinglady]

I'm thinking children and young adolescents are prone to quick mood changes and instability anyway. When people get older their "true" selves begin to emerge. I am prone to think such a disorder shouldn't "officially" be labeled until late adolescence, especially since it's a life-time disorder.

I am bipolar and my husband is bipolar. Our sons are in their mid twenties and are not bipolar--at least as yet. Bipolar runs on both sides of our families. But not all our relatives have it.

Why the rush to diagnose? The meds have so many potential side effects and can be debilitating.

That's my take on it anyway.

Originally Posted by xRavenx

I have mixed opinions on this. I definitely think doctors need to be extra careful when diagnosing at such a young age, because there is evidence the brain is not fully developed until at least 20, sometimes up to 25! Because of this, young people tend to be more impulsive, which is more 'the norm.' However, there's impulsive behavior that goes way beyond being the average risk taking teenager, and when that's combined with other Bipolar symptoms...well, that needs to be taken into account as an issue that needs to be assessed.

The DSM now includes a new diagnosis with some parallels to Bipolar called "Disrupted Mood Dysregulation Disoder" for children, which eliminates diagnosing someone too early with Bipolar, which is interesting to read about.

I am convinced though that adolescents can certainly experience Bipolar episodes for the first time. The hypomania felt good at age 15-16 when I first experienced it, but it unraveled into something terrible. I became clearly manic. Paranoia set in, which definitely doesn't fall under the norm for a teenager. The behavioral change was huge. I couldn't sit in class. I spent every day at the Child Study Team, needing to speak to a counselor. I had pressured speech, extreme anxiety, off-the-wall ideas, and ended up in a Mixed Manic state that was terrifying to me. I had no clue what was wrong with me until I was "labeled" and read about my problem. Counselors were afraid to label me early on, but I wish they had, because it took multiple recurrent episodes to finally learn. I went without adequate care during that dark time.

So to sum it up, yes, I believe Bipolar episodes can first occur in teenage years. I believe children can have features of it, but I think it's too early to label it. Besides, there's such a broad spectrum for these symptoms. One thing that bothers me though is that people (a lot of mothers) throw around the term too loosely to label a kid as Bipolar at times when there could be environmental and other physical problems going on. Some kids do grow out of stuff, like hormonal mood swings.

Yes, you raise some excellent points! There are certainly very distinct symptoms between your average "raging hormonal teenager" and a teenager with bipolar disorder.

Which brings me to my next question: what sorts of techniques could we use to distinguish a "raging hormonal teenager" from a bipolar teenager if we suspect the teenager has bipolar disorder? You did mention that a child or adolescent with bipolar disorder will exhibit behavioral differences, but sometimes the child or adolescent may have difficulties discussing their symptoms mainly because they are "too young" to understand what is "normal" and what isn't. Any medical tests? Psychological tests?

And what about children who very CLEARLY present bipolar symptoms before puberty? Should we even medicate them, or do you think there is too much risk? e.g., ADHD can look very similar to BP at a young age. But even if a child is KNOWN to be bipolar, do you think that medicating them may impact their brains since their brains are still developing?

Originally Posted by Miguel'smom

My son was dx. PDD/ ADHD/ possible bipolar. His pdoc wasn't going to stick him with the label until he had to be hospitalized. He was treated and medicated as having bipolar. He did fairly well. Then we moved. He got labeled with impulse control disorder which I liked the name better. Not as much stigma. Problem is the changed all his meds. They weren't working so we dropped them.

I think broader labels should be used on kids.

That's very interesting. I'm going to play devil's advocate

What do you think of the "impulse control disorder" label, besides "less stigma"? Do you think it's a safety net? Basically, "we strongly think you have BP, but we don't know for sure, so we'll label you as having impulse control disorder."

Do you like having that safety net? But if they're medicating a child as they would medicate someone with BP and clearly the child is doing well on BP meds, would you rather have your psychiatrist change the Dx to BP? Like, are you comfortable with that? Or do you think it's too soon to tell?

Originally Posted by usehername

My daughter was hospitalized and still had to wait over a year for someone to call it what it clearly was WITH family history. She's 14 now, and only recently got a mood stabilizer and is doing SO much better with it. She still has psychosis regularly, but at least she sleeps and wakes almost normally now, and her rages have subsided.

That's very good to hear. Congratulations

It sounds like you're hands down okay wth the BP Dx if there is a clear genetic linkage. But what about children who *don't* have a clear genetic linkage? Are you okay with that too, or do you think there are certain *extra* steps we should take?

Originally Posted by Guess7131

I see why some doctors will diagnose it and why some wont. I think as long as the symptoms are being treated then there is no immediate rush to diagnose it. I've had this happen to me when i was 17, Was extremely manic etc but i wasn't diagnosed then, although i was put on medication used to treat bipolar. Anyway thats just my opinion.

Yup, valid point.

But if they're treating you as if you're BP, do you think they might as well just give you the BP label? Or do you think it's too early to do that? (This question is basically the same I'm asking miguel'smom )

Originally Posted by scatterbrained04

I kind of have mixed feelings about it. On one hand, a diagnoses could help get a handle on it young. I probably could have been diagnosed around 17. My symptoms started at 13-14. But on the other hand, children and adolescents change so much that it could be hard to differentiate what is normal and what is not. Also, not sure meds at a young age is that great unless the problems are very severe. My son is showing some signs he could have issues in this department. He's 11. Has had issues since he was 6. But how they displayed at 6 is not the same as now. Time will tell, I guess. I don't think I'd want him diagnosed with it this young, if he even is bipolar. He's already been diagnosed with ADHD.

Good points!

Is he on any medication for his ADHD? If so, does he have any adverse effects that might suggest mania?

Let's say he is on meds for ADHD and he's experiencing what you suspect is mania. Would you medicate him for BP or would you be hesitant?

Originally Posted by Travelinglady

I'm thinking children and young adolescents are prone to quick mood changes and instability anyway. When people get older their "true" selves begin to emerge. I am prone to think such a disorder shouldn't "officially" be labeled until late adolescence, especially since it's a life-time disorder.

I am bipolar and my husband is bipolar. Our sons are in their mid twenties and are not bipolar--at least as yet. Bipolar runs on both sides of our families. But not all our relatives have it.

Why the rush to diagnose? The meds have so many potential side effects and can be debilitating.

That's my take on it anyway.

Good points!

I'm the opposite of your sons: no mood disorders of ANY kind run in my family, yet I have clear upswings and downswings. Lots of sui behavior on my part that no one in my family has had (as far as I know). So genetics are pretty funny!

I'll play devil's advocate: don't you think that diagnosing early could point psychologists and psychiatrists in the right direction?

[scatterbrained04]

Originally Posted by bluebicycle

Good points!

Is he on any medication for his ADHD? If so, does he have any adverse effects that might suggest mania?

Let's say he is on meds for ADHD and he's experiencing what you suspect is mania. Would you medicate him for BP or would you be hesitant?

He is on meds for the ADHD. I think I would be hesitant to even declare anything as mania per say. He does have periods were he is more talkative or more into projects. But it'd be so hard to decide if it's really mania or not. Maybe it's just a developmental change or something to do with the ADHD. Meds losing effectiveness, etc. It's all so confusing. The attention and focus issues do stay constant. He's not as hyper as he was when he was younger though. Idk hypomania if anything.

I'd be so hesitant to declare anything without him being about to explain things from his perspective. Which I doubt he'll be able to do until he's much older.

Now I do notice it when he'll suddenly seem more sad or angry. He'll start thinking and talking more about death and just dark subjects in general. Much more profound difference.

[Victoria'smom]

I think it is a safety net but I think it's more "Is this something you'll grow out of, just a bad reaction to hormones or is this real BP?" Currently he's not medicated as there's a shortage of child psychiatrist and he hasn't had an IP crisis yet. I'd rather him not be labeled BP at least until he's an adult. He doesn't need the label for school if he did my answer would change. I'm hoping he learns to manage it better. I don't want BP to follow him around. I feel ASD and ADHD have less of a stigma.

[Naynay99]

Hey. Great question.
About 10 years ago it seemed like all my HS kids with any behavior and impulse problems were being dx as bipolar. For a little while there it semed like doctors were disgnosising kids as bipolar in record numbers. I don't work with HS age kids anymore but it seems as if drs are not so quick to put that label on a kid anymore. Which I fully support. We had 15 year olds on abilfy and other APs; I know some kids may need meds but it shouldn't be the first line of defense! And some of what has been identified as childhood bipolar symptoms- rages, tantrums, etc looks very different from adult bp. Is it really even the same disorder? Idk.

I would be very hesistant to put a kid with a still developing brain on a psychotropic medication unless all other avenues have been tried. And let's say they do have some bipolar looking disorder- what if they grow out of it, what if they never have another hypo/manic or depressive episode in their lifetime- they could be dx bipolar and put on heavy duty medications with dangerous side effects for life when they may not actually need them long term. And the stigma attached to such a disorder is huge- what's the rush to dx them? Just my opinion.

I did read about that mood dysregulation disorder the dsm 5 came up with. Sounds like a good idea to me as an alternative to slapping the bipolar label on them too soon. Anyway good topic to think over.

[usehername]

Originally Posted by Guess7131

I see why some doctors will diagnose it and why some wont. I think as long as the symptoms are being treated then there is no immediate rush to diagnose it. I've had this happen to me when i was 17, Was extremely manic etc but i wasn't diagnosed then, although i was put on medication used to treat bipolar. Anyway thats just my opinion.

I had the opposite experience. I spent a couple years going in and out of mania in childhood with psychotic events and was always dx'd with freaking depression. I was like where the hell are you getting that?? Obviously, urge antidepressants made me MORE psychotic, more manic. It was HORRIBLE. I wasn't properly dx'd until I was forced into an appointment in full-blown mania at the place I now work (but at the outpatient clinic). They wanted me hospitalized, but I'm a single mom so they just loaded me with seroquel. I was 26. My first symptoms appeared at age 8. That's WAY too long.

[usehername]

Some kids don't change at all. I have never wavered in who I am, neither has my kid. She's had the same life plan since at least age 7. Maybe we are weirdly consistent people? Maybe we were born knowing who we were? I have no idea... I really should've been dx'd much earlier, her too. At the very least, when she was admitted to the hospital and held there with a guard for days on end (severe HI)... that was clear full blown-mania induced psychosis. I was so frustrated because it was so obvious! I lived it and couldn't see how anybody could possibly not see it! She cheeked her haldol, of course, because she thought they were poisoning her. She threatened staff. She refused to eat. She only drank bottled water (not even ice! Hospital ice is her favorite and they know that). No wonder they B52'd her on her next admit...

It likely has everything to do with the regional rules than a psychiatrist's unwillingness to do so.

I also am thinking this has much to do with puberty. Bipolar is an illness of a chemical imbalance in the brain. Such an imbalance could similarly be attributed to chemical changes owing to puberty. There are additional external factors that are more prevalent - particularly social - that could be affecting mental health (are social difficulties the cause of emotional problems or is it the other way around?).

My understanding though is that a psychiatrist will treat the symptoms.

Originally Posted by scatterbrained04

He is on meds for the ADHD. I think I would be hesitant to even declare anything as mania per say. He does have periods were he is more talkative or more into projects. But it'd be so hard to decide if it's really mania or not. Maybe it's just a developmental change or something to do with the ADHD. Meds losing effectiveness, etc. It's all so confusing. The attention and focus issues do stay constant. He's not as hyper as he was when he was younger though. Idk hypomania if anything.

I'd be so hesitant to declare anything without him being about to explain things from his perspective. Which I doubt he'll be able to do until he's much older.

Now I do notice it when he'll suddenly seem more sad or angry. He'll start thinking and talking more about death and just dark subjects in general. Much more profound difference.

Yeah, I understand what you mean about him being able to explain things.

Even when I sought help at 22, I didn't know how to explain things. I couldn't say I had depression because I honestly didn't know what "depression" was. I had obviously heard of the term, but I wasn't aware of the symptoms, I guess. I wasn't educated on it.

Do you think schools should start educating children on mental illness symptoms to help children learn how to identify symptoms to allow mental health professionals to give out early diagnoses? We don't have to educate children on diagnoses per se, but educate them on symptoms... e.g, "I want to kill myself" vs "I feel sad because Tommy took my toy". If so, what at what age should we do this? We already have sex ed, and I got that when I was 12.

Originally Posted by Miguel'smom

I think it is a safety net but I think it's more "Is this something you'll grow out of, just a bad reaction to hormones or is this real BP?" Currently he's not medicated as there's a shortage of child psychiatrist and he hasn't had an IP crisis yet. I'd rather him not be labeled BP at least until he's an adult. He doesn't need the label for school if he did my answer would change. I'm hoping he learns to manage it better. I don't want BP to follow him around. I feel ASD and ADHD have less of a stigma.

Yeah, that's a very good point. If he doesn't need the label, then there's no rush to getting him a BP Dx. Treating the symptoms is most important.

But do you think he ultimately *might* need the label for school at some point (if he is indeed BP)? For example, what if he comes down with a very dark depression and just can't do work? I know that some students can get a leave of absence for things like that.

Originally Posted by Naynay99

Hey. Great question.
About 10 years ago it seemed like all my HS kids with any behavior and impulse problems were being dx as bipolar. For a little while there it semed like doctors were disgnosising kids as bipolar in record numbers. I don't work with HS age kids anymore but it seems as if drs are not so quick to put that label on a kid anymore. Which I fully support. We had 15 year olds on abilfy and other APs; I know some kids may need meds but it shouldn't be the first line of defense! And some of what has been identified as childhood bipolar symptoms- rages, tantrums, etc looks very different from adult bp. Is it really even the same disorder? Idk.

I would be very hesistant to put a kid with a still developing brain on a psychotropic medication unless all other avenues have been tried. And let's say they do have some bipolar looking disorder- what if they grow out of it, what if they never have another hypo/manic or depressive episode in their lifetime- they could be dx bipolar and put on heavy duty medications with dangerous side effects for life when they may not actually need them long term. And the stigma attached to such a disorder is huge- what's the rush to dx them? Just my opinion.

I did read about that mood dysregulation disorder the dsm 5 came up with. Sounds like a good idea to me as an alternative to slapping the bipolar label on them too soon. Anyway good topic to think over.

Yes, I agree. It is very concerning if we inappropriately Dx a child with BP when they're not actually BP. And it is scary that children are being put on APs, especially since their brains are still developing, as you mentioned.

One thing I wonder... what if we medicate a child who we think has BP and the child doesn't have BP? Could those meds *cause* BP because of what they might do to the brain structure? Or at least cause some sort of permanent chemical imbalance? IDK. Just a random thought of mine.

As I brought up with scatterbrained, do you think it might be worthwhile to give children mental illness education? Again, we don't have to teach these children what all the diagnoses are. We just want them to be able to identify depression, abnormal anxiety, paranoia, and things like that.

And indeed, the mood dysregulation disorder is a good label. I think ADHD and BP overlap a lot and that it is possible for a child to have ADHD but "display" BP symptoms. And also, now that I think of it, I suppose childhood trauma could also result in the appearance of a mood disorder too.

Originally Posted by usehername

I had the opposite experience. I spent a couple years going in and out of mania in childhood with psychotic events and was always dx'd with freaking depression. I was like where the hell are you getting that?? Obviously, urge antidepressants made me MORE psychotic, more manic. It was HORRIBLE. I wasn't properly dx'd until I was forced into an appointment in full-blown mania at the place I now work (but at the outpatient clinic). They wanted me hospitalized, but I'm a single mom so they just loaded me with seroquel. I was 26. My first symptoms appeared at age 8. That's WAY too long.

Originally Posted by usehername

Some kids don't change at all. I have never wavered in who I am, neither has my kid. She's had the same life plan since at least age 7. Maybe we are weirdly consistent people? Maybe we were born knowing who we were? I have no idea... I really should've been dx'd much earlier, her too. At the very least, when she was admitted to the hospital and held there with a guard for days on end (severe HI)... that was clear full blown-mania induced psychosis. I was so frustrated because it was so obvious! I lived it and couldn't see how anybody could possibly not see it! She cheeked her haldol, of course, because she thought they were poisoning her. She threatened staff. She refused to eat. She only drank bottled water (not even ice! Hospital ice is her favorite and they know that). No wonder they B52'd her on her next admit...

That's interesting.

Do you think you were Dx'ed with depression because you didn't know how to describe your psychosis? And again, I'm thinking that we need to do a better job on educating children about what's "normal" and what isn't.

Originally Posted by justafriend306

It likely has everything to do with the regional rules than a psychiatrist's unwillingness to do so.

I also am thinking this has much to do with puberty. Bipolar is an illness of a chemical imbalance in the brain. Such an imbalance could similarly be attributed to chemical changes owing to puberty. There are additional external factors that are more prevalent - particularly social - that could be affecting mental health (are social difficulties the cause of emotional problems or is it the other way around?).

My understanding though is that a psychiatrist will treat the symptoms.

Yes, I agree... it is difficult to differentiate between "hormonal" behavior and bipolar behavior. Which type of chemical imbalance it is quickly becomes confusing.

I know that I had social difficulties when I was younger. Looking back on things, I strongly believe my emotional/mood problems were the cause of my social difficulties. I always did bizarre stuff, and I had very "dark" times where I isolated myself and had suicidal thoughts. I just didn't know how to describe my behavior and feelings to my parents, so we never sought help for me.

So I do think that it is possible to diagnose a kid with BP if the parents keep close watch on their child and the child is able to accurately describe their feelings, but again, as naynay said, sometimes psychiatrists are label happy and just hand out the BP Dx's like candy. That's something we have to be aware of.

But whether or not we hand out the BP label, do you think we should medicate children? I mean, their brains are developing (as some people here have mentioned). Whether or not they have BP, could medication permanently cause "damage" of some sort?

[usehername]

Originally Posted by bluebicycle

That's interesting.

Do you think you were Dx'ed with depression because you didn't know how to describe your psychosis? And again, I'm thinking that we need to do a better job on educating children about what's "normal" and what isn't.

I REFUSED to describe it. I was too paranoid, much like my daughter. Her's is just more obvious because it's worse.