New Approaches Needed for Bipolar Disorder in Children
> 9/4/2007 11:40:26 AM

Bipolar disorder, long considered a severe and stigmatic condition first making its presence known in the late 20's-30's, is being diagnosed among children and adolescents at an astounding rate, and the numbers continue to rise precipitously. This development has also led to an expansion of the controversial practice of prescribing antipsychotic medications to young children.

In a replay of the autism epidemic hypothesis, many believe that the increasing readiness of many doctors to diagnose the condition, rather than its commonness, is to blame for the surging numbers. And, as with autism, a growing knowledge of and sensitivity to the condition also comes into play. This development on its own is a positive one, but charges of overdiagnosis remain; bipolar disorder is now more common among children than clinical depression. Most children treated for the condition do not go on to develop its most traditionally dramatic "manic" symptoms as adults, and this fact casts further doubt on the validity of the inital diagnoses. Common sense indicates that childhood cases of bipolar disorder would not be simply carbon copies of the condition made manifest in adults, and until researchers develop a distinct underaged version of the diagnosis, the act of assigning it to children will be subject to very legitimate debate. From a developmental angle, correctly diagnosing a child with a chronic condition like bipolar disorder at 5 or 6 years of age is an imprecise and potentially dangerous practice. Medications like those prescribed to treat such mood disorders may have profound effects on a child's growth and help to define the adult that he or she will become; caution should be the number one concern of all involved.

The number of adolescents diagnosed with bipolar disorder increased 40-fold in less than a decade (1994-2003). Almost one percent of the population under the age of 20 has now been labeled bipolar, and nearly all affected parties take related medications - 50 percent receive prescriptions for antipsychotics such as Seroquel, and the rest take some combination of mood stabilizers, antidepressants and stimulants. As in cases of adult bipolar disorder, most of these children receive more than one prescription. Images of 15-year olds on lithium are frightening for good reason, especially when hearing psychiatrists report that they've been actively "encouraged" by pharmaceutical companies to prescribe these "off label" medications to children in the wake of their FDA approval for the treatment of adults.

Still, some insist that bipolar disorder is a more accurate description of the intense rages and subsequent lows experienced by teens and young children than unipolar depression or isolated ADHD (yet 50% of those diagnosed are also attributed with comorbidities, the most common of which is, predictably, ADHD). Adolescent behavior often follows a more extreme trajectory than that of adults, and most parents, teachers and therapists will tell you that the stereotypical moody teen, alternately sullent and obstinate, is not a myth. But for those with unbearable and unexplainable behavior problems, new approaches and diagnoses are necessary, and the fact that the increasingly refined scrutiny of medical researchers has uncovered bipolar symptoms at earlier stages of the patient's life is understandable.

This big jump in diagnoses comes along with reports recommending further talk therapy for bipolar patients. Atypical antipsychotics, notorious for their side-effects including serious weight gain, have also come under greater scrutiny, leading many to consider alternative treatments ranging from the logical to the bizarre. Examples include a drug designed to combat seasickness, a patch for motion sickness, and the electrical fields created by brain scan machines. Specialized talk therapy has proven extremely successful among bipolar patients, but it remains relatively inaccessible, especially for those in remote or rural areas. Unlike pharmaceuticals, the talk therapy "industry" does not boast an array of well-funded public advocates and TV ads. One-on-one psychotherapy may be helpful, but family-based treatments and cognitive behavioral therapy are more often recommended, as a patient's daily routines can have a pronounced effect on his or her emotional state. Experts say that upcoming practitioners should receive more intensive training in talk therapy as it would most likely prove beneficial to a considerable number of their patients.  And it might work for children as well; we clearly need to exhaust all other options before we willingly give antipsychotic chemicals to 5-year-olds. 

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