Physician: Childhood Onset Bipolar Disorder

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Please explain "Childhood Onset Bipolar Disorder" and how it relates to the Internationally adopted child.

Bipolar Disorder is characterized by intense, persistent mood swings between the states of depression and mania. These moods are greatly intensified or clearly different from the youngster's usual personality and are far out of proportion to the child's usual state.

To be diagnosed with this condition, a person must have experienced the typical signs of depression - helplessness, hopelessness and worthlessness - as well as the signs of mania - grandiosity and exuberance. The disorder may be genetic and caused by a chemical imbalance in the brain. Medication is extremely successful in moderating the symptoms.

Bipolar disorder, or manic-depressive disorder, is characterized by intense mood swings that can last hours, days, or weeks, and involves phases of depression and mania - excessive feelings of happiness and excitement with an increase in energy and activity. Bipolar illness is generally seen as an adult disorder that may start in adolescence.

To be diagnosed as having BP, a child must exhibit symptoms of major depressive disorder for least two weeks, and periods of mania. The main difference between BP disorders and other psychiatric disorders is the distinct episodes of elated moods, feelings of grandiosity, and unusual energy seen only in Bipolar disorder.

This condition is thought to be quite rare in children under the age of twelve, and most often diagnosed during adolescence between the ages of 15 and 19 years. There is, however, increasing belief that the signs are present, but unrecognized, early in life. The lifetime risk for developing this disorder is about 1 percent in the general population but can be much higher in families in which other members have mood disorders. Although this disorder is highly treatable, 90 % of those who discontinue medication have a recurrence within 18 months. Without treatment, individuals with Bipolar Disorder are at risk for alcohol and drug abuse.

Parents describe their child as going through hours or days of hyperactivity, elation, high energy, followed by episodes of extreme sadness, even violence, and then going into periods of normal child behavior. Each distinct episode lasts from several hours to several days. Some parents mention that their child started exhibiting mood-swing symptoms at a very early age.

About 40% of the children with Bipolar Disorder also have Attention-Deficit / Hyperactivity Disorder (ADHD). Some experts believe this is a progression of the illness; that the ADHD symptoms occur and are recognized earlier because they are behaviorally manifested. Other symptoms of Bipolar Disorder may become evident once a child has more developed language and social skills.

For some youngsters, periods of time when they are functioning quite well and have normal moods are interspersed with periods of time when they are manic or depressed. Mixed presentations are most common for pre-pubertal children. Teens show discrete manic and depressive episodes. Less common are youngsters who alternate rapidly, many times a year, or day to day. In young children the symptoms of Bipolar Disorder can appear like one of the Attention-Deficit/Hyperactivity Disorders, with impulsivity and lack of control. Many of the signs of ADHD and Bipolar disorder overlap.

There is clear evidence that Bipolar Disorder is genetic. The physiological basis of the disorder is supported by neuroimaging studies that reveal that the two sides of the brain are different. In addition, neurochemical imbalances play a significant role in the cause of the disorder, pointing the way to its most effective treatment. Consulting a professional who has experience treating children with this disorder is important. With the young child the disorder is difficult to diagnose.

These results suggest that BP disorder in youth is an illness that is chronic and difficult to treat, often accompanied by behavior problems, poor psychosocial functioning, psychosis - derangement of personality and loss of contact with reality, and risk for suicide.

Medication helps regulate the mood swings that youngsters with this disorder experience. In addition, cognitive behavioral treatments and comprehensive school and home-based plans help a child stay in control and know what to expect.

BP is often associated with other psychiatric disorders. The illness increases family problems and can cause financial hardship: The multiple medications and interventions required by patients are not always covered by health insurance.

Children who are adopted internationally fall into a select category with respect to bipolar disorder. It is quite common to adopt a child with no medical history and no information regarding the clinical / psychiatric states of the birth parents. The rigors of an institutional setting increase the possibility of psychiatric or behavioral as well as medical problems in the adopted child. Prospective families should remain observant of subtle changes in the child’s demeanor, relationship with new family members or peers as well as authority figures. If emotional, behavioral or psychiatric disturbance is suspected, immediate referral to a qualified health professional is necessary.

Medication is the foundation of treatment for a child with Bipolar Disorder. Mood stabilizers not only arrest current symptoms of an episode, but can effectively decrease the frequency and severity of future episodes for close to 80% of those treated. Among the variety of other drugs, medications used to treat depression can be helpful but are used cautiously.

Medication management should be accompanied with education about the disorder, stressing the importance of continuation of the medication. Noncompliance is common due to youngsters' perception that they don't need medication any more. Often individual and family treatment is indicated to help with the management of the disorder, understanding the symptoms, and avoiding the stress that promotes a depressed or manic phase.

Most parents may feel inadequate when trying to manage a child with this disorder. These children are often demanding and cause everyone around them to worry about setting them off. Parenting these children requires specialized skills, and under the guidance of a professional, parents can be helped to understand the child's internal state and predict what situations will be most problematic.

Unfortunately many patients do not seek treatment for bipolar disorder. Moreover, because it runs in families, parents and siblings of patients diagnosed with this disorder are at higher risk for the disease and should be assessed by qualified mental health professionals.

by Nicholas Rogu, M.D.

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The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit or call 631-499-4114.

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