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Diagnosis and Treatment of Bipolar Disorder in Children and Adolescents

Posted Nov 17 2008 9:04pm

by Mary Beth CoganSince 1980, criteria for diagnosing bipolar disorder in adults have also been used to diagnose mania in children, with some modifications to adjust for age. Similarly, to diagnose a child or adolescent with bipolar disorder, there need be at least one period of mania that is manifested by a distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least one week or any duration if hospitalization is required. In addition, during the period of mood disturbance the children or adolescents may experience to a significant degree at least three of the following symptoms (or four if their mood is irritable): inflated self-esteem or grandiosity, decreased need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal­ directed activity, or excessive involvement in activities with the potential for painful consequences. For a diagnosis of bipolar disorder these symptoms must also produce marked impairment in functioning and be unaccounted for by other psychiatric disorders due to physiologic effects of substances or medical conditions.

Obstacles in identifying and diagnosing this disorder in children and adolescents include the low base rate of the disorder, the diversity in clinical presentation within and across episodes, the symptomatic overlap of mania with other disorders commonly found in childhood, such as attention-deficit hyperactivity disorder (ADHD), and the constraints placed upon symptom expression due to the developmental stage of the child. Developmental factors may confound the presentation of symptoms; for example, normal behavior in children may sometimes resemble hypomanic activity. Therefore, if not viewed within the context of normal behavior, psychopathology may not be recognized.

In young children it is difficult to identify discrete episodes of mania or depression. The clinical presentation of childhood bipolar disorder is variable but includes a waxing and waning course, worsening disruptive behavior, moodiness, irritability, difficulty sleeping, impulsivity, hyperactivity and decreased concentration. Episodically they experience short attention span, low frustration tolerance, explosive anger followed by periods of guilt, depression and declining academic performance.

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