The Bipolar Child, Part II: Childhood bipolar disorder criteria

CLPsych wrote a post on the "Growing Up Bipolar" Newsweek cover story. I agree with most of his points. Especially:

1. Max's problems are described by the journalist as "incurable" and as "a life sentence." It is true that the kid is likely in for a life of trouble. But stating that such difficulties are a certainty for the rest of his life? That's a little too certain and it's not based on any evidence. Show me one study that indicates that 100% of children like Max will always have a high level of psychological difficulties and essentially be unable to function independently.

The article even mentions that "Max will never truly be OK." Apparently, I just learned from my recent viewing of Depression: Out of the Shadows that diagnoses are not static.

Miracles have happened but to say that Max's future doesn't have a grim tint to it is unrealistic. Not because of his diagnoses but because of all 38 different medications that he's already been on.

By 7½, Max was on so many different drugs that Frazier and his
parents could no longer tell if they were helping or hurting him. He
was suffering from tics, blinking his eyes, clearing his throat and
"pulling his clothes like he wanted to get out of his skin
," says

By the time Max had reached 8 years old, he was already showing the symptoms of side effects that can occur long-term. Tardive dyskinesia, hyperglycemia, diabetes, akathisia, neuroleptic malignant syndrome are all very real side effects that could develop in Max's teenage years and stick with him permanently. "Max will never truly be OK." Not because of his disorders but because these medications have given him a different "life sentence" — a life sentence of physical, visible afflictions in addition to the emotional and mental disorders he already struggles with.

I haven't really gotten into the child bipolar disorder conversation on this blog because

  • it's such a controversial diagnosis that would require lengthy posts that I didn't have time for
  • I found the entire diagnosis to be a bunch of hooey

But I will now.

CLPsych, in another post about child bipolar, lists the criteria for bipolar NOS (Not Otherwise Specified).

Children, aged 7 to 17 years, in this study could be diagnosed with bipolar NOS if they had a

distinct period of abnormally elevated, expansive, or irritable mood

*plus two of the following symptoms (three if irritated mood only) that
were "clearly associated with the onset of abnormal mood"

(1) inflated self-esteem or grandiosity
(2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
(3) more talkative than usual or pressure to keep talking
(4) flight of ideas or subjective experience that thoughts are racing
(5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli
(6) increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
(7) excessive involvement in pleasurable activities that have a high
potential for painful consequences (e.g., engaging in unrestrained
buying sprees, sexual indiscretions, or foolish business investments)

*The above symptoms must have been associated with "clear change in functioning"

*Mood and symptom duration of a minimum of 4 hours within a 24-hour period for a day to count toward bipolar disorder diagnosis

*"A minimum of 4 days (not necessarily consecutive) meeting the mood,
symptom, duration and functional change criteria over the subject's
, which could be two 2-day episodes, four 1-day episodes, and
so forth."
(emphasis not mine)

Basically, any kid — especially adolescents — could easily fall into this criteria. I can't tell you how many times I thought as a teenager that I suffered
from bipolar disorder. But I'll get to that story in a forthcoming post.

Even Maria at intueri broke this down more than a year ago:

We need to stop the belief that a pill will always cure everything.

I agree with her in more ways than one.

One thought on “The Bipolar Child, Part II: Childhood bipolar disorder criteria

  1. This is definitely a complex subject. Maria’s quote brought to mind the issue regarding how often children are being “diagnosed” as ADD or ADHD and then quickly put on Ritalin, etc. I think since society in general is over-medicated today, it’s safe to say that our kids are too. When I was a teenager I was taking 14 pills a day at one time and I doubt that I needed all of them, but being a kid I didn’t ask questions. We really can’t take too much care in making sure that [we and] our children are receiving appropriate treatment.

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