Andrew
10-21-07, 08:32 PM
Published in the Fayetteville Observer on Friday, October 19, 2007
Children’s bipolar disease is often undiagnosed
Alicia Chinlund
As the mother of four, I was deeply moved by another mother’s account of a child’s life cut short in a moment of such hopelessness that death seemed the only way out. I refer to Nancy McCleary’s account of 17-year-old Andy Jordan’s descent into despair.
As a psychotherapist for the past 20 years, I’ve seen many young people suspended in that same tenuous net of hopelessness in which Andy Jordan seemed caught time and time again. I’ve listened to many a distraught mom tearfully share the same story shared by Andy’s mother, Lisa Lynch. I didn’t know Andy or his family but they have my deepest sympathy as they continue to grieve the loss of this precious young life.
There are many such families in our community, struggling to find help for a teenager spinning out of control toward an emotional abyss. Mrs. Lynch suspected her son may have had bipolar disorder.
Andy was diagnosed as a child with attention deficit/hyperactivity disorder and a learning disability. He had a history of abrupt mood shifts, anxiety, severe depression, suicidal behavior, abuse of alcohol and drugs, aggressive behavior, legal trouble, paranoia, explosive outbursts and rage episodes.
I would not presume to diagnose someone I have never met, but I venture Mrs. Lynch may have been correct. And, because patients with bipolar disorder present the highest suicide risk of any psychiatric population, a tragedy might have been prevented with accurate diagnosis and treatment.
Bipolar affective disorder, formerly referred to as manic-depression and diagnosed primarily in adults, was once thought to be rare.
Prevailing theoretical models and the absence of child research throughout much of the 20th century maintained the perception that children were incapable of experiencing depression and suicidal impulses.
Several recent studies suggest, however, that as many as a million children who are diagnosed with ADHD in the United States may be suffering early symptoms of early-onset bipolar disorder, and as many as 1 to 2 million children diagnosed with depression will go on to manifest the bipolar form.
More common
Childhood bipolar illness may be more common than ever imagined. So why aren’t more kids being treated for early-onset bipolar disorder?
Because the disorder is poorly understood and manifests itself differently than adult-onset bipolar, it is often missed.
Early-onset bipolar disorder looks like many other childhood disorders through the course of the illness — attention deficit/hyperactivity disorder; oppositional-defiant disorder; separation anxiety disorder; obsessive-compulsive disorder; and major depressive disorder.
Because of the mixed symptom picture, many of these children are given diagnoses and treatments that obscure the possibility of bipolar disorder even being considered, despite positive family histories of mood disorder. Bipolar disorder is considered to be one of the most highly heritable psychiatric disorders.
Research suggests that many individuals diagnosed with bipolar disorder were first diagnosed with a major depressive disorder — manic symptoms emerged later in the course of the illness.
The mania that appears in early-onset bipolar disorder looks little like the symptoms for adults described in the DSM-IV, the diagnostic manual used as the profession standard for psychiatry.
The mania that appears in childhood bipolar cycles more rapidly and is characterized more often by mixed symptoms of depression, irritability and anger.
Research indicates that there are early indicators, some present in infancy, that are distinct from other childhood disorders: inflexibility and resistance to change; excessive irritability, especially in the morning; explosive rages and tantrums that go for hours; destruction to property; violent threats to self, parents or siblings; hyperactivity, evident even before birth for some; erratic bodily rhythms and disruptions in day/night cycles; ability to walk and talk at very early ages; significant separation anxiety; vivid, intense, gory nightmares; persistent fear of death; conflicts with peers due to bossy, demanding, aggressive behaviors; oversensitivity to sensations, smells, sounds; appetite irregularities; hypersexuality; hallucinations; and suicidal thinking, to name a few.
Many of these kids fall through the cracks in the mental health system because of diagnostic criteria that insist upon fitting pediatric square pegs into adult round holes.
It is estimated that children who are ultimately diagnosed with bipolar disorder have been in treatment for an average of 10 years before an accurate diagnosis is made. Many health professionals are reluctant to diagnose bipolar when other disorders seem more obviously present, such as ADHD or major depression.
Triggering mania
Treating ADHD or a major depression when bipolar may be present can aggravate rather than relieve symptoms of the disorder. Some antidepressants and stimulants may actually trigger an emergent mania with increased aggression and active suicidal thinking in the bipolar child.
Unlike other medical disciplines, there are no lab tests for psychiatric disorders and psychiatry is not an exact science. The primary diagnostic tools of the mental health clinician are patient/parent report; behavioral observation; family history and developmental history. Only the parent or child who has ridden the harrowing bipolar roller coaster ride can adequately describe the tormented experience, but they often find themselves mute in frustration after repeating their story many times to insensitive ears.
Too often, the inexperienced or impatient clinician will attribute continuing problems to poor discipline or exaggeration on the part of an overwhelmed parent when traditional interventions do not work.
Difficult diagnosis
Childhood diagnosis is difficult and should only be made by a qualified, licensed health provider experienced in the diagnosis and treatment of bipolar disorder, one knowledgeable about how the illness manifests itself in childhood. A competent clinician will obtain a thorough patient and family history and rule out other possible medical bases for the symptoms.
Evaluation and treatment by a child psychiatrist is essential. Psychological tests, particularly neuropsychological testing, can go a long way in supporting an initial diagnosis and identifying needs in treatment.
Resources available
While finding a child psychiatrist and supportive mental health care can be unnecessarily difficult, there are qualified professionals and agencies who can help. More than ever, resources are available to guide families in their search for proper diagnosis and treatment, especially online. Interested parents can access the Web site of the Juvenile Bipolar Research Foundation (jbrf.org) to connect with other families for support, obtain the latest research data and participate in ongoing research.
The National Alliance for the Mentally Ill (NAMI) provides advocacy, information and support at multiple levels and can be accessed online.
I applaud Mrs. Lynch’s courage in sharing her son’s story with others and hope it will inspire others to seek help.
Alicia Chinlund, who was born at Fort Bragg, graduated from Westover High School before earning bachelor’s and master’s degrees in psychology. She is a psychologist in private practice and can be reached at achinlund@msn.com.
Copyright 2007 - The Fayetteville (NC) Observer
http://www.fayobserver.com/print?id=275375&type=article
Children’s bipolar disease is often undiagnosed
Alicia Chinlund
As the mother of four, I was deeply moved by another mother’s account of a child’s life cut short in a moment of such hopelessness that death seemed the only way out. I refer to Nancy McCleary’s account of 17-year-old Andy Jordan’s descent into despair.
As a psychotherapist for the past 20 years, I’ve seen many young people suspended in that same tenuous net of hopelessness in which Andy Jordan seemed caught time and time again. I’ve listened to many a distraught mom tearfully share the same story shared by Andy’s mother, Lisa Lynch. I didn’t know Andy or his family but they have my deepest sympathy as they continue to grieve the loss of this precious young life.
There are many such families in our community, struggling to find help for a teenager spinning out of control toward an emotional abyss. Mrs. Lynch suspected her son may have had bipolar disorder.
Andy was diagnosed as a child with attention deficit/hyperactivity disorder and a learning disability. He had a history of abrupt mood shifts, anxiety, severe depression, suicidal behavior, abuse of alcohol and drugs, aggressive behavior, legal trouble, paranoia, explosive outbursts and rage episodes.
I would not presume to diagnose someone I have never met, but I venture Mrs. Lynch may have been correct. And, because patients with bipolar disorder present the highest suicide risk of any psychiatric population, a tragedy might have been prevented with accurate diagnosis and treatment.
Bipolar affective disorder, formerly referred to as manic-depression and diagnosed primarily in adults, was once thought to be rare.
Prevailing theoretical models and the absence of child research throughout much of the 20th century maintained the perception that children were incapable of experiencing depression and suicidal impulses.
Several recent studies suggest, however, that as many as a million children who are diagnosed with ADHD in the United States may be suffering early symptoms of early-onset bipolar disorder, and as many as 1 to 2 million children diagnosed with depression will go on to manifest the bipolar form.
More common
Childhood bipolar illness may be more common than ever imagined. So why aren’t more kids being treated for early-onset bipolar disorder?
Because the disorder is poorly understood and manifests itself differently than adult-onset bipolar, it is often missed.
Early-onset bipolar disorder looks like many other childhood disorders through the course of the illness — attention deficit/hyperactivity disorder; oppositional-defiant disorder; separation anxiety disorder; obsessive-compulsive disorder; and major depressive disorder.
Because of the mixed symptom picture, many of these children are given diagnoses and treatments that obscure the possibility of bipolar disorder even being considered, despite positive family histories of mood disorder. Bipolar disorder is considered to be one of the most highly heritable psychiatric disorders.
Research suggests that many individuals diagnosed with bipolar disorder were first diagnosed with a major depressive disorder — manic symptoms emerged later in the course of the illness.
The mania that appears in early-onset bipolar disorder looks little like the symptoms for adults described in the DSM-IV, the diagnostic manual used as the profession standard for psychiatry.
The mania that appears in childhood bipolar cycles more rapidly and is characterized more often by mixed symptoms of depression, irritability and anger.
Research indicates that there are early indicators, some present in infancy, that are distinct from other childhood disorders: inflexibility and resistance to change; excessive irritability, especially in the morning; explosive rages and tantrums that go for hours; destruction to property; violent threats to self, parents or siblings; hyperactivity, evident even before birth for some; erratic bodily rhythms and disruptions in day/night cycles; ability to walk and talk at very early ages; significant separation anxiety; vivid, intense, gory nightmares; persistent fear of death; conflicts with peers due to bossy, demanding, aggressive behaviors; oversensitivity to sensations, smells, sounds; appetite irregularities; hypersexuality; hallucinations; and suicidal thinking, to name a few.
Many of these kids fall through the cracks in the mental health system because of diagnostic criteria that insist upon fitting pediatric square pegs into adult round holes.
It is estimated that children who are ultimately diagnosed with bipolar disorder have been in treatment for an average of 10 years before an accurate diagnosis is made. Many health professionals are reluctant to diagnose bipolar when other disorders seem more obviously present, such as ADHD or major depression.
Triggering mania
Treating ADHD or a major depression when bipolar may be present can aggravate rather than relieve symptoms of the disorder. Some antidepressants and stimulants may actually trigger an emergent mania with increased aggression and active suicidal thinking in the bipolar child.
Unlike other medical disciplines, there are no lab tests for psychiatric disorders and psychiatry is not an exact science. The primary diagnostic tools of the mental health clinician are patient/parent report; behavioral observation; family history and developmental history. Only the parent or child who has ridden the harrowing bipolar roller coaster ride can adequately describe the tormented experience, but they often find themselves mute in frustration after repeating their story many times to insensitive ears.
Too often, the inexperienced or impatient clinician will attribute continuing problems to poor discipline or exaggeration on the part of an overwhelmed parent when traditional interventions do not work.
Difficult diagnosis
Childhood diagnosis is difficult and should only be made by a qualified, licensed health provider experienced in the diagnosis and treatment of bipolar disorder, one knowledgeable about how the illness manifests itself in childhood. A competent clinician will obtain a thorough patient and family history and rule out other possible medical bases for the symptoms.
Evaluation and treatment by a child psychiatrist is essential. Psychological tests, particularly neuropsychological testing, can go a long way in supporting an initial diagnosis and identifying needs in treatment.
Resources available
While finding a child psychiatrist and supportive mental health care can be unnecessarily difficult, there are qualified professionals and agencies who can help. More than ever, resources are available to guide families in their search for proper diagnosis and treatment, especially online. Interested parents can access the Web site of the Juvenile Bipolar Research Foundation (jbrf.org) to connect with other families for support, obtain the latest research data and participate in ongoing research.
The National Alliance for the Mentally Ill (NAMI) provides advocacy, information and support at multiple levels and can be accessed online.
I applaud Mrs. Lynch’s courage in sharing her son’s story with others and hope it will inspire others to seek help.
Alicia Chinlund, who was born at Fort Bragg, graduated from Westover High School before earning bachelor’s and master’s degrees in psychology. She is a psychologist in private practice and can be reached at achinlund@msn.com.
Copyright 2007 - The Fayetteville (NC) Observer
http://www.fayobserver.com/print?id=275375&type=article