Out of the Shadows: The rise of bipolar disorder in children

Why diagnoses for the disorder have multiplied 40 fold since 1995

October 18, 2011

Julianne Hill

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Between 1995 and 2005 the number of kids diagnosed as bipolar increased forty fold.

Between 1995 and 2005, the number of adults in the nation diagnosed with bipolar doubled. In the same time-frame, the number of kids diagnosed as bipolar increased forty fold. Unchecked, the illness can deeply affect a child's ability to learn and care for themselves. It can also increase their risk of suicide.

Natalie Flanagan is a triplet, born eight weeks early. While her brothers are developing on a typical schedule, Natalie has developmental delays. She also struggles with mood disorders.

“Right from the time Natalie was born, she was anxious,” says her mother, Lisa Flanagan. “It looked just like she wanted to crawl out of her skin and that looked like anxiety to us but we felt like her world was shrinking.”

Then in the 5th grade, Natalie’s symptoms escalated. She was admitted to an inpatient psych ward.

Her mother says she was petrified. “I was thinking One Flew Over the Cuckoo’s Nest,” Flanagan explains. “They did get her mania to subside, but the experience was pretty terrible. She was restrained with medicine and physically.”

But it was during this period Natalie’s family learned she had bipolar disorder. “And I really wanted to understand what it was,” her mother says.

Now 13 years old, Natalie checks in with her doctor on a sunny Thursday morning. Her doctor is Mani Pavuluri, a professor of pediatric brain research at the University of Illinois at Chicago and a leading expert on bipolar children.

“There are classic symptoms like hyper-sexuality and not sleeping at night,” Pavuluri says of children like Natalie. “Happy one minute, then crying, then you start to think there is something wrong with this child’s mental state and you look for classic symptoms."

"When you say the child’s symptoms are very similar to adult mania, there are some things that are different in children," Pavuluri explains. "In children, they are very rapid in cycling, moving from depression to mania rather fast with multiple cycles within an even a bigger cycle, which we call complex cycling.”

But Dr. Jason Washburn of Northwestern University’s Feinberg School of Medicine says the definitions being used to identify the disorder are problematic, leading to the jump in diagnosis.

“We don’t have definitive answers,” Washburn says. “This is probably highly unlikely that this is due to a change in our children. So we’re not necessarily seeing bipolar disorder increase in any sort of actual way. What we’re seeing is an increase in diagnostic practices. What we’ve seen is a movement toward expanding what is included in a bipolar disorder diagnosis. Children who were previously diagnosed with another disorder are being put into the bipolar disorder bucket.”

There’s been no official change in the criteria for pediatric bipolar disorder. But the definition has been expanded to include aggression, chronic irritability, and rageful behavior. These factors are now criteria for pediatric bipolar.

Most adolescents sometimes display those behaviors, but often bipolar kids take a combination of several very expensive medications to reign in their symptoms.

“So right now, she’s on 1200 mg of lithium, 600 mg in the morning, and 600 mg at night," says Lisa Flanagan of daughter Natalie. "She’s on 4 mg of Intuniv, 2 mg in the morning, and 2 at night,” as well as a host of other drugs.

Some doctors, like Dr. Washburn, warn about the long term effects of such medications.

There are several medications being used for this -- mood stabilizers as well as second-generation atypicals and anticonvulsant medications,” Washburn says. “Unfortunately, we don’t know what the long term effects are. We don’t have 10- year longitudinal studies of children put on these medications. We don’t have the data. But we do know if we don’t do anything, they’re going to get worse. It’s hard to say we’re overmedicating and it’s hard to say we’re not overmedicating because these are youth with significant problems. They’re failing out of school, costing society more dollars later on, with major problems at home children and causing major strife.”

This comes at a time when insurance companies are covering less of the cost for long term hospital stays or other types of extensive and expensive therapy. Dr. Mark Stein is a clinical psychologist and researcher at the University of Illinois at Chicago. He studies ADHD, a disorder that often exists alongside bipolar disorder. Stein says availability of medications for mental health issues sometimes influences a doctor’s diagnosis.

“We really want to help people and if you’re aware there’s a specific treatment, that’s going to increase one’s awareness in looking for those symptoms,” Stein says. “If all you have is a hammer then everything looks like a nail.”

But catching bipolar at a young age might help the kids cope as they grow up with the disorder, because other factors complicate living long-term with the diagnosis.

Dr. Elliot Gershon is a professor of psychiatry and human genome genetics at the University of Chicago. His work looks at the genetic component of bipolar disorder.

“The outlook for early onset bipolar is before puberty, relatively poor, compared to later onset bipolar,” Gershon says. “And it’s made worse by the person becoming engaged in substance abuse, which is fairly frequent among bipolars. One of the reasons that mood disorders in children are so devastating for the rest of their lives is that their education tends to not go as well as it might otherwise, as you might appreciate.”

Still, Lisa Flanagan remains hopeful for her daughter.

“Her academics since we’ve been with [Dr. Pavuluri] have increased so much that I’m a lot more hopeful she can be at a place with additional learning, in a vocation or college,” Flanagan says. “I feel like her future is going to be okay.”

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