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Fall 2010

Bipolar Disorder Difficult to Diagnose in Children

VS-Fall10-Bipolar ChildrenAn estimated 2 percent of children and adolescents in the United States are living with bipolar disorder, formerly known as manic-depressive illness. Experts say the condition is difficult to diagnose, particularly in younger children. But there is agreement on one thing: Bipolar disorder makes it difficult for a child to function well in school or get along well with friends and family.

“Children with bipolar disorder often experience symptoms differently than adults, and they may also have more difficulty explaining how they feel,” says David J. Miklowitz, Ph.D., director of the Child and Adolescent Mood Disorders Program at UCLA, one of only a few programs in the country specializing in the diagnosis and treatment of bipolar disorder in children and teens. “To make what we call a presumptive diagnosis, we interview the child and his or her parents — looking for specific emotions, behaviors, sleep patterns and cognitive styles consistent with bipolar disorder — and then put the pieces of the puzzle together to decide if the child meets the diagnostic criteria for the illness.”

The most common symptoms of the manic side of bipolar disorder include irritable or elated mood, racing thoughts, rapid speech, grandiosity and sleep disturbance without feeling tired. These phases are often followed by periods of severe depression, hopelessness, suicidal thoughts or actions, insomnia and fatigue. Depression tends to become more common during and after puberty, particularly among girls. Children with mood disorders are also at greater risk for co-occurring problems, such as anxiety disorders, attention-deficit disorder, disruptive-behavior disorders, substance abuse and attempts at self-harm and suicide.

“Rather than only talking to the child, it’s very important to get family members involved in the process of providing information to make the diagnosis and later to manage the disorder,” Dr. Miklowitz says. “We usually start with medications, such as mood stabilizers, anti-psychotics or drugs to manage attention-deficit disorder or improve sleep, but our research shows that combining medications with therapies that involve the family is usually the most effective regimen for staving off future episodes.”

Psychotherapy includes family intervention to teach children and parents how to recognize early warning signs of relapse, identify important stress factors that play a role in recurrences, communicate better as a family and solve family problems. According to Dr. Miklowitz, compared with those who receive medication alone, children who receive both medication and family therapy recover from episodes more quickly, feel well more often, experience less severe depression symptoms and report more life satisfaction. He emphasizes that early intervention is important and that parents should seek a diagnosis from qualified professionals as soon as they suspect their child has bipolar disorder or some other mood disorder.

“As with any illness, bipolar disorder can get worse over time,” Dr. Miklowitz explains. “The earlier we can get kids on an effective treatment regimen, the better the long-term outcome will be.”

For more information about the Child and Adolescent Mood Disorders Clinic, go to: www.semel.ucla.edu/champ





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