Bipolar Rabbit-Hole

In response to my post yesterday about diagnostic criteria for DMDD and BPD, there was a comment about the overlap in symptoms with childhood bipolar disorder.  I had really not looked into this very much before, but when I started reading, I practically dove down this rabbit-hole!

A word of caution that I have not done extensive research on this, I have only started learning about this today….but here are some takeaways that I found most interesting. 

1)      “Mania” in children does not look like it does in adults…rather than distinct euphoric episodes, mania in children can just appear as persistent, non-episodic, severe irritability.  ¹

2)      Some research shows that children with bipolar can cycle rapidly, meaning that they can go between mania and depression multiple times in a day.² 

3)      A majority of children with bipolar also have ADHD (one study showed 98% of the bipolar sample also had ADHD!) because of the overlap in symptoms (distractibility, motor activity, impaired attention, poor impulse control, rapid speech, etc.)  ³

4)       The number of children with bipolar is on the rise. In the US, the rate in 1996 was 1.3 per 10,000 children; in 2010, that had reached 7.3 per 10,000.⁴  (These numbers were before they introduced some new DSM categories, that may have shifted things, I’m guessing.)

5) Although there are similarities in symptoms, children with SMD (a precursor to the DMDD diagnosis that doesn’t line up perfectly) had different types of brain activity than children with bipolar when frustrated. During emotion-based tasks, kids with SMD showed less activity in the amygdala than the kids with bipolar, and when they were presented with negative feedback, different areas in the brains were activated in the two groups. ⁵

6) On average, it takes a person with bipolar 10 years to get a diagnosis. ⁶

7) One study talked about how the new DMDD diagnosis appeared to separate out the kids who went on to have depression as adults from those with a diagnosis of bipolar - NOS, who went on to have bipolar as adults.⁷ But they didn’t really talk about the differential diagnosis, so I’m still confused on that part.

8) Diagnosis for childhood bipolar seems to be quite a bit more involved than other diagnoses with which I’m familiar. There were lists of different types of screening tools and rating scales to test for the presence and severity of symptoms.

Here is one that I found interesting, to screen for the severity of mania: https://qxmd.com/calculate/calculator_473/young-mania-rating-scale-ymrs

And here’s another one to screen for bipolar:
https://qxmd.com/calculate/calculator_677/mood-disorder-questionnaire-mdq
Out of curiousity, I took this one, guessing how Eli would answer, and was screened positively for Bipolar I. (FYI - I’m not a trained clinician, the screening tool was originally meant for adults so this is not its intended use, and a positive screening is not a diagnosis.)

I found this table highlighting the differences between adult and pediatric bipolar to be fascinating. ⁸

My head is spinning a bit. I have always thought of diagnosis as simply a useful tool - the thing that tells you which treatment to try first. But if I let myself get sucked in, I can start to get caught up in the “prognosis” bit…..if his diagnosis is this, then his adult life will probably look like that, and so on. And getting spun out over future problems is just useless. Worse than useless, it’s destructive.

For the moment, I’m going to put it all out of my head, and go scoop up my gorgeous baby and take him to bed. Yes, he’s 11 and in a year, he’ll be able to scoop ME up; but he at the moment, he humors me and lets me dote on him. After these long, challenging 6 years (in which there was at least one year when I got nothing but snarls and glares), I’ll baby him any damn time he lets me, no matter what age. In fact, I hereby decree that his Most Important diagnosis is and always will be that of Mama’s Boy. God, I love this complex little creature I was entrusted with to raise.

1. https://pubmed.ncbi.nlm.nih.gov/10743841/

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695748/

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695748/

4. https://pubmed.ncbi.nlm.nih.gov/17306773/

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254488/#R10

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695748/

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4254488/#R10

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695748/