About Pediatric Bipolar Disorder

Bipolar disorder (also known as manic-depression) is a chronic brain disorder marked by bouts of extreme and impairing changes in mood, energy, thinking, and behavior. The most outwardly apparent symptoms are behavioral; however, the illness often has less visible, but serious, cognitive, cardiac, and metabolic effects. Symptoms may emerge gradually or suddenly during childhood, adolescence, or adulthood. Researchers have identified cases of bipolar disorder in every age group studied, including preschoolers.
  
Here, The Balanced Mind Foundation examines bipolar disorder that emerges in childhood or adolescence. Bipolar disorder does not affect every child in the same way. The frequency, intensity, and duration of a child’s symptoms and the child’s response to treatment vary dramatically. As the child grows up, bipolar disorder may affect the size, shape, and function of brain regions and networks. Recent research suggests that pediatric bipolar disorder is a neurodevelopmental disorder. Parts of the brain mature (or come online) at different rates and times; brain maturation is not complete until an individual is 25 or so. Consequently, the symptoms and diagnosis of a psychiatric illness may change as the child grows. 

Children and adolescents can have bipolar disorder. Some of our ill children meet the textbook definition of bipolar disorder. Some of our ill children with severe mood dysregulation might not meet the textbook definition because they don't have distinct episodes of a certain duration or have few clear periods of wellness between episodes. They might have rapid and severe cycling between moods or they might present in a mixed state that produces chronic irritability. Experts have not yet reached consensus as to whether children with chronic irritability and clear mood swings, but without mania, should be classified as having bipolar disorder.  The Balanced Mind Foundation urges the research community to agree on a common terminology and a way to communicate with each other and with families about the full spectrum of the severe illness(es) impairing our children. It is imperative that we work together to alleviate the terrible suffering that this disorder wreaks.

Bipolar I. In this form of the disorder, the individual experiences one or more episodes of mania. Episodes of depression may also occur, but are not required to diagnose bipolar disorder. 
Symptoms of mania include:

• euphoria (elevated mood)—silliness or elation that is inappropriate and impairing
• grandiosity
• flight of ideas or racing thoughts
• more talkative than usual or pressure to keep talking
• irritability or hostility when demands are not met
• excessive distractibility
• decreased need for sleep without daytime fatigue
• excessive involvement in pleasurable but risky activities (daredevil acts, hypersexuality)
• poor judgment
• hallucinations and psychosis

For an episode to qualify as mania, there must be elevated mood plus at least three other symptoms, or irritable mood plus at least four other symptoms.
Symptoms of depression include:

•  lack of joy and pleasure in life
• withdrawal from activities formerly enjoyed 
• agitation and irritability
• pervasive sadness and/or crying spells
• sleeping too much or inability to sleep
• drop in grades or inability to concentrate
• thoughts of death and suicide
• fatigue or loss of energy
• feelings of worthlessness
• significant weight loss, weight gain or change in appetite

Stable periods occur between episodes of mania and depression. An episode must last at least one week, or, if hospitalization is necessary, may be of any duration.

Bipolar II. In this form of the disorder, the individual experiences recurrent periods of depression with episodes of normal mood (euthymia) or hypomania between episodes. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity and energy and may, but not always, progress into full-blown mania if not treated. Some people with bipolar disorder never develop full-blown mania. 

Bipolar Disorder NOS (Not Otherwise Specified).Doctors may make this diagnosis when there is severe mood dysregulation with serious impairment, but it is not clear which type of bipolar disorder, if any, is emerging.  Perhaps the individual has always been impaired, with cycling apparent since infancy. Maybe there have been no discernable periods of wellness. Perhaps the child is experiencing the emergence of another neurodevelopmental illness and the symptoms of that disorder have not yet been fully expressed. The inability to pinpoint a diagnosis should not be taken as a dismissal of the severity of the child’s symptoms. 

Bipolar disorder is often accompanied by symptoms of other psychiatric disorders (those other disorders are said to be "comorbid" with the bipolar disorder). In some children, proper treatment for bipolar disorder clears up the symptoms thought to indicate another diagnosis. In other children, bipolar disorder may explain only part of a more complicated case that includes neurological, developmental, and other components. An accurate diagnosis of a child or teen presenting with severely troubled behavior is perhaps the most problematic issue facing families.
Diagnoses that mimic, mask, or co-occur with pediatric bipolar disorder include:  

• Attention-deficit hyperactivity disorder (ADHD)* 
• Depression** 
• Oppositional-defiant disorder (ODD) 
• Conduct disorder (CD) 
• Pervasive developmental disorder (PDD) 
• Generalized anxiety disorder (GAD) 
• Panic disorder 
• Obsessive-compulsive disorder (OCD) 
• Tourette's syndrome (TS) 
• Seizure disorders 
• Reactive attachment disorder (RAD)

read more: http://www.thebalancedmind.org/learn/library/about-pediatric-bipolar-disorder?page=1