Many believe that one of the reasons for this occurrence is that some children have been misdiagnosed with bipolar disorder, instead these kids have a different illness altogether. In response, the American Psychiatric Association is creating a new diagnosis that will appear in the DSM-5 guide called Disruptive Mood Dysregulation Disorder, for labeling kids that don’t fit under the “classic adult symptoms” of bipolar disorder.
I don’t doubt the above theory of why some “bipolar” kids don’t grow up to have bipolar disorder, but I also wonder if in addition, there’s another factor to consider.
Is it possible that our kids are showing the early signs of bipolar disorder, but because of early treatment with medication and therapy, their brains are rewired as they develop. I’ve been told many times that it’s hard to diagnose children since their brains are still growing and changing and many kids experience less severe symptoms as they grow older. Is it too far of a stretch to ask the question, “Are we able to change the course of early onset bipolar disorder in children with early treatment?”
Some would argue that bipolar disorder can not be cured or altered for once an adult is diagnosed, it stays with them for a lifetime. But we’re talking about “adult brains” that are already complete in their development. Is it possible that the illness can be altered in children?
I don’t claim to know the answers, I’m just curious and wonder what your thoughts are? As far as I’m concerned, we’re years away from having the research to provide us the answers. Even with a new diagnosistc label, I believe we’ll still have confusion. For example, if most “bipolar kids” grow up to have unipolar depressive disorders or generalized anxiety disorders, then how is the Disruptive Mood Dysregulation Disorder label going to fix this? Won’t we now have kids with Disruptive Mood Dysregulation Disorder growing up to have depression or anxiety? How do we know what meds are right? What if our kids are responding to bipolar medication?
I read in the DSM-5 Development guide the following research:
The only treatment trial of SMD used lithium and did not show efficacy vs. placebo (Dickstein et al, 2009).
It all seems so complicated, I don’t know what the answers are, I just have more questions. What about you, do you think the course of early onset bipolar disorder can be altered with early treatment? Is bipolar disorder an extreme form of a mood disorder illness on a spectrum of other illnesses, many yet undefined? Why isn’t a Bipolar 2 diagnosis applied to children that look bipolar but don’t have clear mania? Is it really as cut and dry as the diagnostic statistical manual makes it?
As a final note, I thought I would share what Dr. Kiki Chang said in a Frontline documentary filmed in 2007 called The Medicated Child:
These medications have effects on the brain directly—that’s how they work. But some of the effects on the brain could also be protective. In animal studies and cell-line studies, there’s some evidence that suggests that these medications have what we call neuroprotective qualities. They actually protect the brain against injury and insult. They may even help with healthy neuronal growth in certain areas. If that’s the case, perhaps finding the right medication early on can protect a brain against all these further insults of kindling later on and maybe even directly have some sort of neuroprotective effect, so that these children never do progress to full bipolar disorder.
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Please notes that the American Psychiatric Association does recognize that there are real cases of bipolar disorder in children, this proposed diagnosis does not deny the existence of bipolar disorder in children.
Also I think it’s important to note that the guide also clarifies that youth with SMD (now Disruptive Mood Dysregulation Disorder) are as severely impaired as those with BD.
DSM-5 Proposed Justification for Disruptive Mood Dysregulation Disorder (Once called Temper Dysregulation Disorder with Dysphoria)
Disruptive Mood Dysregulation Disorder:
The Medicated Child Frontline Interview Transcript: