MHM Magazine

Issue 6 | 2022 | MENTAL HEALTH MATTERS | 9 MHM Bipolar mood disorder in children has been controversial for a long time, but the controversy has now shifted from whether it can be diagnosed in children and adolescents to how it’s diagnosed and how it can be differentiated from other more common childhood psychiatric disorders. There are many diagnostic challenges in children and adolescents with bipolar, and on average it takes 10 years before bipolar patients are properly diagnosed and treated. For each year of untreated illness, bipolar youth have a 10% lower likelihood of recovery. This is important as bipolar disorder affects the normal development and psychosocial functioning of a child and is associated with: • Increased risk for suicide • Psychosis • Substance abuse • Behavioural, academic, social and legal problems DIAGNOSTIC CHALLENGES 1. Children are not ‘little adults’ but unfortunately, in the Diagnostic and Statistical Manual of Mental Disorders (DSM), adult criteria are used to diagnose bipolar disorder in children. It’s universally accepted that the clinical presentation of bipolar in children is significantly different than adults. (See Table below) 2. There is a high rate of co-morbid psychiatric disorders (especially Attention Deficit Hyperactivity Disorder (ADHD), and there is significant symptom overlap, which makes the task of reaching a diagnosis even more difficult 3. Children and adolescents find it difficult to verbalise their emotions, and symptoms can have different meanings based on the developmental level of the child. 4. We always need to consider the developmental stage of the child when making a diagnosis as bipolar mood disorder as for e.g., mania during adolescents, usually presents as psychosis, also labile, unstable and changeable mood is a prominent feature of stages of development, and having to recognise when it’s developmentally appropriate vs when it’s developmentally inappropriate is often very difficult. 5. The assessment process is equally challenging as multiple informants are required, with a minimum being the child and one parent. There are usually discrepancies between informants. Parents are better at reporting behavioural disturbances and the time course of symptoms and children are better at reporting mood, anxiety and sleep/ neurovegetative symptoms. In the case of bipolar mood disorder, children are better able to report on symptoms like elevated mood, grandiosity, flight of ideas, racing thoughts, Dr Alicia Porter Psychiatrist Child and Adolescent Fellow Charlotte Maxeke Johannesburg Academic Hospital alicia.porter@wits.ac.za COMPLICATIONS OF RECOGNISING BIPOLAR DISORDER IN CHILDREN