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Bipolar Disorder: Catching It Early (It isn’t ADHD…)

As with any disease, the prognosis for bipolar disorder vastly improves with early and accurate diagnosis. And in childhood presentations, differentiating it from ADHD is huge.

The days of bipolar disorder being considered an exclusively adult disease are long gone. Yes, it’s now being diagnosed in children and adolescents. Correctly, I might add.

In fact, an article in the May 2010 issue of The Journal of Pediatrics confirms how common bipolar disorder is in children. More so, it reveals just how often the diagnosis is missed, mistaken, or flat-out not considered.

And that seals a very unpleasant fate for millions.

Cited in the article is research work funded by the National Institutes of Health, the National Institute of Mental Health, and other organizations. Here are their findings…

For those who experienced the onset of bipolar disorder before the age of 13 (22-28%), the average time before the first pharmacological intervention for either depression or mania was in excess of 16 years. In addition, experienced were more depressed days, more days during which major depressive and manic episodes occurred within a 24-hour period (ultradian cycling), and a greater number of major depressive and manic episodes throughout adulthood.

Also noted was an increased risk for substance abuse, suicide attempts, and anxiety disorders; as well as an overall resistance to treatment.

Another issue brought to the fore is the harsh reality that many bipolar children are mistakenly diagnosed with attention-deficit hyperactivity disorder (ADHD) and/or major depressive disorder. And with the incorrect diagnoses comes treatment with stimulants and antidepressants. Both contraindicated, and potentially dangerous, for one enduring bipolar disorder.

By the way, I have frequently seen such cases and it’s terribly frustrating and hurtful to all involved. But I have to admit – the impulsivity, irritability, and inattention common to pediatric bipolar disorder (PBD) and ADHD make a diagnostic distinction a very tough call.

So what’s up in the world of research that may be able to help? This is very cool.

According to scientists at the University of Illinois at Chicago, brain imaging is just the ticket. Their work is detailed in the October 2010 issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

The researchers assigned children working memory tasks while viewing faces showing a variety of emotions. And their brain activity was monitored using functional MRI. Oh, the subjects: ages 10-18, 23 non-medicated bipolar disorder, 14 non-medicated ADHD, and 19 non-disordered controls.

The results? Dysfunction in the prefrontal cortex (PFC) existed in both the bipolar disorder and ADHD kids. However, it was much worse in the ADHD subjects. The PFC is all things executive functioning, impulsivity, and complex cognitive processing.

And when it came to the areas of the brain associated with emotional processing and regulation, the bipolar group showed greater dysfunction.

Can you see the beauty – the practical applications – of this work? Imagine no longer having to rely solely upon symptoms and meds-response for a diagnosis! I mean, we’ll be able to blend these with observable/objective anatomical and physiological data. No more “pin the tail on the donkey!” That’s incredibly exciting.

Of course, it’s going to take a bit of time to bring the protocol to the everyday world of diagnostics and treatment. However, it at least sounds as though we’re well on our way.

So what’s our take-away here? In my opinion, several things…

  • The sooner bipolar disorder is diagnosed, the better.
  • Bipolar disorder is diagnosable in children.
  • Bipolar disorder in children is often mistakenly diagnosed as ADHD – and that’s potentially dangerous.
  • An observable/objective anatomical and physiological diagnostic protocol is on the immediate horizon.
  • Never give-up hope.

What about you? We all would benefit from your comment(s)!