The Bipolar Child Puzzle

As I’ve been away on vacation this past week, I missed this great (but lengthy) article by Jennifer Egan published last week in the New York Times Magazine about the controversial and complicated issue of bipolar disorder in children.

Egan makes a compelling case for the legitimacy of this disorder in a nonscientific and very human way — by retelling her account of following families who’ve been dealt the bipolar child diagnosis. It’s a poignant, moving tale to read about these families’ distress and attempts at getting to the “right” diagnosis and treatment for their child, and the trauma involved in living with these children:

But even with Risperdal and a shadow, James struggled in his second year of pre-K; with his anger under control, his attention problems became more visible. “He could not stay on tasks,” Mary said. “He couldn’t stick with anything. He’d go to the drawing table and make one scribble. . . . He was hopping around.” James’s condition was diagnosed as Attention Deficit Hyperactivity Disorder, a problem that is said to afflict between 3 and 7 percent of American schoolchildren. Normally A.D.H.D. is treated with stimulants like Ritalin, which can temporarily improve focus, but the two stimulants his doctor tried made James nasty and angrier, and he couldn’t stay on them. In first grade he moved to a school for children with special learning needs, but by second grade he was having trouble even there. “He would cry every morning, and cry and cry and cry,” Mary said. “I now realize that that was depression.”

Home life was almost unbearable. “I couldn’t bring them to a playground together, because if he got behind Claire on the slide, he would push her down. If she walked by, he put out his leg to trip her. If they were watching TV and he became overstimulated, he would kick and punch her. . . . There’s never been a dinner hour; he’d push her plate. He didn’t like the way she was chewing. He’d rage. We never had any family meals. No family trips. Ever.”

The challenge remains however, as Egan points out in her article, in developing well-defined diagnostic criteria that differ more significantly from the diagnostic criteria for other common childhood ailments, such as ADHD. There is still way too much overlap, making accurate diagnosis of childhood bipolar disorder (also known as manic depression) very challenging. And because it’s not yet an accepted diagnosis in the official diagnostic handbook, even payment for treatment of it remains an issue.

I have my doubts as to whether or not childhood bipolar disorder will also make it into the next version of the DSM. While childhood versions of adult disorders enjoy a lower threshold in inclusion in the diagnostic handbook (ostensibly because they’ve already been “proven” to exist in adults), the current version makes no mention of such a disorder. While not unheard of, it’s rare for a disorder to go from “unknown” to full inclusion in a single revision of the book.

Read the full New York Times Magazine article: The Bipolar Puzzle – What Does it Mean to be a Manic-Depressive Child?

Also last week, in a timely coincidence, Philip over at Furious Seasons received an answer from the U.S. Food and Drug Administration about their acceptance of the childhood bipolar disorder diagnosis.