By: Farida Raj
“My son needs help. He has bipolar disorder. Bipolar! How can a seven year old child have bipolar?”
I, a Remedial Educator, was sitting with a parent who had recently relocated from Canada to Hyderabad, India. A pediatric psychiatrist had diagnosed her son as having bipolar. She was advised that her son needed remedial teaching to enhance classroom learning.
“7 year old Kartik is constantly seeking excitement. He is often hyperactive to the extent of being hysterical. He is always looking for opportunities to provoke excitement. In class, he blurts out answers before the teacher finishes the question. Neither does he learn nor let his classmates learn. But on some days, Kartik looks sad. He comes into class without a word. He sits on his own and does not even speak with other students. He never offers any answers and he sometimes seems unable to respond when the teacher asks a direct question. He seems oblivious to his surroundings.”
It was his unpredictable day-to-day behavior that led the school to ask his parents to seek professional help.
Bipolar disorder is a serious mental illness. It is a mood disorder marked by extreme changes in moods and activity levels, as well as unusual sleep habits, thoughts, or behaviors. In a child, these moods and activity changes must be very different from his usual behavior and from the behavior of other children of the same age. “Bipolar disorder in children is now referred to as disruptive mood dysregulation disorder (DMDD)” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)(Medscape). Children with this disorder usually alternate between extremely high moods (mania) and low moods (depression). Dr. Aftab, psychiatrist with Global Hospital Hyderabad, says diagnosing bipolar disorder in young children is difficult, because many of the symptoms are similar to those of Attention Deficit Hyperactivity Disorder (ADHD) or behavior issues or even just normal childhood behavior. Children who exhibit these symptoms of bipolar disorder need to be met with an experienced mental health professional who specializes in treating children and has a well-informed grasp on the subject. One notable difference with bipolar disorder in children: while manic and depressive periods may be separated by weeks, months, or years in adults, they can happen within a single day in children.
Dr. Omsai Ramesh, associate professor of psychiatry at the Lady Harding Medical College Delhi, says that bipolar disorder is often diagnosed in older children and teenagers, but rarely at or before 7 years of age. In recent years, it has become a controversial diagnosis. Some experts believe that bipolar disorder in children is rare and being over diagnosed, while others think the opposite. Therefore, it is important not to jump to conclusions. A second opinion should be considered.
Many children and especially adolescents experience mood swings as normal part of growing up, but when these moods are extreme, they make it hard for a child to do well in school or get along well with friends and family members. When such feelings begin to interfere with a child’s ability to function in daily life, bipolar disorder could be the cause.
Bipolar disorder is treatable. Early identification, diagnosis and treatment will help children reach their full potential. Treatment includes both medication and therapy. Sometimes, young children are medicated to help them overcome the negative effects of bipolar disorder. Different types of therapy or “talk” therapy can help children change their behavior and manage their routines. Sometimes, therapy includes family members too. A big challenge facing those affected by this disorder is low self-esteem. The gaps between demands and capacities can leave them open to criticism and ridicule. Parents and teachers have a tremendous role to play by helping children to feel good about themselves, being patient, understanding mood swings, identifying strengths, and instilling a powerful sense of optimism about their future.