Bipolar Disorder In Children Appears More Severe Than In Most Adults

The findings were presented today at the Fourth International Conference on Bipolar Disorder. The conference, held in Pittsburgh every other year, is the only venue in the world devoted exclusively to highlighting new research into bipolar disorder.

“Typically adults with bipolar disorder have episodes of either mania or depression that last a few months and have relatively normal functioning between episodes,” said Barbara Geller, M.D., the study’s principal investigator. “But in manic children we have found a more severe, chronic course of illness. Many children will be both manic and depressed at the same time, will often stay ill for years without intervening well periods and will frequently have multiple daily cycles of highs and lows. These findings are counterintuitive to the common notion that children would be less ill than their adult counterparts.”

Geller and colleagues are studying 93 children with bipolar disorder and comparing them to 81 children who have attention deficit hyperactivity disorder (ADHD) and another 94 healthy children from the community. “In particular, we want to distinguish between children with bipolar disorder and ADHD because many parents, teachers and health care providers might confuse the overlapping symptoms of the two problems and think that these are just hyperactive kids,” said Geller, who is a professor of child psychiatry at Washington University School of Medicine in St. Louis.

The confusion arises because both mania and ADHD have hyperactivity, irritability and distractibility as symptoms But only bipolar disorder includes elated mood, such as giggling inappropriately at getting failing grades; grandiosity, such as telling the teacher what to teach in the classroom; flight of ideas, that is jumping illogically from topic to topic; racing thoughts, such as feeling like an “energizer bunny” is controlling their thoughts; and a decreased need for sleep. In fact, some children may stay up rearranging furniture most of the night.

This work was developed to diagnose bipolar disorder in children as young as 7 or 8 years old, something that was rarely attempted previously. Whereas physicians and relatives might suspect bipolar disorder in an adult with behavioral problems such as “maxing out” credit cards, getting married four or more times, or continually starting new, unrealistic business ventures; Geller's group needed to establish how these behaviors would appear in children.

“A bipolar adult with symptoms of grandiosity might call the President or the Governor to tell him how to run things,” Geller said. “In this study, we have investigated children who have repeatedly called the principal or other officials at school to tell them to fire a teacher or do something else to make the school run more effectively in the eyes of that child.” These children were not just playing teacher after school but were acting as if they were in charge of the principal's office.

The average age of the bipolar children involved in this study was just over 10. More than half had not yet reached puberty and 43 percent were between the ages of 7 and 10 years old. Almost a quarter of the bipolar study participants were seriously suicidal.

Geller’s group has now validated the mania diagnosis in these young children by showing that the symptoms are stable at follow-up over a one-year period. This helps dispel the notion that manic children were just children with ADHD who were having a bad day.

The study participants were evaluated diagnostically in the research unit, but were treated by their own practitioners in the community. Only about 50 percent of the bipolar children in the study were receiving medications that are prescribed to control mood swings in bipolar adults — drugs such as lithium, neuroleptics or anticonvulsants.

Geller believes this low use of anti-manic medications may be because gatekeeper physicians are not yet aware that children can have manic -depressive illness. Only about one-third of these children had recovered from their mania at the end of one year. Geller plans to continue following these children over time to see if their chronic, rapid cycling illness continues or if they will develop the episodic pattern with relatively well periods that is seen most commonly in adults. Her group also is conducting molecular genetic and neuroimaging studies to learn whether the genetic factors involved in the disorder are similar for children and adults and whether the brains of children with bipolar disorder differ from the brains of normal children.

This research was supported by grants from the National Institutes of Health.

The full-time and volunteer faculty of Washington University School of Medicine are the physicians and surgeons of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.