Bipolar children: fact or fad?

New UNC center delves into sharp upswing in diagnoses among youth

Judi Sharp's son used to get so depressed he refused to come out of his room. The next moment he would be giggling uncontrollably. Sometimes, he became so irritable other children didn't want to be around him.

Sharp, who lives in Mebane and asked that her son not be identified by name, chalked it up to the attention deficit hyperactivity disorder her son was diagnosed with at age 3.

But when Sharp's son had a violent outburst last Thanksgiving, a psychiatrist diagnosed bipolar disorder and put the young teenager on mood stabilizers. Sharp says the drugs have helped tremendously.

"He's back to being my sweet boy, like he was when he was little," she said.

Twenty years ago, bipolar disorder was considered a disease of adults and a rare one at that. Now psychiatrists are increasingly willing to make the diagnosis -- and at younger and younger ages. A study published this month in the journal Archives of General Psychiatry noted a 40-fold increase of bipolar diagnoses in youths up to age 19 since 1994.

That has led some to question whether the brain disorder is over-diagnosed and over-treated, turning the normal behavior of children and adolescents into a disease. Many symptoms of bipolar disorder, such as fanciful thinking or impulsiveness, can look like age-appropriate behavior in children.

"How many adolescents have mood swings? How many have severe mood swings? A lot," said Paul Brinich, a Chapel Hill child psychologist.

Brinich said he thinks bipolar disorder has become the latest fad diagnosis for children with behavioral problems. He is particularly concerned about the drugs that almost always accompany such a diagnosis. Many of the newer medicines used to treat bipolar disorder such as Risperdal have worrisome side effects in children, such as rapid weight gain, which might put them at risk for diabetes and other health problems.

Early treatment

At the same time, however, psychiatrists see hope that people with a major mental illness are finally getting help, and getting it earlier.

The increasing attention to the disorder has prompted UNC Hospitals in Chapel Hill to establish a center that will study and treat both adults and children. Dr. Jair Soares, its director, became interested in bipolar disorder more than a decade ago while training at a University of Pittsburgh bipolar program. He feels certain that heightened awareness is helping more children get treatment sooner.

"That's a wonderful thing," Soares said, noting that people with bipolar disorder are at increased risk of disability, hospitalization and suicide. "Treatment at the right time can be lifesaving."

Early treatment might lessen the severity of a child's illness over time, Soares said. If bipolar episodes play out unchecked in a child's still-developing brain, the brain wires itself to become more prone to episodes. Soares said proper treatment can break that cycle, protecting the brain.

An abrupt rise

Diagnoses of bipolar disorder among adults nearly doubled between 1994 and 2003, the recent study found. The illness is now seen in 1,679 of every 100,000 adults.

But for children, diagnoses have skyrocketed. In 1994, the disorder was found in 25 of every 100,000 youths under 20. By 2003, it was diagnosed in 1,003 of every 100,000 youths. Experts say it has probably increased since then.

The spike might have come from research showing that most adult bipolar patients had symptoms of the illness by their teen years, if not earlier. Psychiatrists and others treating children's behavioral disorders began to look for the illness.