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Childhood-Onset Bipolar Disorder

All those with bipolar disorder experience mood swings that alternate from periods of severe highs (Mania) to severe lows (depression). However, while these abnormally intense moods usually last for weeks or months in adults with the illness, children with bipolar disorder can experience such rapid mood swings that they commonly cycle many times within a day. The most typical pattern of cycling among those with COBPD, called ultra-ultra-rapid or ultradian, is most often associated with low arousal states in the mornings followed by increases in energy towards late afternoon or evening. It is not uncommon for the initial episode of COBPD to present itself as major depression. But as clinical investigators have followed the course of the disorder in children, they have observed a significant rate of transition from depression into bipolar mood states.

One of the most important factors in establishing the diagnosis is family history. According to several recent studies, a history of mood disorders (particularly bipolar disorder) and/or alcoholism on both the maternal and paternal sides of a family appears to be commonly associated with COBPD.

An estimated 50% to 80% of those with COBPD have attention–deficit hyperactivity disorder (ADHD) as a co-occurring diagnosis. Since stimulant medications often prescribed for ADHD (Dexedrine, Adderall, Ritalin, Cylert) have been known to escalate the mood and behavioral fluctuations in those with COBPD, it is important to address the bipolar disorder before the attention-deficit disorder in such cases.

Some clinicians suggest that the prescription of a stimulant for a child genetically predisposed to develop bipolar disorder may induce an earlier onset or negatively influence the cycling pattern of the illness.

How does the illness affect school performance and social relationships?

Deficits in shifting and sustaining attention, as well as difficulties inhibiting motor activity once initiated, can strongly influence both classroom behavior and the establishment of stable peer relationships. Distractability, daydreaming, impulsiveness, mischievous bursts of energy that are difficult for the child to control, and sudden intrusions and interruptions in the classroom are also common features of the COBPD.

Stubborn, oppositional, and bossy behavior, usually appearing between the ages of six to eight, poses significant problems. Risk-taking, disobedience to authority figures, and the likelihood of becoming addicted to psychoactive drugs such as marijuana and cocaine also present serious concerns. A high percentage of children with COBPD have co-occurring learning disabilities.

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