The idea that bipolar disorder in young children is rare is increasingly being challenged, according to Arman Danielyan and colleagues in 2007 in the “Journal of Affective Disorders.” In fact, one estimate cites that 70 percent of cases of bipolar disorder onset at age 5 or younger, the researchers note.
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The current diagnostic model requires that there is a distinct period of abnormally and persistently elevated, expansive or irritable mood with a duration of four days for a hypomanic episode, as discussed by Danielyan and colleagues. The requirement that episodes of mania must be distinct presents a challenge when diagnosing young children because they tend to cycle through mania rapidly.
Young children tend to have a more severe and developmentally complicated subtype of bipolar disorder where there tends to be a poorer course and fewer remissions, according to Danielyan and colleagues. In children as young as 5, bipolar disorder frequently manifests as daily mood swings, short episodes of intense mood, hostile and aggressive behaviors, and chronic irritability, the researchers note.
Since bipolar disorder in young children transitions rapidly, symptoms tend to overlap that of other disorders. Therefore, a child cycling rapidly through the phases of bipolar disorder may mistakenly be thought to have other disorders or a combination of other conditions. In fact, bipolar disorder is often misdiagnosed as ADHD, major depressive disorder, conduct disorder and other psychiatric conditions, the researchers note. This is problematic because treatment delays are linked to poorer outcomes with the disorder in adulthood, as found in a study conducted by Robert Post and colleagues published in the July 2010 issue of the “Journal of Clinical Psychiatry.”
Since bipolar disorder is a complicated disorder in young children, it is difficult to label appropriate behavioral outcomes. The estimates for early onset bipolar disorder may be lower than the actual prevalence rate. For one, there is a scarcity of data regarding diagnostic criteria for children diagnosed with bipolar disorder prior to age 7, note Danielyan and colleagues.
Bipolar disorder is caused in part by genetic factors that predispose children to having the disorder. In stressful situations, those prone to developing the disorder are likely triggered by stressful events in the environment. Over time, the disorder maintains itself and environmental stressors are no longer required to trigger episodes, according to Bryan Kolb and Ian Whishaw in the 2003 book “The Fundamentals of Human Neurospychology.”