Mood Swings

A psychiatrist surveys the mind and the wider world

Your Child Is Not Bipolar, But Your Adolescent Is

Puberty seems to be the magical secret to denying childhood bipolar disorder

I have now had a number of discussions on this website with colleagues who are adamantly opposed to the possibility, even in a single human being on the planet earth, of childhood bipolar disorder. Readers can follow that discussion on the various posts.

I've come to the conclusion that two justifications seem to exist for this anti-childhood bipolar ideology: 1. The first, which applies mostly to colleagues from the humanities, involves a belief in postmodernism - the view that knowledge is about power, and psychiatric knowledge in particular is not about truth or reality, but about interest groups vying for power.  This is, at root, not a scientific critique, but a political and cultural one. In my forthcoming book, "On Depression", I address that critique in detail, and I have done so on other posts too.

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2.  The second, which is the focus of this post, has to do with colleagues who are child psychiatrists and who are quite willing to give drugs to children, especially amphetamines, and to make psychiatric diagnoses in children, especially ADHD, they just don't want to diagnose bipolar disorder in children.  In some discussion in particular with my colleague Dr Stuart Kaplan, it has become clear that he has to admit that bipolar disorder occurrs in adolescents, but denies it in preadolescent children, meaning before age 13.

Since my colleague has written a book and has title his blog, Your child is not bipolar, I suggest a revision to the title of this blog post. I make that suggestion since most non-physicians define adolescence as part of childhood, and that childhood lasts until the legal definition of adulthood at age 18.  Thus, to be clear, it would be more honest to say that your adolescent may well have bipolar disorder, but these colleagues deny that your preadolescent child can have bipolar disorder.

As shown in our previous post of the National Comorbidity Survey epidemiology study of adolescence, the prevalance of bipolar disorder at age 13 was found to be 1.9%.  My colleague says that bipolar disorder does not occur before that age at all. Zero.  And then, suddenly, it rises to 1.9%.  When I wondered how that change suddenly happens, the response was - puberty.  

So now I think we have more clarity on the attitudes of anti-bipolar child psychiatrists:  They think that puberty causes mania. 

That's an interesting claim: So we go from 0.0% of childhood bipolar disorder at age 12 to suddenly 1.9% at age 13? And it's because of puberty?  Well puberty happens in some children at 12 or even a bit earlier.  So is it really the case that zero children before age 13 can have bipolar disorder, even if we allow for puberty as a cause?

And is puberty the sole cause? Certainly puberty can be contributing factor to increasing one's likelihood of getting manic, presuming that one has an underlying biological susceptibility to mania (meaning, one has bipolar illness).  But my colleague is claiming something stronger: without puberty, no one can ever experience mania. If you don't have puberty, you won't get manic.

Now that's a strong claim that is not supported by biological research of any kind; perhaps my colleague can provide that evidence. 

Instead, there are numerous studies (reviewed here) that show that children below the age of 12 demonstrate full-blown mania, as defined in adults.  The frequency of that mania can range up to 4% of children in a psychiatric clinic setting.  These studies include many done outside of the US - in countries like Spain and India - contrary to the Australian belief that only American citizens ever claim to have childhood bipolar disorder.   Since Navarra Spain is not a town in Kansas, I would say the Australian critics of childhood bipolar disorder need some geography lessons. 

Puberty as risk factor; yes. Puberty as sole cause; no.  The science doesnt support that claim.

So let's recap and revise: Even the strongest critics can't deny that your adolescent child could have bipolar disorder.  And the science of the biology and clinical expression of mania won't allow those critics to succeed in denying the occurrence of bipolar disorder in children at that verboten age of 12 or lower.

 

Nassir Ghaemi, M.D., M.P.H.,

is Professor of Psychiatry at Tufts University School of Medicine, and Director of the Mood Disorders Program at Tufts Medical Center in Boston. more...

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