Mental Health Awareness Month: Is It Normal Childhood Behavior or Is It Bipolar Disorder?
In acknowledgement of Children’s Mental Health Awareness Week, part of Mental Health Awareness Month...
You may have noticed that kids behave somewhat differently than grown-ups. I got an insight into this two years ago at the International Congress on Schizophrenia Research when I heard a panel of brain scientists describe what is supposed to be happening when a young brain transforms into a mature one:
To start, during adolescence, certain dopamine cortical microcircuits that mediate the balance between excitation and inhibition experience dramatic connecting changes. Also during adolescence, “synaptic pruning” occurs in the neuron's "dendritic spines," which play a major role in brain cells talking to one another.
Another crucial thing that goes on during adolescence is “axonal myelination.” This is the "white matter" that, among other things, regulates communication between the thinking and emotional parts of the brain.
As Beatrix Luna of the University of Pittsburgh explained to me over breakfast at the conference, adolescence is when the brain changes gears. In essence, brain function becomes more equally distributed, with less reliance on impulses from the basal ganglia and other more primitive regions of the brain. But what if something goes wrong in the transition?
Another way of stating this is that the kind of emotionally impulsive behavior that adults would not be able to get away with is perfectly normal in kids.
So, when a kid is driving his parents crazy, is this bipolar - or is it perfectly normal? This is the question Katie Couric on 60 Minutes three years ago put to the mother of four-year-old Rebecca Riley, who had died from a meds overdose.
"Did you ever think," asked Ms Couric with a derisive smirk, "well, she's two and a half years old. There's this thing called the terrible two’s. Did you think this could, in fact, be normal?"
This would have been a perfectly legitimate question had not 60 Minutes labored so hard to discredit the child bipolar diagnosis. So let’s take a look at the type of behavior that parents typically describe to incredulous listeners. This from “The Bipolar Child,” by Papolos and Papolos:
One day, after [mother] Melissa refused to buy him candy, Eric [kindergarten age] ran out of the grocery store and attempted to run across the street. A few times he attacked her - hitting, kicking, and biting. Once, when sent to his room for a time-out, he opened the second-story window, knocked out the screen, and threatened to jump. Later he told his mother he thought he could fly.
Hmm. Definitely not normal. But is it bipolar?
Back in the 1990s, Joseph Biederman of Harvard identified a population of kids coming through his clinic whose behavior could not be explained simply by ADHD or other disorders. The best way to describe their behavior was that it bore a semblance to the type of bipolar symptoms seen in adults.
Nonsense, said the skeptics. A lot of their disbelief centered around the notion that bipolar typically makes its appearance in late adolescence and early adulthood, right around the time the brain is developmentally supposed to be changing gears. Identifying a younger population with the illness, in essence, was a crime against the calendar, both Julian and Gregorian.
Nevertheless, over the years, researchers at other centers corroborated Dr Biederman’s observations. The diagnostic fine points are still very much in dispute, but these are more in the nature of academic food fights rather than substantive differences of opinion.
Many parents report the joy of finally getting to know their children once a correct diagnosis is made, with the right treatment. But meds are still highly problematic with kids, particularly in side effect profiles. Some clinicians are focusing on managing the child’s sleep (there is strong evidence of “phase delay” and other sleep problems with these kids) on the basis that other symptoms will diminish. There is also a heavy emphasis on working with teachers and counselors to help these kids face the challenges of the day.
Misdiagnosis may occur, but this happens in the realm of highly distressed children requiring clinical attention. There is no validity to the hysterical assertion that perfectly normal kids are being victimized by the psychiatric-Pharma establishment.
Yes, kids of all ages will always drive their parents crazy. But virtually all parents are able to distinguish normal kid behavior from not normal. We’re still working on separating out different types of “not normal,” but it is clear that bipolar is part of that picture.
And that these kids deserve a decent shot of turning into normal children who drive their parents crazy.