Childhood bipolar disorder

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Childhood bipolar disorder

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Bipolar disorder was observed really in the 1880s as a clinical phenomenon. And I was taught when I was trained in the 1980s and 90s that bipolar disorder only existed in adults. Researchers looked at a population of kids with Attention Deficit Disorder and evaluated some of the most extreme kids in terms of the emotional disregulation and their mood disregulation and just said the simple statement, "if you applied adult bipolar disorder to these kids, they would actually meet it." This ignited a controversy in the field. And what's important to know about it is we don't understand the underlying biological mechanism for adults or for children. So the worry that the controversy has generated is, well if there is bipolar disorder in childhood or in adolescence (and I think there is) we have a trouble as a field identifying the edge of it. Very important to be able to tell a person that you don't have diabetes. And in a developing child, you don't know what behavior is going to show up over time. So it's easy to overdiagnose, I would say, a condition like bipolar disorder. But I think the idea that teenagers can have bipolar disorder, that children can evidence some of these same kind of behaviors is progress for the field, because a generation before me was taught that children couldn't have depression, and we know that there are kids in junior high school that are trying to kill themselves as a result of untreated depression. So I would say the field has to approach the problem of untreated child and adolescent bipolar disorder with a fair bit of humility. And I tell parents we're on the edge of a field that we don't know much that about. I let them know that most of the treatments and medications are off-label. There's no FDA approval. So I try to help them think about all the other ways they can help their child regulate their mood, their school environment. I help them with their parenting to look at all the ways to evaluate this problem without getting into this even more controversial area, at least with this first step.

View Kenneth Duckworth, MD's video on Childhood bipolar disorder...

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Kenneth Duckworth, MD

Psychiatrist, Harvard Professor & Medical Director for NAMI

Ken Duckworth, MD, serves as the medical director for NAMI, the National Alliance on Mental Illness. He is triple board certified by the American Board of Psychiatry and Neurology in Adult, Child and Adolescent, and Forensic Psychiatry and has extensive experience in the public health arena.

Dr. Duckworth is currently an Assistant Clinical Professor at Harvard University Medical School, and has served as a board member of the American Association of Community Psychiatrists. Dr. Duckworth has held clinical and leadership positions in community mental health, school psychiatry and now also works as Associate Medical Director for Behavioral Health at Blue Cross and Blue Shield of Massachusetts.

Prior to joining NAMI in 2003, Dr. Duckworth served as Acting Commissioner of Mental Health and the Medical Director for Department of Mental Health of Massachusetts, as a psychiatrist on a Program of Assertive Community Treatment (PACT) team, and Medical Director of the Massachusetts Mental Health Center.

Dr. Duckworth attended the University of Michigan where he graduated with honors and Temple University School of Medicine where he was named to the medical honor society, AOA. While at Temple, he won awards for his work in psychiatry and neurology. He also has a family member living with mental illness.

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Transcription: 
Bipolar disorder was observed really in the 1880s as a clinical phenomenon. And I was taught when I was trained in the 1980s and 90s that bipolar disorder only existed in adults. Researchers looked at a population of kids with Attention Deficit Disorder and evaluated some of the most extreme kids in terms of the emotional disregulation and their mood disregulation and just said the simple statement, "if you applied adult bipolar disorder to these kids, they would actually meet it." This ignited a controversy in the field. And what's important to know about it is we don't understand the underlying biological mechanism for adults or for children. So the worry that the controversy has generated is, well if there is bipolar disorder in childhood or in adolescence (and I think there is) we have a trouble as a field identifying the edge of it. Very important to be able to tell a person that you don't have diabetes. And in a developing child, you don't know what behavior is going to show up over time. So it's easy to overdiagnose, I would say, a condition like bipolar disorder. But I think the idea that teenagers can have bipolar disorder, that children can evidence some of these same kind of behaviors is progress for the field, because a generation before me was taught that children couldn't have depression, and we know that there are kids in junior high school that are trying to kill themselves as a result of untreated depression. So I would say the field has to approach the problem of untreated child and adolescent bipolar disorder with a fair bit of humility. And I tell parents we're on the edge of a field that we don't know much that about. I let them know that most of the treatments and medications are off-label. There's no FDA approval. So I try to help them think about all the other ways they can help their child regulate their mood, their school environment. I help them with their parenting to look at all the ways to evaluate this problem without getting into this even more controversial area, at least with this first step.