Question: How might symptoms of bipolar disorder differ in children compared to adults?
Answer: This is an excellent question, and a source of a lot of current controversy. Basically, the way we diagnose bipolar disorder today is based on symptoms and that's the way we have it. There's no blood test, there's no brain imaging test that will tell you whether or not you have bipolar disorder. So we're left with symptoms. And the symptoms were originally designed, or at least clarified in adults with bipolar disorder.
So now that we're trying to diagnose children, it's a little bit more difficult because we have to take these adult symptoms and apply them to children who are in a greatly different developmental stage than adults are. And so for example, what is grandiosity in a -- which is a manic symptom -- in an adult, can look very different for a child. Now the same thing goes for other kinds of symptoms, like for example a decreased need for sleep. Many children with bipolar disorder don't yet have sleepless nights. And many people think that's because this is something that's highly conserved until they get older -- in other words, sleep is very important for you while you are young. But adults who have mania very often have only two or three hours of sleep during those days that they are having their manic episode. So those are some of the developmental differences that we see.
One of the biggest differences that we see between the groups are the duration of their symptoms. In other words, adults tend to have more of an episodic duration. You can see one week of mania, you can see two weeks of mania. It's a little clearer defined. Not always, but usually. However, as you get younger and younger, you start to lose those distinctions around the edges, and it's harder to discern discrete episodes. In other words, very often a child is rapidly moving from one mood to another, and so it's difficult to tell exactly when the mania starts and when the mania ends.
And that's probably the biggest controversy right now in diagnosing this in children because many people say, 'well if you don't know when an episode begins and ends, how can you tell it's a true manic episode?' And the answer to that is: it's very tricky, and that's why you need to have a very experienced clinician make the diagnosis.