Most first time parents probably wonder what typical or normal behavior is for their child. And since typical and normal has such a wide range of expression, that answer is hard to come by no matter how many books you read or how many professionals you consult. It is difficult for a book or professional to pinpoint the difference between energetic or hyperactive; sensitive or distressed; quiet and unassuming or depressed.
Many times, it isn’t until a child is in preschool or kindergarten that a question about a disorder gets raised. After all, especially when the child is your first one, distinguishing between normal behavior or not can be tough. And so often, when you hear the dreaded words “We need to discuss your child” it can be in the form of behavior problems.
Mood disorders are generally accepted to be depression or bipolar disorder and these are still considered to be adult illnesses. Some researchers believe that childhood mood disorders are one of the most underdiagnosed group of psychiatric illnesses. And yet it is important to accurately diagnose these illnesses because about 2000 teenagers commit suicide per year in the United States alone.
One reason that mood disorders in childhood go undiagnosed is because these disorders look different in children than they do in adults. Another reason is that children are not always able to articulate how they feel, especially when a mood disorder is in the way.
Mood disorders may also mimic or overlap with other issues more commonly associated with children such as ADHD or attention deficit hyperactivity disorder; conduct disorder which usually includes violent behavior; or even schizophrenia in adolescents. In fact, mood disorders in children were not even included in diagnosed psychiatric illnesses until the 1980’s.
However, there is emerging evidence that major depression can develop in children. Children of depressed parents experience onset of major depression rather earlier than children of non-depressed parents, with the average age being 12 versus 16 years of age.
In children of preschool age, depression may express itself in somber, almost sick appearance; tearful or irritable frequently, not just when they don’t get their way; being self-destructive; or making frequent negative statements about themselves. In the elementary or teenage child, depressive behavior includes poor school performance; disruptive behavior; being difficult to please; and increased irritability with aggression.
Bipolar disorder has been notoriously difficult to diagnose in children. That is mostly because the way the disease manifests itself in childhood is very different from the way it is expressed in adults. Manic children do not typically experience the euphoria that adult bipolar patients do. The most common mood manifestation in a bipolar child or adolescent is typically irritability, excessive crying, and motor agitation. Childhood onset bipolar disorder also seems to be more continuous and chronic, as opposed to the episodic highs and lows characteristic of an adult bipolar patient.
While there is some overlap with ADHD and bipolar disorder symptoms in children such as hyperactivity, inattention and impulsivity, bipolar disorder includes such symptoms as psychosis, aggression, lack of appropriate feelings for others, and depression.
Conduct disorder and bipolar disorder may appear to overlap in the older child in such things as trouble at school, breaking the law, or substance abuse. But bipolar disorder may include antisocial behavior and lack of peer influence.
Schizophrenia and bipolar disorder in the adolescent both include paranoid delusions and some grandiosity. But schizophrenia is going to have further symptoms of thought disorder and more bizarre delusions. Psychotic features are a documented part of adolescent bipolar disorder, but this mood disorder is commonly misdiagnosed in the teenage years as schizophrenia.
Treatment for these disorders during childhood is very important. Early onset of depression, for instance, places the child at a much greater risk for depressed episodes throughout his or her lifetime. Children typically respond well to treatment because the they are more adaptable and the symptoms are not totally entrenched. Treatment for children with mood disorders may include medication for major depression or mania; psychotherapy to help children recognize, cope with, and put words to their feelings; educational therapy is important to help the struggling child with learning; and family therapy may be indicated to improve interactions between family members, particularly other siblings.
So what should you do if you suspect one of your children is not just temperamental but has a mood disorder? Experts suggest keeping a behavior chart for two or three months to keep track of when and how often the child exhibits the troublesome behaviors. Your child’s pediatrician is a good starting point for feedback, referrals, and initial evaluation. But if you suspect your child has a mood disorder, the diagnosis should only come from a child psychologist. Look for a professional who has experience in play therapy, is trained in speaking with children, and who will treat the family as an integral part of the child’s life.
None of us like to think of our children having problems. But catching and treating the problem of mood disorders quickly can be the key to a successful life.
