Why are so many children being diagnosed Bipolar?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Person with masks

Bipolar.
Photo courtesy of Pixabay.com

Early Onset Bipolar Disorder.

Bipolar diagnoses in children have increased 40 fold in the ten-year period from 2000 to 2010.

What is behind the increasing number of children and teens who are being diagnosed with Bipolar Disorder?

We are learning more about the risk factors for early onset all the time. Still, as we learn about what may be causing this increase in the number of cases of early onset Bipolar Disorder, the picture of how to treat or prevent early life Bipolar Disorder is getting less clear.

If we could detect symptoms of Bipolar Disorder early, presumably we should be able to treat those symptoms and reduce the incidence of Bipolar Disorder or at least reduce the severity of the disorder.

Unfortunately, there is often a lag of ten years or more from the first symptoms until the child has a manic or hypomanic episode that qualifies them for a diagnosis of Bipolar.

I have written in past blog posts about how many of the things that cause people to think of someone as Bipolar are in fact not necessarily symptoms of the disorder. Being moody does not make you Bipolar.

What does help define the Bipolar condition is the ability to sleep only a few or no hours per night and still have plenty of energy. That along with excessive energy, being driven to do things and being impulsive are the hallmark features of Bipolar Disorder.

Here are some of the possible causes for the increasing number of Bipolar diagnoses in children.

1. Taking Stimulant ADHD meds or antidepressants can set off a manic or hypomanic episode.

One huge risk factor for developing a Manic or hypomanic episode, the key factor in a Bipolar Disorder diagnosis is having taken either a stimulant or antidepressant medication.

Having been treated with a stimulant ADHD med seems to correlate with developing mania. Not all children treated for ADHD develop Bipolar and not all people with a Bipolar Disorder diagnosis were first diagnosed with ADHD but the overlap is disturbing.

In one study of adolescents with Bipolar Disorder, 98% had been diagnosed with ADHD and treated with stimulant meds first.

This points to the need for psychiatric diagnosis to be reviewed by psychiatrists and in children by a child psychiatrist.

2. Abusing substances increases the risk of developing Bipolar disorder.

Over 40 % of children who receive the Bipolar Disorder diagnosis have been abusing substances. In their lifetime, 60% of all people with Bipolar Disorder will develop a substance use disorder.

This is not limited to just stimulant drugs. There is a high overlap between Bipolar Disorder and alcohol abuse as well as developing problems with excessive use of Marijuana.

3. Being the victim of physical or sexual abuse or neglect.

Abuse or neglect increases the risk of developing Bipolar disorder. This also accounts for the difficulty in many cases of distinguishing between Bipolar disorder and Borderline Personality Disorder. It is possible for people to have both illnesses.

There is also an overlap between trauma induced problems, stress disorders like PTSD, dissociation and the like and Bipolar Disorder. We would like to think the boundaries between genetic disorders and those that are the result of life experiences were easy to find. In practice those lines are blurry.

4. Poor diet and lack of exercise are risk factors for Bipolar Disorder.

Poor diet, particularly diets deficient in some vitamins and minerals can increase the risk of getting a Bipolar diagnosis. Hard here to tell which came first. People with depression or mania, both symptoms of Bipolar Disorder neglect their diet. Poor diet increases the risk and around the circle goes.

Lack of adequate exercise has resulted in an explosion in weight-related problems. There is the thought that this lack of exercise and poor diet is also contributing to the increased prevalence of Bipolar Disorder.

5. Genetics is a Bipolar Disorder risk factor.

If you have one parent with Bipolar Disorder the risk you will develop Bipolar Disorder is 33%. Two parents with Bipolar Disorder and the risk goes up to 70%.  Add to that the difficulty that parents who have an emotional problem have in parenting and you can see how the interplay of genetics and environment increase the risk dramatically of your grow up with a Bipolar, substance abusing parent.

6.  A changing environment may make Bipolar Disorder more noticeable.

Some of the characteristics that we today call Bipolar Disorder would have had survival benefits in the past. Fast processing speed and jumping to conclusions might save your life in the woods but can get you into trouble in the classroom.

People with milder varieties of bipolar disorder enjoy the hypomania – for a while. Even full-on Mania can be fun until those impulsive decisions get you into trouble. Bipolar Disorders are often associated with overspending, excessive sexual activity, and substance abuse. All things that damage relationships and can cost you your job.

The increase in children receiving the diagnosis of Bipolar disorder will continue to result in more adults with those labels as these early life cases age. If your child is having problems consider family therapy to help everyone find simple solutions to these problems.

If you or someone you know has Bipolar Disorder or another emotional problem that might look like Bipolar Disorder consider getting help. Therapy can be effective in helping you to learn how to control your symptoms. Medication can also be useful in keeping your moods within bounds.

People can and do recover from the symptoms we call Bipolar Disorder.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

 

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ADHD epidemic rages out of control – News Update

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

ADHD?
Photo courtesy of Pixabay.com

Almost all U. S. children infected with Attention Deficit Hyperactivity Disorder.

In my morning news was the startling report that Attention Deficit Hyperactivity Disorder is spreading among America’s children (AHRQ, September 2012.) It now appears likely that all U. S. Children will not be able to pay attention sufficiently to grow into mature adults.

In a short ten-year period (2000 to 2010) the number of ADHD-related visits to doctors’ offices increased by a whopping 68%. During the much longer decade of the 1960’s, most doctors office visits centered on getting children off drugs.

If I read those news statistics right, in just four of those recent years (2003-2007) 5.4 million children caught a case of ADHD.

So far this epidemic has been confined to the United States. The United Kingdom and northern Europe have not yet seen a flood of ADHD cases, but given the prevalence of internet viruses, the impact of this epidemic may soon be felt worldwide.

This problem has become so severe that two and three-year-old’s are now being brought in for diagnosis and medication to improve their attention. The fear has become that some children may forget how to grow older if they do not get medications.

The magnitude of this crisis has required that an army of child psychiatrist be redeployed from less serious issues like schizophrenia and suicidal depression to facing the onslaught of pediatric ADHD.

The news release on this topic reports that the huge increase in public education of ADHD may have led parents, children and providers to identify conditions that previously would have been dismissed as behavioral and conduct disorders to now be attributed to ADHD.

Over this time period while we have been spending an increasing share of our resources on fighting a war on stimulant abuse in adults, from 87% to 98% children identified with ADHD have been prescribed amphetamine-like stimulant ADHD medication. If amphetamines have been so effective in improving attention and behavior in children it is hard to understand why the widespread use of Methamphetamines has not eliminated the occurrence of adult crime.

In fairness to the manufacturers of stimulant ADHD medications, the evidence does not indicate that childhood use of stimulant ADHD medications increases adult drug abuse.

This huge rise in the number of American Children leads me to several possible Hypotheses.

1. All children have ADHD and should receive a prescription for medication at the time of birth.

OR

2. Children are inherently young and immature and no amount of effort on our part will get children to act like responsible adults until they have in fact grown old enough to legally be adults.

In support of hypothesis two I note that in countries where children start school at older ages, they have significantly less ADHD. Also, children, who receive more exercise and are allowed to waste time at recess on physical activity, are better able to sit quietly in class. Classrooms which eliminate recess to increases classroom time and test scores are those that have higher rates of ADHD.

All that said, with tongue protruding from my cheek, I do believe there legitimately are cases of ADHD and those with ADHD are vastly helped by medication. My concern continues to be that we are trying to medicate our way out of family, societal, and economic problems, lack of quality education and efforts to raise test schools by excessive expectations of very young children rather than more educational opportunity as the school experience progresses.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

ADHD Cure- – Treat Parents

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sad child

ADHD?
Photo courtesy of Pixabay.com

Could we cure ADHD or depression in children, especially preschool children, by treating the parents?

Just read a report that concluded that the epidemic of ADHD in preschool children can be very effectively treated by training the parents in Parent Behavioral Therapy (PBT). This raised a lot of questions. Why the increase in ADHD? Why in Preschool children? And most importantly how could treating the parents – cure the children?

The Press Release about the report by the McMasters Center can be found here. 

The McMasters center report suggested a different way of viewing ADHD and the older ADD. As I understand their concept they are convinced there is one larger umbrella disorder – Disruptive Behavior Disorder meaning the kid is doing things or not doing things that cause the adults problems.  This more general description, which is a recognized diagnosis in the DSM-4-TR they then subdivide and refine into ADHD in all its varieties, Optional Defiant Disorder and finally the most severe form Conduct Disorder.

This makes sense to me since most of the referrals for ADHD screening begin with things like – he won’t stay in his seat, is not doing his work etc. These are complaints teachers and parents have, not things a child, especially a preschool child would complain about. Hence the child’s behavior disrupts an adult’s life and the diagnosis. They report that this disorder began with the label of “minimal brain damage” but when no one could find the specific brain damage we dropped that label.

Further, the study says that ADHD should be thought of as a spectrum disorder. So it might vary from no problem, through milder forms to “for sure you got it” forms. This like so many other mental illnesses is not a case of you got it or you don’t but rather how much of this disorder do you have. Also, there is no medical test for ADHD. We use screening tests and other ways of diagnosing this but the truth is who gets the diagnosis depends on who does the diagnosing.

So why an increase in ADHD cases in preschool children?

Calling them preschool children does not mean that they do not attend school. ADHD and related problems first began to be recognized about 1902 when most children on earth began to attend mandatory universal education.  Now a large number of children are attending preschool – hence lots of preschool age children are attending school. The report on effective ADHD treatments included all children under six in the preschool group. They especially noted that at this age it is difficult to separate the effects of a condition like ADHD from normal maturation.

I think young children – by definition are immature, so we don’t diagnose “too young” as a condition unless they don’t act like we want them to then they have some kind of disruptive behavior disorder. Some countries in Europe have children wait until they are at least six to start school on the premise that before six they are too immature to benefit from school. In America, we go the other way and start them out at age two or three on the premise that the younger we start pushing them the sooner they will grow up.

So who gets diagnosed with ADHD?

Most new diagnoses of ADHD occur when children begin to attend some form of formal education and are asked to sit still and concentrate on things the adults want them to learn instead of the things kids want to learn. The majority of diagnoses are made between the ages of five and ten years of age. Diagnoses of ADHD after the six grade drop sharply and those first diagnosed after age eighteen are even rarer.

The majority of those diagnosed are boys. In fact, boys in the primary grades are four times more likely to get the diagnoses than anyone else. In my own experience, the time’s children are more likely to get referred for assessment for ADHD are when they first start school, preschool, kindergarten or first grade. The next big surge in referrals is between the third and fourth grade when there is a shift from learning to read to reading to learn, and the poor readers get really bored.

The number of adult cases is half of those in children, so either a lot of people outgrow this condition with or without treatment or it is not so much of a problem once you are out of required school.  Or maybe a lot of kids get the diagnosis because they are bugging someone in the position to make a diagnosis.

The poor, especially those on Medicaid are much more likely to be diagnosed, but the rich (higher Socio-economic status) are much more likely to receive medication. The poor are more likely to stop taking meds after one prescription. For much the same reasons the poor are much more likely to drop out of parenting education programs.

When meds work for someone it is wonderful, unfortunately, the only way to see if a med will work for you or your child is to try it and there are side effects to worry about. Note that any meds may have side effects but some are worse than others.

In very young children – under the age of six, treatment with a stimulant ADHD med is likely to reduce the ADHD symptoms, but it increases the depression and other mood symptoms. Or maybe the sadness was always there but it becomes more noticeable when the child is able to sit still. The meds also suppress growth, something that a forty-year-old who is overweight might hope for – but not something we want to see in a child under six. And there is another problem.

In one well-documented study children who took a placebo – a non-active pill – did almost as well on managing their ADHD as children who took the real med. When the meds were stopped, 97.5 % of the kids on ADHD meds did not have a relapse, pretty impressive. But of the kids on a placebo who were treated with nothing resembling a drug other than the pill form it was given in, well a full 88% of these non-medicated kids did not relapse either. The conclusion here could be that the thing that helped the kids was the extra attention involved in treatment, not the medication.

Now, why not just send all these kids for therapy? Well as much as that helps some kids, and remember I am a therapist, there is a limitation on therapy. We see the kid for one hour a week. What happens the other 167 hours? So when parents take a class in Parent Behavioral Therapy or work with the therapist on how to help their child, they are able to maintain the treatment all week not just in the therapy hour.

Now if your child is on meds, please do not suddenly take them off, talk to your child’s doctor or psychiatrist first. But for very young children consider approaches other than medication.

The moral of this story? The more we adults work on our skills the more we can help kids with ADHD, with or without medication. So if your child has ADHD or depression or any other emotional problem, consider participating in therapy and learning new skills that might help your child.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

“Speeding up” the third grade

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sad child

ADHD?
Photo courtesy of Pixabay.com

There must be a connection between Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder and behavioral problems like Disruptive Behavior Disorder. If they are not connected why do I see so many children who progressively get all three diagnoses?

Recently a child was referred for assessment. The parents were concerned their child might have ADHD. They had been sent by the third-grade teacher with a stern warning that they needed to get this child help before it was too late. The teacher pointed out that she had been teaching for a great many years, she had seen many ADHD children and that she knew a child with ADHD when she saw one. She was certain that this child had ADHD and needed medication. The teacher had told the parents she was sure of this because the child was in the bottom third of the class.

This troubles me. Now I know that there are people who suffer from ADHD. I have worked with adults who were unable to stay focused enough to succeed on a job without their medication. I have seen children with ADHD who have been struggling in school and then they get put on the right medication. It can work miracles. But this was different. If we are going to refer every child in the bottom third of the class for medications what does that say about us and our educational system? Really does that mean one in three children have ADHD? I find that hard to believe.

Now if this was an isolated incident I could explain it away. But this sort of thing is happening more and more.  Another parent shared with me that they were pressured to have their child evaluated for ADHD. The school had said that the child did not stay in their desk or do their work. Further, the parents were told that if the child continued to ignore the teacher and not do their work they might have to be placed on homeschooling. This parent took the bold step of talking to other parents in the class. Turns out that in this class of about thirty students more than half were on ADHD medication, most of them referred by the teacher and principal.

Have we reached the point where test scores are so important that we need to put a third of a class on stimulant medication to get their test scores up?

And if taking pills to get smarter really works, if drugs make kids smarter, than why only the bottom third? Aren’t we then cheating the top third by not giving them the drugs so they can do better also?

What also bothers me is the number of children who are diagnosed with ADHD who are subsequently suspended, sometimes expelled for fighting and violent behavior. I know from my work with substance abusers that when they abuse stimulants they are more likely to become violent or otherwise act impulsively. So could a stimulant ADHD med increase the child’s level of violence and result in him being expelled for behavioral problems? I asked a couple of psychiatrist about this issue. I was told that yes a side effect of some ADHD medications is an increase in violence.

On interesting new development in the field has been the availability of several newer drugs that are non-stimulant ADHD medications. While every medication has its side effects, and these meds are no exception, if the medication we are giving a child is making the problem worse not better shouldn’t we consider other options? I would if it was my child.

Now, remember here I am a therapist and not a doctor so if this gets you thinking how about talking with your doctor? And please don’t just suddenly stop giving or taking meds without consulting your doctor.

Here is another example of this problem. A child was referred for assessment. Please hold your CPS dialing finger till you read to the end. The caregiver, an older sibling, was trying to help her younger brother. He was constantly in trouble at school. Did not do his homework, daydreams in class and would not stay in his seat. The teacher (different teacher this time) was sure this was another classic case of ADHD. The sister told me she tried to do what she could but she and her baby’s father were living with friends in a motel room and there was no place for this young man. Still, she was his school contact and she came to help him when she could. His primary care doctor had prescribed ADHD meds, but the minor still was not doing his homework and was not paying attention. His meds had been increased and still no improvement. What to think?

So I interviewed the young man. He reported his father was not around. Bio Father was in prison and would not be released for a few more years. He was staying with his mother but she was in jail right now and would not be released until Monday. So in the meantime, he had been staying with relatives. He had slept on the couch, several different couches for that matter, different relatives on different nights and most of these homes were small and overcrowded. He had not slept well or eaten well since mom had been arrested. He was sad all the time and nothing made him feel better anymore. So was my diagnosis ADHD? Not on your life. Clearly, this young man was suffering, and I do mean suffering, from depression. The end of the story is, mom was released, minor and mom found a safe place to stay and the child is in counseling. I hope mom gets some counseling also.

Did I mention the referral for ADHD whose father was just deported and dad will not be allowed back in the U. S.again? He refuses to do his homework, will not listen to the teacher and – Well you get the idea.

In each of these cases and so many, more, the first diagnosis was ADHD because of poor school work, inattention and not following rules, like being out of their seat. Later when the medication did not fix them they get diagnosed with some kind of disruptive behavior diagnosis. But in most cases when we look really carefully there was also a lot of depression and sometimes eventually a manic episode occurs and the diagnosis changes to Bipolar Disorder. Not every child who does not do homework has ADHD.

If you have had an experience with this issue or thoughts you would like to share please contact me. So much for my thoughts on Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder, behavioral problems like Disruptive Behavior Disorder and Depression.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.