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Question
Posted by: Distraught Mom | 2011/08/01

Son, 9, diagnosed with early onset bipolar

Hi Doc

My son is 9 and has ADD and is in a remedial school and doing well without medication for his ADD

The school requires a neurologist to look at each child and give a report to exclude other problems such as epilepsy, dislexia etc.

I took my son last week to a well known pead neurologist in PTA. I was told my son has early onset bipolar.

I believe him as the signs are there and have been for some time but I just find myself dumbstruck, numb and scared.

My brother committed suicide when he was 16 and I found him and I cannot go through this depression and possible suicide threat.

I am so emotional today, I have been crying non stop.

I have so many questions but cant find answers to them:

1. My son does not have manic episodes - or at least I dont think he does, can it be hypomanic (he is sometimes more busy and funny and then also loves to draw, build things etc)
2. His mood does not fluctuate often, he will get about 1 depressed episode a month, lasting 2-5 days
3. How many classification for bipolar are there and what is the difference (eg>  BD1 , BD2)

I am lost and I tired and affraid. I do not want to go through what my mom had to go through with my brother. No amount of help was enough to save him (he did not have bipolar though)

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Our expert says:
Expert ImageCyberShrink

The diagnosis of "early onset bipolar" is far from formally recognized and its criteria not agreed internationally ; the diagnosis is still controversial to many. And frankly, though your son may have seen an excellent specialist, very highly complex psychiatric diagnoses should be made by a highly trained specialist child psychiatrist, not a neurologist. Neurologists are not usually trained in child psychiatrisy diagnostics, and only if they have pursued this field with special training they undertook theemselves, might they have adequate specialist skills in this particular field.
So I would recommend you get for your son a second opinion ( NOT with someone recommended by the neurologist, who would be more likely to have similar opinions ) but with a recognized child psychiatrist in your area, for a full review of the complex combination of diagnoses that have been made, and make treatmnent proposals.
Of course your despair, based on your earlier experiences, is understandable, but not as appropriate as it feels.
Years ago, in your brother's time, and even recently, childhood and young teen depression was not properly recognized and treated. If your son does indeed have early signs of bipolar disorder, and it is monitored and treated as necessary, he should be able to lead a normally enjoyable life.
What you describe does not sound, to me, like manic episodes, and I am personally sceptical of diagnosing Bipolar Disorder in the absence of clear and unquivocal manic episodes. I am also yet to be convinced that the increasingly complex classifications of Bipolar Disorder are useful in terms of deciding treatment, or even making more useful predictions of likely long-term outcome.
Have your boy see a good local child psychiatrist for a thorough assessment, and a discussion of diagnoses, treatments and long-term management with you.


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Our users say:
Posted by: cybershrink | 2011/08/01

The diagnosis of "early onset bipolar" is far from formally recognized and its criteria not agreed internationally ; the diagnosis is still controversial to many. And frankly, though your son may have seen an excellent specialist, very highly complex psychiatric diagnoses should be made by a highly trained specialist child psychiatrist, not a neurologist. Neurologists are not usually trained in child psychiatrisy diagnostics, and only if they have pursued this field with special training they undertook theemselves, might they have adequate specialist skills in this particular field.
So I would recommend you get for your son a second opinion ( NOT with someone recommended by the neurologist, who would be more likely to have similar opinions ) but with a recognized child psychiatrist in your area, for a full review of the complex combination of diagnoses that have been made, and make treatmnent proposals.
Of course your despair, based on your earlier experiences, is understandable, but not as appropriate as it feels.
Years ago, in your brother's time, and even recently, childhood and young teen depression was not properly recognized and treated. If your son does indeed have early signs of bipolar disorder, and it is monitored and treated as necessary, he should be able to lead a normally enjoyable life.
What you describe does not sound, to me, like manic episodes, and I am personally sceptical of diagnosing Bipolar Disorder in the absence of clear and unquivocal manic episodes. I am also yet to be convinced that the increasingly complex classifications of Bipolar Disorder are useful in terms of deciding treatment, or even making more useful predictions of likely long-term outcome.
Have your boy see a good local child psychiatrist for a thorough assessment, and a discussion of diagnoses, treatments and long-term management with you.


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