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Most Children With Rapidly Shifting Moods Don’t Have Bipolar Disorder

Relatively few children with rapidly shifting moods and high energy have bipolar disorder, though such symptoms are commonly associated with the disorder. Instead, most of these children have other types of mental disorders, according to an National Institute of Mental Health-funded study published online in the Journal of Clinical Psychiatry.

Some parents who take their child to a mental health clinic for assessment report that the child has rapid swings between emotions (usually anger, elation, and sadness) coupled with extremely high energy levels. Some researchers suggest that this is how mania—an important component of bipolar disorder—appears in children. How mania and bipolar disorder are defined in children is important because rapid mood swings and high energy are common among youths.

Furthermore, many experts believe that overdiagnosis and misdiagnosis of bipolar disorder in youths may play a role in the increasing numbers of children being diagnosed with and treated for bipolar disorder. In choosing proper treatment, it is important to know whether children with rapid mood swings and high energy have an early or mild form of bipolar disorder or instead have a different mental disorder.

In the Longitudinal Assessment of Manic Symptoms (LAMS) study, Robert Findling, MD, of Case Western Reserve University, and colleagues assessed 707 children, aged 6 to 12, who were referred for mental health treatment. Of the participants, 621 were rated as having rapid swings between emotions and high energy levels, described as "elevated symptoms of mania" (ESM-positive). Parents of the other 86 children did not report rapid mood swings. These participants were deemed ESM-negative.

At baseline, all but 14 participants had at least one mental disorder, and many had two or more. Attention-deficit/hyperactivity disorder (ADHD) was the most frequent diagnosis, affecting roughly 76% in both the ESM-positive and ESM-negative groups. However, only 39% were receiving treatment with a stimulant, the most common medication treatment for ADHD, at the start of the study.

Only 11% of those with rapid mood swings and high energy (69 out of 621) and 6% of those without these symptoms (5 out of 86) had bipolar disorder, meaning that only this small percentage had ever experienced a manic episode, as defined by the current diagnostic system. Of the children with rapid mood swings and high energy, another 12% (75 children) had a form of bipolar disorder that includes much shorter manic episodes.

Compared with children without rapid mood swings and high energy, those with the following symptoms:

• reported more symptoms of depression, anxiety, manic symptoms, and symptoms of ADHD;
• had lower functioning at home, school, or with peers; and
• were more likely to have a disruptive behavior disorder (oppositional defiant disorder and/or conduct disorder).

Given that 75% of ESM-positive youths did not meet the diagnostic criteria for any bipolar disorder, the researchers suggest that bipolar disorder may not be common among children who experience rapid swings between emotions and high energy levels. Nevertheless, children with these symptoms experience significant impairments due to mood and behavior problems.

The researchers also noted that ESM-positive and ESM-negative youths were prescribed psychotropic medications—including antipsychotics—at similar rates. Further study may provide insight into how serious mental illnesses should be treated in children.

The study participants will be reassessed every 6 months for up to 5 years, allowing the LAMS researchers to determine which children with rapid mood swings and high energy develop bipolar disorder later in life. Such research may inform efforts to identify early markers or predictors of the illness as well as possible protective factors.

— Source: National Institute of Mental Health