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Bipolar disorder in children and adolescents has long been a controversial subject. Until recently it was assumed that bipolar disorder did not occur in childhood and therefore could not be diagnosed until symptoms showed up in adults.

Even in adults the illness presents in so many varieties that many individuals reach middle age or older before they learn bipolar disorder has been the source of their lifelong problems.

We are now in a phase where some believe bipolar disorder is overdiagnosed, but in my opinion it has too long been underdiagnosed. Historically in the U.S., more mentally ill were diagnosed with schizophrenia while in Europe bipolar disorder had a greater incidence. In recent decades we have moved closer to European thinking on the subject. As we learn more about the brain and human genome we become better diagnosticians.

The Harvard Mental Health Letter, a monthly news letter from Harvard, devotes a summary on childhood bipolar disorder in its latest issue. The following information is so critical it needs to be shared.

At least one-third of the time bipolar disorder is first seen in children. However, it manifests with a wide array of symptoms, making diagnosis a challenge. It can begin in very early childhood. Some of the signs are rapid mood swings, sometimes hourly; long tantrums over minor issues, irritability, and violence. Children with bipolar disorder seldom have the classic clearly identified cycles of mania and depression.

Other symptoms are sleep problems, defiance of authority, listlessness, physical complaints and morbid thoughts. Suicidal thoughts are not uncommon in children with bipolar disorder. Attention deficit disorder with or without hyperactivity often accompany bipolar disorder. The connection between the two is being studied.

When a child has bipolar disorder the effects on family can be devastating. Parents are bewildered, frightened and angry with the irrational, sometimes dangerous behavior. Siblings have no understanding and may be terrorized. If any child manifests behavior that is frequently unmanageable and out of proportion to the situation a mental health evaluation is strongly indicated. These are not bad children; they have a mental illness and the sooner it’s diagnosed and treated the better the outcome.

Treatment unfortunately involves medications, which always carry the danger of side effects. Medication alone is not the answer. Bipolar disorder is complex. Patient and family need to learn as much as possible about the individual’s specific cycles and triggers. They need to understand the important role of diet and regular sleep habits. Individual and family therapy are imperative to develop coping and relational skills. Therapy will also assist patient and family to accept the reality of the illness.

I’m including a few resources — including Web sites — for anyone desiring more detailed information; Child and Adolescent Bipolar Foundation (www.bpkids.org), American Academy of Child and Adolescent Psychiatry (www.aacap.org), Juvenile Bipolar Research Foundation (www.jbrf.org). For telephone numbers contact me at the email below.

If your child indicates any behavioral difficulties that seem out of the ordinary consider the possibility of bipolar disorder. It’s a treatable condition, especially when diagnosed early. Needless suffering is experienced by too many individuals who are unaware they have bipolar disorder.

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Elinor Stanton is a psychiatric nurse practitioner on Marco Island. She has 29 years of experience as a therapist in private practice and with a large health maintenance organization in Boston. Send comments and questions to etseven@aol.com or call 394-2861. Visit her Web site at http://www.etseven.net.