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Monday, April 21, 2014
Bipolar Disorder (Children and Adolescents)
Finding A Doctor Who Can Make A Diagnosis
Dear Sir: I have a foster daughter (nearly 5 years old) who was prenatally exposed to cocaine and alcohol (and possibly other drugs) and who appears to have a bipolar condition. I owned a family psychiatric care home (am a Psych Nurse) for 20 years and lived with 2 bipolar adults for a total of 9 years. Although I`m very sure that I`m seeing a bipolar condition in my child, there isn`t a doctor around who believes that the condition even exists in children. Even Children`s Hospital told me that when my daughter was having her developmental assessment. She is extremely fragile and suffers terribly with rapid cycles that can be initiated after a sudden fright or strong negative emotional experience. She has always had problems with state regulation and presents an extremely variable condition depending on the type and amount of information processing she undergoes through circumstances. Her symptoms affect not only her mood and appitite (classic up with hyperactivity/sleeplessness or sleep disturbance and down with depression/weepy/clinginess etc) but also her eliminations. She can go through periods where she has almost no intake or output of urine and a cessation of bowel movement for several days followed by a day when every few hours she will have bowel movement to catch up for the lack of bowel activity. Every Doctor I`ve spoken with says they can`t explain the causitic physiology. (I`ve read that 80% of serotonergic neurons are found in the bowel and affect peristalsis) Because my child is `in care` I have to submit to the doctors and can`t have my own opinion as I would with my own children. I desperately need to find a doctor who is able to diagnose her condition. I live in the Calgary Alberta, Canada area.
Thank you for your e-mail regarding your daughter.
Bipolar disorder in children is certainly more accepted in U.S., but even here I believe it is still "under" and "over" diagnosed because of a lack of careful assessment. As you're probably aware as a psychiatric nurse, the only way to know if your daughter's behavior is caused by bipolar disorder, or any psychiatric disorder/other situation in her life is to get a comprehensive and detailed psychological assessment from a trained mental health professional. Because symptoms can mimic several other disorders and many disorders occur together (comorbidity), it's essential that a comprehensive and detailed psychological assessment of ALL the psychiatric diagnoses be conducted to identify which diagnoses and symptoms are present and which can be ruled-out and any other conditions that may be triggering this behavior.
I'm afraid I'm not aware of any doctors who specialize in childhood bipolar disorder in Alberta. I'd suggest calling your local university department of psychiatry/psychology, children's hospital or community mental health center to ask for names, locations and phone numbers of mental health professionals who have expertise assessing and treating children with mood disorders. You may also want to call:
The Canadian Academy of Child and Adolescent Psychiatry (http://www.cacap-acpea.org/)
and/or the Child and Adolescent Bipolar Foundation (http://www.bpkids.org/site/PageServer)
I hope that helps!
Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University