An estimated one million American children suffer from juvenile-onset bipolar disorder — and yet the illness remains under-diagnosed, under-treated, and under a cloud of intense controversy, according to psychiatrist Dr. Demitri Papolos.

“Bipolar disorder in children has been neglected over the past half-century. There is a bias against diagnosing bipolar disorder in children,” said Papolos, director of research for the Maplewood-based Juvenile Bipolar Research Foundation and author, with his wife, Janice, of the seminal book in the field, The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder.

More than 185 clinicians from across the region were on hand Jan. 18 to hear Papolos’ remarks during an all-day professional workshop, Juvenile-Onset Bipolar Disorder: Under-diagnosed, Under-treated, Under Discussion, in the Conference Center at Mercer County Community College in West Windsor.

The workshop was one of two programs on the issue sponsored by the Jewish Family and Children’s Service of Greater Mercer County. The evening before, JFCS had invited Papolos to share his expertise with a lay audience during a community program, Understanding the Bipolar Child, at Adath Israel Congregation in Lawrenceville.

The spur for the complementary programs was a telephone call made to JFCS about three years ago by the anguished Jewish mother of a bipolar child, recalled Debra Levenstein, director of prevention and support services for JFCS.

“She was looking to the Jewish community for some recognition and acknowledgement about the issue, and there really wasn’t anything out there,” Levenstein said as she stood in the auditorium. “She asked, couldn’t we do something to pull that together? Since that time, we’ve been trying to find the right time and the right support.

“It is a growing concern,” she added. “Our clinicians are dealing with a higher number of families who are dealing with bipolar disorder in children. So it was time.”

Papolos told the professional gathering that recent studies have shown that bipolar disorder is at least as common in children as it is in adolescents and adults. Nevertheless, he said, the field is beset by diagnostic controversy and confusion.

“Validated diagnostic criteria that define the features of the illness and how it actually presents in youngsters have not been developed yet,” Papolos said as he opened the day of lectures, panel discussions, educational sessions, and films. He noted that bipolar disorder in children is often misdiagnosed as attention-deficit hyperactivity disorder, obsessive-compulsive disorder, or oppositional-defiant disorder.

“Clinicians are left without a clear picture,” he said. “If it exists, what does childhood bipolar disorder look like?”

Papolos painted a dark portrait of the typical patterns of bipolar disorder in children. “Ultra, ultra rapid cycles of mood and energy — this is one of the hallmarks of the illness in childhood,” he said.

Those rapid and abrupt shifts in mood and energy may swing from a manic phase — “a silly, goofy, giddy state marked by behaviors intended to incite a response” — to melancholia, to explosive rages of long duration — “prolonged temper tantrums with destructive and violent rages,” he said.

“Bossy, demanding, relentless, explosive, intimidating — these are some of the terms parents use to describe the demeanor of their children,” Papolos added.

But even as these children manifest traits of fearfulness and aggression, they can also be incredibly creative, according to Papolos. He noted that researchers have identified a number of creative geniuses who most likely suffered from juvenile-onset bipolar disorder — for example, Ludwig van Beethoven, Isaac Newton, Charles Dickens, and Vincent Van Gogh.

“We are in many ways, by not identifying these children and treating them early, allowing great havoc to occur…,” he said. “And we are losing a huge resource that could contribute greatly to society.”

The take-home message from his presentations, Papolos said during an interview with New Jersey Jewish News, is that a great deal more needs to be done to promote research into this poorly understood disease.
“There is an enormous paucity of funding to accomplish that — in large part because of the controversy over the diagnosis,” the psychiatrist said. “If leukemia had a prevalence of one million [cases] in the general population, there would be huge sources of funding, particularly in an area that has not been studied.”

Papolos noted that at least 15 percent of children suffering from bipolar disorder end up committing suicide. “That’s a higher mortality rate than with leukemia,” he said. “That puts it into perspective.”