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Preverbal toddlers and infants cannot manifest the disorder so clearly, and there is no agreement about whether they exhibit any symptoms at all. However, many parents of a bipolar say they noticed something off about their baby almost from birth, reporting that he or she was unusually fidgety or difficult to soothe. Broman insists she knew her son Kyle was bipolar even when he was in the womb. "This child never slept inside," she says. "He was active 24 hours a day."
For Broman, making that diagnosis may not have been hard since the condition, as Ketter puts it, "is hugely familial." Broman herself is bipolar, though her illness was not diagnosed until adulthood. Children with one bipolar parent have a 10% to 30% chance of developing the condition; a bipolar sibling means a 20% risk; if both parents are bipolar, the danger rises as high as 75%. About 90% of bipolars have at least one close relative with a mood disorder.
For all that, when the disorder does appear in a child, the diagnosis is often wrong. ADHD is the likeliest first call, if only because some of the manic symptoms fit. The treatment of choice for ADHD is Ritalin, a stimulant that has the paradoxical ability to calm overactive kids. But giving Ritalin to a bipolar child can deepen an existing cycle or trigger one anew. Brandon Kent, a 9-year-old from La Vernia, Texas, in whom ADHD was diagnosed in kindergarten (they did not yet know he was bipolar), took Ritalin and paid the price. "It sent him into depression," says his mother Debbie Kent. "Within a couple of months, he was flat on the couch and wouldn't move." By some estimates, up to 15% of children thought to have ADHD may actually be bipolar.
Similar misdiagnoses are made when parents and doctors observe symptoms of the low phase of the bipolar cycle and conclude that a kid is suffering from simple depression. Treat such a child with antidepressants like Prozac, however, and the rejiggering of brain chemistry may trigger mania. Some researchers believe that nearly half of all children thought to be depressed may really be bipolar.
For most kids, the consequences of not identifying the illness can be severe, since the bipolar steamroller gets worse as children get older. Though they tend to be verbally skilled and are often creative, bipolars find school difficult because the background noise of the disorder makes it hard for them to master such executive functions as organizing, planning and thinking problems through. The most serious symptoms may appear when kids reach age 8, just when the academic challenge of grade school starts to be felt. "They're being asked to do things that they're very poor at," Papolos says, "and it's a blow to their self-esteem." If school doesn't kick the disorder into overdrive, puberty often does, with its rush of hormones that rattle even the steadiest preteen mind.
Still, all these natural stressors and the new awareness of the disorder may not be enough to account for the explosion of juvenile bipolar cases. Some scientists fear that there may be something in the environment or in modern lifestyles that is driving into a bipolar state children and teens who might otherwise escape the condition.