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Rages, Temper Tantrums, Mood Swings, and bipolar kids: Figuring out the diagnosis

By James Chandller MD FRCPC Yarmouth Nova Scotia Canada

 

One of the most common reasons a child comes to see me is that his behavior is out of control. Often they are easily frustrated, angry, or irritable. Often things are getting broken, or people are getting hurt, and usually there is lots of yelling.When parents look up information about this, it seems that the child could have symptoms of many illnesses, but right now the main question is whether or not they have bipolar illness. a google search of bipolar and temper tantrums in children yields 250,000 results!

 

You get the best results if you have the best diagnosis. Here is how we separate out the causes of rages and tantrums.

Questions to ask

How many clear signs of bipolar disorder are there?

Classic Bipolar Disorder

Children who have all the signs of bipolar disorder, which means mania, (See bipolar handout)and have it for at least a week. I have never seen a child under 10 with this. I see many 13-16 year olds who have this. This is quite severe, and usually leads to further bipolar illness as adults.

Children who have some signs of bipolar disorder

Right now in 2011, this is called severe mood dysregulation or SMD.These children are almost always irritable, and never have a really high or elevated mood.They have huge anger outbursts with at least 3 signs of mania plus distractibility. These children usually end up having depression and anxiety when they are older, and even though they do have a few manic symptoms, they donít turn out to have bipolar disorder. (1)

Are there other aspects of their lives that are out of control?

Children who canít seem to regulate anything.

These children canít control their emotions. Little things make them very excited, very angry, very frustrated, and very mad. All of their emotions, good or bad, seem extreme. Besides this, they have signs of ADHD and canít sit still, are hyperactive, and do things without thinking. Their thoughts are also not under control and they immediately do everything they think of, never consider the risk to themselves or others, and never know why they did anything.This profile of dysregulation of moods, behavior and thinking doesnít really have a good name right now except dysregulation profile. These children end up with drug abuse, ADHD, depression, personality disorders, and anxiety, but not bipolar disorder.

Children who were horribly neglected, abused, or traumatized††††††††††††††††††††

A combination of different disorders of neglect and trauma can cause horrible tantrums and moodiness, but the cause is totally different from bipolar illness. These are described in the youtube videos on attachment, PTSD, and dissociation.

Children with Autism

When autistic children get overwhelmed, they can decompensate in a way that looks like bipolar illness or psychosis.

Fetal Alcohol Syndrome

Exposure to alcohol during pregnancy can lead to a host of problems that cause temper tantrums, out of control behavior, no inhibitions, and aggression

Children with conduct disorder

What seems to be out of control isnít always. Anger outbursts can be very useful for controlling others and getting your way.

Drugs and alcohol

This should be at the top of the list after age 13

A host of other rarer problems

Concussion, stroke, Intellectual disabilities, seizures, tumor, other rare medical problems

A combination of the above.

Most of the children I see donít have one cause. Here are some sadly typical examples.

Out of control from:

Drugs, Conduct Disorder, and being sexually abused

Autism and abuse related disorders

Fetal Alcohol Syndrome, Neglect, Abuse, ADHD

Full Bipolar Disorder, Drugs

Treatment

No matter what the cause, out of control kids need treatment as soon as possible. The treatment usually requires the right medication, the right parenting techniques, changes in the environment, and counseling. The medical treatment will depend on the diagnosis, which is why I am seeing the child!

 

In summary,when a child is out of control and raging they look pretty much the same no matter what the cause is. I have seen many home videos of children who are out of control, and they look remarkably the same no matter what the cause of the outbursts. To figure out the cause, you need to carefully look at the childís history, medical problems, and genetics. Once you know the cause, then the treatment should be easier to figure out.

 

Reference:

Althoff RR. Dysregulated children reconsidered. J Am Acad Child Adolesc Psychiatry. 2010 Apr;49(4):302-5.