A new diagnostic category is emerging: Childhood bipolar disorder. It was traditionally thought that as few as one in 200 cases of bipolar disorder had an onset which could be traced to childhood. Biederman’s recent research shows that perhaps on the other of 20% of children identified as ADHD could be on the way to developing full-blown bipolar disorder. To make this identification, however, the markers of childhood bipolar disorder are destructive rage and irritation rather than the euphoria and elation that characterizes the adult form. The proof that the childhood form of the disorder metamorphoses into the adult form eventually must still be outstanding. The model is still too new.
The Bipolar Disorder model is the latest attempt to give diagnostic order and specificity to the most extreme end of the disruptive behavior spectrum. It is of course not the first. Years ago, George Murray of Harvard suggested that temporal lobe epilepsy was under-recognized by mental health professionals by a factor of 25. Clearly he was not referring to overt seizures here, which tend to attract clinical attention, but rather to the subclinical seizure activity that can manifest in erratic behavior, severe mood swings, rages and explosive behavior – but goes unrecognized as such. Partly based on Murray’s model, we have emphasized as well the continuity between overt seizures and extreme behavioral disregulation. Both are effectively treated with anti-convulsants, and both respond to the same Neurofeedback protocols. The developments in Neurofeedback therapy neatly parallel developments in psychopharmacology. But seizures have remained in the domain of neurology, and other mental health professionals have been reluctant to build on that model.
Over the years we have talked about our own son Brian in terms of his temporal lobe epilepsy, and we generalized from there to severe behavioral disorders. That always had limited appeal as a model for both practitioners attending our classes and for parents of difficult children. Most professionals don’t relate readily to “subclinical seizure phenomena,” nor are parents thrilled to see the term seizure disorder used in connection with their children unless the diagnosis is obligatory. Talking about seizure disorder in larger terms was a non-starter.