Question: What is a prodrome? I heard the doctor say my child’s behaviors might be “prodromal” symptoms of bipolar disorder.
Answer: The word “prodrome” is a medical term that means “an early symptom indicating the onset of a disease or illness.”
It’s used by medical professionals to note early signs and symptoms of an illness before all the major symptoms of the illness are fully present. These early signs are often called prodromal symptoms.
Typically, the early symptoms of a disorder are initially blamed on other more common diseases or illnesses. For example, increased energy, talking fast, interrupting friends and teachers at school may be early signs the child might be developing Attention Deficit Hyperactivity Disorder (ADHD). Then, as it becomes clear that attention is not sustained on tasks, the child has increased forgetfulness, experiences restlessness, and has trouble sleeping, the parent may be asked to complete assessment tools designed to assist providers in diagnosing ADHD. Because ADHD is the most common developmental disorder in childhood, and because its symptoms appear to overlap with symptoms of bipolar, a mood disorder is often overlooked in favor of an ADHD diagnosis.
Prodromal symptoms of bipolar can occur years before the full onset of the illness. Just because all the symptoms are not fully present doesn’t mean that the child isn’t experiencing serious difficulties with daily living.
It is important to understand the prodrome and keep bipolar in mind during treatment planning, especially if there is a family history of major depression, bipolar, schizophrenia, or addiction. Not including bipolar, or emerging bipolar, as part of the possible picture creates a potential for complications. Early consideration of bipolar could preserve the rest of a person’s childhood and contribute to better long term outcomes.
When there is one parent living with bipolar there is approximately a 30 percent chance the child will also inherit the disorder*. If both parents live with bipolar then there is between 60 and 75 percent chance their child will inherit the disorder*. A thorough medical, psychological, social, and family history should help guide the provider in treatment plan development and implementation with the goal to reduce the symptoms the child is experiencing. An assessment like this takes time but consideration of biological, psychological, and social factors, and how they intersect to impact overall functioning is essential. This helps guide the medical team or provider when making suggestions for managing symptoms and developing a treatment plan.
Dr. Demitri Papolos, co-author of The Bipolar Child, advocates in his book that if there is a family history of bipolar, it is important to treat the child with medications targeting bipolar before attempting to manage and treat other disorders. That includes if the child is in the prodromal stage and is not yet experiencing all the signs and symptoms of bipolar.
Dr. Charles Popper, author of Diagnosing Bipolar vs. ADHD, reminds us that “All of the features of ADHD can be seen in mood disorders at times, so ADHD is a diagnosis reached only after ruling out a mood disorder.”
The reason these two renowned professionals caution treatment for bipolar first is that medications used to manage disorders such as ADHD, generalized anxiety, and depression can cause significant and serious issues in children who live with bipolar. If a child is not living with bipolar and has a trial period of a mood stabilizer, and there is no improvement in reducing symptoms, then the likelihood of significant issues from those medications is minimal in most cases. Targeting other disorders when symptoms are the result of prodromal or emerging bipolar can increase the risk of prolonged mania, depression, anxiety, irritability, aggression, mixed and psychotic episodes. The risk of not considering prodromal symptoms can greatly impact the trajectory of treatment and quality of life when a child or teenager is experiencing early onset bipolar.
* The Bipolar Child by, Demitri Papolos & Janice Papolos
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