New ABC's - Bipolar

Bipolar disorder in children is a neglected public health problem. It is estimated that 1/3 of all the children in this country who are being diagnosed with ADHD are actually suffering from early symptoms of bipolar disorder.

Through history, bipolar disorder, also called manic-depression has afflicted people like Isaac Newton, Abraham Lincoln, Winston Churchill, Theodore Roosevelt, Beethoven, Tolstoy, Charles Dickens, Virginia Woolf, and Ernest Hemingway to name a few.

Bipolar disorder in children presents very differently from how it presents in adults. Adults typically experience a more classical pattern of mood swings. Children rarely fit the recognizable pattern. They have a more chronic course of illness where they cycle back and forth with few discernible well periods in between.

Almost all bipolar children have certain temperamental and behavioral traits in common. They tend to be inflexible and oppositional. They tend to be

extraordinarily irritable and a large majority experience periods of explosive rage.

They tantrum for hours at a time. Siblings and parents (most often mothers) can be threatened and hurt. The rages are typically triggered by a simple parental “no”. The child goes into an almost seizure like tantrum where they may kick, hit, bite, punch, break things and scream foul language.

Bipolar children don’t often show this rage to the outside world. Parents, often due to their own shame and guilt, keep this behind closed doors as they desperately try to find the answers. Even if parents are able to talk about it, friends, family and teachers cannot usually imagine the reality in which these families live.

No one symptom identifies a child as having a bipolar disorder, but if hyperactivity, irritable and shifting moods and prolonged temper tantrums happen AND there is a history of mood disorders and/or alcoholism coming down either or both sides of the family tree, bipolar should be suspected.

Children with Bipolar disorder frequently experience separation anxiety from infancy and it lasts longer than their neurotypical peers. They also suffer from horrible, frightening and violent nightmares. They are often extremely oppositional because they lack the flexibility that allows a smooth transition from one activity to another. Frequently, children with Bipolar are extremely sensitive to stimuli of all sorts and may not be able to tolerate tags on clothing, certain fabrics, sounds, or odors. Many children with Bipolar may have difficulty making and keeping friends. They are often described as bossy, intrusive, or having to always have their own way.

‘The Bipolar Child” by Dr. Demitri Papolos is an excellent book (I credit the above information to Dr. Papolos). The website, bpkids.org is full of information if you are interested in learning more about this disorder.

I am posting about this because my 9-1/2 year old son was just diagnosed with a mood disorder and it took over 5 years of me knowing something was not right and no one truly helping us. In one form or another, all any psychologist or therapist could offer was to give rewards and consequences. Be more consistent. Be firm. Use 1-2-3 Magic. Make him understand that no rewards come without good behavior. Use complicated points systems to entice him. These methods failed miserably because they came with the assumption that he could control himself. He could behave. He was just choosing not to. That is an assumption that caused me a lot of resentment.  I don’t think I will ever get over how bad I feel about all the yelling, threats, consequences and at times, belittling comments that I made to him.

I was angry - angry that we were trying as hard as we could and it felt as if he was spitting in our faces. We were trying so hard and we were not making a bit of progress. It was actually getting worse. His tantrums were still happening, only now, he was a pretty big kid and more than capable of harming me.

I always thought it was behavioral. I never truly considered it could be medical.

When he was 7 years old, he was diagnosed with ADHD. With desperation, we agreed to try stimulants. I have since learned that the use of stimulants can trigger mania or depression in children with mood disorders. Some studies have shown that the use of stimulants can cause the bipolar disorder to manifest at an earlier age than other kids without stimulant exposure.

In my son’s case, when the stimulants were not in his system and working, he was MUCH more hyper than he had ever been before even going on the stimulants in the first place. I told the doctors that too, but no one listened.

Another family of medicine that children (and adults!) with mood disorders need to avoid is the use of antidepressants. We found this out the hard way (see my post on Zoloft). Antidepressants can cause havoc in a child suffering from a bipolar condition, increasing anxiety states, potentially inducing mania, more frequent mood cycling, increases in aggressive outbursts and temper tantrums and even psychosis. Many children need to be hospitalized it is so severe.

As for us, we have now made the very difficult decision to medicate our son with both a mood stabilizer and an anti-psychotic. Since these medicines can have some serious side effects, it was not an easy decision. I am still unsure if we’re doing the right thing. But our family was homebound. We were paralyzed from the effects of this and both my husband and I were literally ill from the stress and constant chaos. We are also starting ABA therapy through our local Autism treatment center and are hopeful that the combination of medicine (biological treatment), therapy (behavioral treatment) and our own education about how we can best help him, can bring us all to a place of peace.

Though I am anxious and worried, I am still hopeful about my son’s future. I am also doing my best to just live in the “now”. Thinking about the future, trying to predict and prepare for all the “what-if’s” is too over-whelming. I just know that I love my son with all that I am and I will do whatever it takes to help him live the very best and the very happiest life he possibly can.