The Bipolar Child
Bipolar disorder, or manic depression, is now being diagnosed in younger children, according to the most recent research information. The National Association for the Mentally Ill (NAMI) describes childhood-onset bipolar disorder as abnormally intense mood swings that alternate from periods of severe highs (mania) to severe lows (depression). Children experience rapid mood swings that can cycle many times within a day. In adults the disorder presents itself with intense moods that last for weeks rather than cycling so quickly.
"Up until five years ago, children with symptoms of bipolar disorder were diagnosed as severe ADHD, depressed or oppositional defiant," says George T. Lynn, a certified mental health counselor from Kirkland, Wash. In his book Survival Strategies for Parenting Children with Bipolar Disorder (Jessica Kingsley Publishers, 2001), Lynn offers his expert advice on how to recognize symptoms, understand medication and other important information for parenting a child with bipolar disorder.
Though it is rare in children who are younger than 12, there are new studies that indicate the signs of bipolar disorder are present at an early age, but go largely unrecognized.
"The instance of misdiagnosis is improving with the work of Dr. Joseph Biederman, and others," Lynn says. "Statistically 22 to 27 percent of kids with a primary diagnosis of ADHD meet the criteria for bipolar disorder. Upwards of 95 percent of those diagnosed with bipolar disorder meet the criteria for ADHD. It is important to note that medication that is used to treat ADHD may precipitate mania in children with bipolar disorder. This is why it is vitally important to identify kids in this first group."
There are certain criteria that must be met when making this diagnosis in children. NAMI lists symptoms in its handbook that is part of a course called Visions for Tomorrow. This class is a helpful tool for parents dealing with mental health issues at home.Symptoms of Mania
- Severe changes in mood compared to others of the same age group – unusually happy, silly.
- Unrealistic highs in self-esteem or grandiosity – a child who feels especially connected to God, for example, or has the feeling of immortality.
- Great energy increase and the ability to go with little or no sleep for days without feeling tired.
- Increased talking or pressured speech – talks too much, too fast, rapidly changing topics.
- Distractibility – the child's attention moves constantly from one thing to another.
- High risk-taking behavior, such as jumping off a roof, running out in the street with the belief that they will not be harmed.
- Feelings of guilt, self-reproach, worthlessness.
- Persistent sadness, frequent crying.
- Loss of enjoyment in favorite activities, reduced motivation.
- Frequent complaints of physical illnesses such as headaches or stomachaches.
- Poor concentration, low energy, easily bored.
- Change in eating and/or sleeping patterns.
- Talk of harming themselves.
There are some behaviors parents see in their children that wave a red flag, as Melisa Rechenmacher of Lancaster, Calif., learned. "She intimidates her sisters," says Rechenmacher about her daughter Kymberly. "She throws things. She is violent when she is in that state of losing it. We started her on medication last year; what a difference. The only problem is that you have to really monitor it because something wasn't right with one of the medications, and one night she got really angry. She picked up her mattress and threw it 20 feet, she threw toys at her father and me and she kicked and screamed. We had to call the police."
Kymberly was admitted for medication evaluation and came home after a week at a local hospital. Rechenmacher says her daughter used to be suicidal – which was scary – but with the anti-depressants Kymberly is currently taking, she worries less about that and more about the everyday struggles of whether it will be a good day. "We all wait with baited breath to see if she's had a good day or a bad one," Rechenmacher says. "Unfortunately the mood of the house depends on how she is that day."
The symptoms, if untreated, can go from bad to worse. Christie Kruger of Olympia, Wash., saw this in her own son at the early age of 10. "It started with mild mood swings, then got more intense," Kruger recalls. "He started having rages. Eventually he raged for hours without stopping; then he started lighting fires and burned himself. We hospitalized him at that point."
Kruger's son was diagnosed with bipolar disorder while in the hospital. He has tried different medication combinations – very common with bipolar disorder – and is now stable on his current medication. Kruger has some tips for parents: "Listen and negotiate with your child. Tell him the rules in advance and the consequences for breaking them. Use tons of encouragement for everything he does well, and talk to him a lot. It helps to have someone that you can talk to, like a psychologist, to get tips for handling a bipolar child."
Leanne Rondeau of Athol, Mass., is living through what a lot of parents who are dealing with a bipolar child can relate to. "Before Thomas was diagnosed with bipolar disorder, at the age of 8, he was totally out of control," she says. "He was explosive, angry, aggressive and had temper tantrums." It can be a roller coaster ride for the entire family. Currently Thomas is on several different medications and has found that the period between manic episodes has gotten longer. She has learned to not sweat the small stuff with his behaviors, but to instead concentrate on the unsafe behaviors and activities.
Thomas is on mood stabilizers, which alleviate the symptoms of an episode and can decrease the intensity of future episodes. There are a large number of medications in use to treat this disorder, but they have to be very closely monitored by a clinical physician. "He is currently taking four different medications right now," Rondeau says. "Although he is stable for longer periods of time, he is going through puberty and I feel like his meds are not working as well."
Remember that as parents of a child diagnosed with bipolar disorder, you are not alone. There are a wide variety of resources available to families, online and within your community. The child also needs to know there is help available; encourage him to talk to someone who is not within the family. It can be great for these kids to have a mentor.
"There are excellent online support groups for parents of children challenged by bipolar disorder," Lynn says. "NAMI is taking the lead in setting up parent support groups in many parts of the country." You can access the support groups at the Child Spirit Web site.