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CHILD BIPOLAR - PART ONE

 

THE MEDIA have an unfortunate tendency of referring to the child bipolar diagnosis as "controversial," as if the psychiatric establishment and Pharma are conspiring to turn "normal" kids into patients for life. But the real debate, if you want to call it that, is not about bipolar vs normal. Rather it's about bipolar vs something else, such as ADHD or conduct disorder or perhaps even a new diagnostic phenomenon.

Surprisingly, psychiatry is very much in accord with the proposition that kids can experience bipolar at a very young age. Even those hesitant about ascribing this type of behavior to bipolar would be the very last to deny that something very severe and disabling is going on in these kids, something that in no way can be mistaken for normal.

This from Julie, posting on this site back in the early 2000s:

It is very difficult to be a parent of a child with bipolar. I have a six-year-old son who is diagnosed with ADHD. Doctors will not officially diagnose a child this young with bipolar. With all the articles I have read and the medicine I have recommended to the doctors, I know he is bipolar. He is currently in a class for behavior disorder. I get called at least once or even twice a week to pick him up because he has hit another child or spit on the teacher.

I am very close to losing my job and I feel like my world is tumbling down around me. I'm afraid to let other people watch him because they do not understand his illness and I am afraid they may hurt him. Most people believe children with bipolar are spoiled and just need some discipline. I am afraid that someone may unintentionally cause harm to him through their anger.

More from Julie:

I feel responsible for him and must leave work to care for him. I feel so alone. No one can possibly relate to the problems a mother must endure for a child like this. I ask God several times a day why couldn't I have just had a normal child. Why must I fight to get his medicine right? Why must I miss work to care for him? Why can't we go out to eat without an episode?

I also have two girls (ages two and 12 ) that must watch his behavior escalate to the point where he knocks holes in the walls, pees in the closet and tears up his and their favorite toys. I feel so alone and drained. I have nowhere else to turn.

These days, Julie would have far better luck in finding a doctor willing to consider the bipolar diagnosis and in working with sympathetic educators ready to make special accommodations for her child. Make no mistake - in the bad old days, Julie would have been accused of being a bad parent and lectured to both love and punish her kid more, and lighten up. Compared to just a short while ago, we are living in enlightened times. But there is a major catch: A correct diagnosis - particularly in psychiatry - does not necessarily presume correct treatment.

 

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The Child Bipolar Dilemma

Ask almost any adult with a bipolar diagnosis and you will hear horror stories of unconscionably stupid doctors who refuse to listen putting them on meds that make them feel worse rather than better. Meds that may knock out some of their worst symptoms, but render them incapable of feeling human. Meds that get some of their worst behaviors under control, but make them incapable of functioning, of working or playing or interacting with their world in a way that those around them take for granted. Then being told they need to stay on their meds - to be like THIS - forever, for the rest of their lives. No one wants to expose a kid to that.

But also talk to any adult with bipolar and you will hear horror stories of the personal hells they have endured - year in, year out - in the throes of their illness. Wanting to die, wanting to kill, raging-screaming, devastated, exhausted, alone, deserted, left to pick up the pieces of their wrecked lives, overwhelmed at the mere thought of it all. No one wants to subject a kid to just one second of that, either.

Childhood Antecedents to Adult Bipolar

Talk to any adult with bipolar and you will also hear strange tales of their unusual childhoods. Their illness may not have manifested in full measure till their late teens or early twenties, but in hindsight the tell-tale signs were there at a very early age. On the outside, everything may have looked peachy keen. They may have been the apple of their parents' eyes, their teachers may have loved them, they may have been wildly popular.

But their inner world was far different and far more disturbed, occasionally bubbling to the surface as strange behavioral anomalies that friends and family and teachers could easily write off. Geena recalls:

I knew that I was different at a very early age. In Catholic school, I questioned religious theories. My questions were met with the "we have a heretic here" response. Childhood was pretty painful. I was an outsider who was bored constantly. My parents tried to keep me involved in activities, but nothing really kept me interested. My room and books provided my safe haven.

Nevertheless, even for those unaccountably off-the-charts displays there was always the equivalent of a get-out-of-jail-free card.

Reports Nassim:

My childhood peak experiences involved making pipe bombs. There was just something about lighting one on a summer evening then sprinting to safety to then experience a flash of light and a shock wave pulsing through my body that transported me out of myself.

Talk to any adult with bipolar long enough and you will hear stories of their younger selves struggling mightily to reconcile their two completely different worlds - their disturbed inner with their out-of-phase outer. Says Serendipity:

My earliest childhood memory is of primary school and the assassination of JFK and wondering why the tears were flowing for someone I had never met. At least then I was "normal" or at least my reactions were. From then on, oh how I wished the aliens would pick me up and place me on the right planet - a place where mood swings are common, ECT and deep sleep were never heard of, medical retirement was not in the dictionary, and "tar and cement" had never been invented.

Some held it together better than others. Nearly all somehow would make it through childhood and adolescence, only to crash and burn as young adults. It was inevitable, they will tell you. In hindsight, anyone could have seen it coming - years and years in advance.

These days, though, something significantly different seems to be going on. This time, the behavior is way too strange to write off. This time, the crazy and outrageous things don't warrant any get-out-of-jail-free card. It's as if these kids had bipolar RIGHT NOW - as early as age seven or even age four - rather than as late teens or young adults.

This from a Newsweek cover story, May 17, 2008:

Max Blake was 7 the first time he tried to kill himself. He wrote a four-page will bequeathing his toys to his friends and jumped out his ground-floor bedroom window, falling six feet into his backyard, bruised but in one piece.

This can't be true, right? Otherwise, the psychiatric literature would be bulging with studies and case reports. A PubMed search for "pediatric bipolar disorder" reveals that the first article substantially devoted to the topic appeared in 1995. One of the entries from that year was a review article that concluded there was nothing much to review. "Pediatric-onset bipolar disorder: a neglected clinical and public health problem," read the heading.

The years 1995 and 1996 saw the publication of a handful of articles, namely from child psychiatrists Joseph Biederman and Janet Wozniak of Harvard. The two had something very strange to report - that 16 percent of the kids in their clinic had some form of bipolar. No, they said in effect, this is not ADHD we are observing. We have expert credentials in ADHD. This is different. No, this isn't some form of conduct disorder or disruptive behavior. We've seen that, too.

PubMed largely falls silent in the years to follow, but things were brewing beneath the surface. Biederman and Wozniak were continuing with their observations and talking to anyone who would listen. Meanwhile, Barbara Geller MD of Washington University (St Louis), with a grant from the NIMH, was recruiting one population of kids with bipolar features, another with ADHD features, plus a control group, and tracking them. Her startling findings that the kids with bipolar features were in worse shape than adults with bipolar would be unveiled at a conference in 2001.

Over the same period Demitri Papolos MD of Albert Einstein University and his writer wife Janice were quietly communicating with an internet listserve. The subscribers to the listserve were parents sharing their stories, much like the parents of an earlier generation that had founded NAMI. This generation, similarly sick of being ignored and abused, would go on to found the Child and Adolescent Bipolar Foundation (CABF, more recently absorbed into DBSA).

As with NAMI, these parents were well ahead of the curve, the ones at Ground Zero, the true experts. But one doctor was actually listening. Demitri Papolos was not a child psychiatrist, but he had served his residency at Columbia University under Robert Spitzer and Jean Endicott, the architects of the ground-breaking DSM-III. These were heady times, pre-DSM-III, when psychiatry was fluid, when every idea was in play, and young psychiatrists were encouraged to throw away their preconceptions and listen and observe.

Dr Papolos paid attention to these parents, objectively, clinically. His writer wife Janice had perfect pitch for connecting with these parents. Their collaboration, published as The Bipolar Child in Jan 2000, created a sensation. Overnight, beleaguered parents found solace and hope.

"Oh my gosh," read one reader review on Amazon, "this book is great. I feel so much better knowing that my son isn't alone and neither am I."

"I've been criticized for so long," commented another reader, "and lived in shame because of it. I now see that I'm doing everything right and that I am indeed a good parent dealing with a bad illness, not a bad child. What a relief!!!!"

Suddenly, a strange phenomenon began occurring - that of parents bringing copies of the The Bipolar Child with them to appointments, educating doctors, therapists, teachers ...

A new diagnosis had arrived, but not necessarily to a world willing to embrace it.

Go to Child Bipolar Part II ...

This article replaces a series of earlier articles, Jan 24, 2011, reviewed Dec 4, 2016

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