Childhood - Onset Bipolar Disorder: A Guide for Families

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1 Bay-Arenac Behavioral Health Childhood - Onset Bipolar Disorder: A Guide for Families For best results, the parents of a child diagnosed with Bipolar Disorder need to play an active role in their child s treatment. This guide will help you to recognize if your child might have Bipolar Disorder, understand what your therapist or doctor may do to treat it, and help you to ask questions and make choices about treatment options. Every child has ups and downs in mood but, for children with Childhood - onset Bipolar Disorder, these ups and downs can be sudden, extreme, and seem unrelated to what is happening in their life at that moment. Bipolar Disorder (once known as Manic - Depress ion) is a serious medical illness that involves a significant chemical imbalance in the brain. This illness tends to be heredita ry and you may recognize other members of your immediate or extended biological family who have shown similar behaviors. At le ast 2 million Americans suffer from Bipolar Disorder. Although usually first diagnosed in adulthood, children and teenagers can also have this condition. The good news is that there are treatments that will help to reduce the symptoms of this disorder and better treatments are being (Continued on page 2)

2 (Continued from page 1-Childhood Onset: Bipolar) developed. If this condition is not accurately diagnosed and properly treated, it can have serious implications for a child s school performance, job future, ability to get along with others, ability to stay out of trouble with the law, and his or her future happiness. How Do I Know If My Child Has Bipolar Disorder or Something Else? Until recently, it was thought that children and teenagers could not have Bipolar Disorder, that only adults could have it. Although controversial, research over the past 5 years has shown that children can, indeed, be diagnosed with Bipolar Disorder, although it tends to take on a different form in children than it does in adults and older teenagers. Bipolar Disorder is composed of 2 distinct mood phases: one phase is called the Depressive Phase. In both adults and children, this may involve symptoms of great sadness which may include episodes of crying, strongly self-critical or pessimistic thoughts, persistent thoughts about death or suicide, loss of interest in things the person is usually interested in doing, loss of appetite, loss of energy, problems keeping to normal self-care and school/job routines, difficulty concentrating, and problems sleeping either too much or not being able to get to sleep despite feeling tired. The other Bipolar phase is called the Manic Phase. In children, it is characterized by increased and extreme irritability and hostility that may include physical assaultiveness or property destruction, problems concentrating and paying attention due to racing thoughts, talking faster and louder than normal or not making sense when they speak, problems in being able to sit still to the point that the child may not feel the need for sleep for one or more nights and still appear full of energy in the morning, problems with inappropriate sexual behavior, episodes of giggling, laughing, or silliness for no apparent reason, or feeling he or she has special powers or abilities that other people don t have. All children may show some of these behaviors from time to time. This does not mean they have Bipolar Disorder. To be diagnosed with this disorder, enough of these symptoms need to be present at (Continued on page 3)

3 (Continued from page 2-Childhood Onset: Bipolar) diagnosis and the symptoms need to be severe. The important thing to remember is that a person with Bipolar Disorder will display both the Manic and Depressive phases of the illness over time, the behavior will tend to have a sudden onset, and the behavior will be way beyond the usual behavior that the child has shown in the past or what is appropriate for the situation where it shows up. In adults, the manic and depressive phases of this disorder can last for weeks or months. The change from a depressive to a manic phase, called a mood swing, can also take months, with a period of normal behavior in between the two phases. In children, the mood swings or cycles can be very rapid, even to the point of happening multiple times in the same day. This type of very rapid cycling is sometimes called ultradian cycling. It is also possible for children to display a mixed state, meaning that they are showing both manic and depressive symptoms at the same time. This can make a correct diagnosis very difficult and it may take a number of assessment sessions with a professional to confirm the diagnosis or rule it out. To the untrained eye, Childhood-onset Bipolar Disorder can look very much like other behavior disorders, such as Attention Deficit/Hyperactivity Disorder (ADHD), Conduct Disorder, and Oppositional Defiant Disorder. It is possible for a child with one of the above-mentioned disorders to be misdiagnosed as having Bipolar Disorder when they really don t. It is also possible for a child with Bipolar Disorder to be misdiagnosed as having ADHD or one of the other disorders listed above, when they really don t. To make things even more complicated, it is even possible to have a combination of the diagnoses mentioned above! Because of overlapping or similar symptoms, the only way to get an accurate diagnosis is by having your child evaluated by a mental health professional who has experience in the diagnosis of children s mental health conditions. To arrive at an accurate diagnosis may involve a number of sessions with the child and the parents. The professional will ask a lot of questions about the child s medical, developmental, (Continued on page 4)

4 (Continued from page 3-Childhood Onset: Bipolar) and behavioral history. The professional may also do some observations of the child s behavior over a period of time, and ask for input from his or her teacher or other adults that have seen the child s behaviors over time. Psychological testing may also be used to rule in or rule out other behavioral conditions. What is the Treatment for Childhood-Onset Bipolar Disorder? Treatment can usually be done on an outpatient basis and will involve the use of medication, such as a mood stabilizer, perhaps along with an antidepressant, or other medication to control manic behavior. The psychiatrist assigned to help your child will determine the specific medication or combination of medications to try. You can expect frequent medication review appointments, at first, while the medications are being adjusted for maximum effectiveness with minimum side effects. At these medication review appointments, be prepared to give the psychiatrist a quick summary of how your child s behavior has changed or not since the last appointment. Also be sure to share any questions or concerns you may have about the medications or your child s behavior. The psychiatrist may also want your child to have some lab work done, from time to time, to monitor how the medication is working in their body. Always keep these appointments. Once your child is stabilized and is doing better, the medication review appointments will become less frequent. Always give the medications to your child as the psychiatrist has directed. Do not add an extra pill or hold back a pill from what has been prescribed; doing that would only increase the problems and complicate treatment. Make sure you understand what the side effects of the prescribed medications are and contact the psychiatrist if you have any questions or concerns about how the medication is affecting your child. You and your family will also be assigned a BABH Case Manager to oversee your child s treatment program. Your case manager will provide you and your family with more information about what Bipolar Disorder is, help to monitor (Continued on page 5)

5 (Continued from page 4-Childhood Onset: Bipolar) your child s medications and coordinate your appointments, and provide the opportunity for supportive counseling to help you and your family to develop effective ways of coping with this medical disorder. Perhaps the most important thing to remember is that Bipolar Disorder is a chronic medical condition, just like having high blood pressure or diabetes. The severity of the symptoms of Bipolar Disorder can be reduced or controlled but the disorder, itself, cannot be cured yet. It will be important for your child to continue to receive treatment in order to remain stable, or to reduce the severity of the symptoms when he or she becomes more unstable, which may occur from time to time. Bay-Arenac Behavioral Health considers you a very important member of your child s treatment team. Your full participation, cooperation, and feedback will ensure the best possible outcome for your child. Is There Anyplace I Can Go to Find Out More About Childhood-Onset Bipolar Disorder? The Child and Adolescent Bipolar Foundation has a great deal of information about this disorder. They offer not only the latest research findings, but also recommendations for books, videos, etc. The can be found on the Internet at Another helpful website: www. bipolarchild.com Book: The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder (Revised and Expanded Edition), by Demitri Papolos, M.D. Depression and Bipolar Support Alliance 730 N. Franklin Street, Suite 501 Chicago, Illinois USA 1(800) ; (312) National Alliance for the Mentally Ill (NAMI) Colonial Place Three TDD: (703) Wilson Blvd., Suite 300 Toll Free: 1- (800) 950-NAMI Arlington, VA Web Site: