Hi! I am wondering how bipolar is diagnosed in children. What
steps are involved? I know that other conditions might mimic bipolar
in a child (or coexist with it). How can they be ruled out and
a firm diagnosis be made? Thanks so much!
Fink, M.D.: Dear Anita - Your question is at the heart of
much current research in child psychiatry. The answer is not clear
yet. But here is some of what we know.
is not diagnosed by a blood test or a scan or even a psychological;
"pen and paper" test. The diagnosis of all psychiatric
disorders is made by history and observation. To be "diagnosed"
means to exhibit a certain pattern of symptoms that are consistent
with a pattern of mood called "bipolar disorder."
typically been called bipolar if they exhibit patterns of periods
of mania and periods of depression, with the episodes lasting
weeks to months usually. To be bipolar someone must have at least
one episode of mania. To be manic one must have the following
the DSM IV).
period of abnormally elevated, expansive or irritable mood lasting
at least one week. During this period 3 or more of the following
symptoms must be present (4 if the chief mood in the above criteria
self esteem or grandiosity
need for sleep
- very talkative
- pressure to keep talking
thoughts or "flight of ideas" - hard to follow their
in goal directed activity or psychomotor agitation
involvement in pleasurable activities that have a high potential
for painful consequences
As you can
see, a number of these symptoms overlap with ADHD--excessive
motor activity, excessive talking, distractibility, impulsivity
(pursuit of pleasurable activities disregarding consequences).
This is why the debate rages about the overlap between bipolar
disorder and ADHD. To be manic though, there must be some element
of either euphoria (extremely happy - unreasonably and persistently
so) and/or grandiosity - way out of proportion sense of one's
powers and abilities. If they are just irritable or moody--without
grandiosity or some periods of euphoria--it is harder to diagnose
mania--because irritability and moodiness (mood reactivity)
can be a symptom of many things--depression, anxiety, sleep
deprivation, pain, and typical adolescence to name a few.
duration is one of the biggest questions in diagnosing kids. Kids
are typically described as having mood cycles very frequently--up
to many times per day. This is quite different than the criteria
listed for mania in the DSM IV. However, we know that kids brains
are less specialized in their development, so we might expect
to see mood episodes that were less well defined. And, even in
adults there is research indicating that mood reactivity and irritability--without
necessarily sustained mood episodes--could be a variant of
bipolar disorder. The problem is, as I noted above, irritability
and reactivity can be the result of many different disorders and
circumstances, so relying on pure irritability and "moodiness"
--ie up and down many times per day--is not adequate to
make the diagnosis of bipolar disorder in kids or adults at this
Keep in mind
that we are still diagnosing by description in psychiatry. We
don't diagnose a particular area of the brain or transmitter pathway
that is "broken." We describe a collection of symptoms
that are present in large groups of people and we create categories
that we call "disorders." The brain doesn't "get
bipolar disease." Pathways are disrupted in the brain and
we see a pattern that we call "bipolar disorder." It
is our description--not the brain changes--that we call
bipolar. This is very imprecise and artificial. As brain science
progresses we will be much better able to define and clarify the
different brain pathways that become disturbed and present as
the old days when doctors could only say that a patient had fever.
It wasn't until better research led to the discovery of bacteria
and viruses that actually cause fevers, and we could diagnose
and treat more precisely.
I wish the
answer were less complicated, but understanding this information
is really important in pursuing help for your child. ~Candida
I am wondering what percentage of children who have been diagnosed
with ADHD actually have bipolar instead (or as well as the ADHD).
Fink, M.D.: Dear
Tammy: This question is very difficult to answer in any firm way.
It is clear, from many studies, that Bipolar Disorder and ADHD
overlap in adult patients. But the distinction is fairly clear
by the time a person's brain is fully "grown up." In
children, the initial interest in pediatric bipolar disorder was
raised by the finding in one university clinic that a large group
of children with severe, treatment resistant ADHD might actually
be suffering from some form of bipolar disorder. The distinctions
are harder to make in children--and the studies are still
working on defining the distinctions--so we don't know yet
what the data will say about percentage rates of ADHD and bipolar
disorder in kids.
We know that
a recent large study of adults indicated that about 3% of adults
in a community sample (meaning just everyday people--not people
in a clinic or hospital) meet the diagnostic criteria for some
form of bipolar disorder. That is a lot of people! Presumable
about 3% of children then are future bipolar patients.
of ADHD in children show about 5% of kids meet criteria for ADHD
in a community sample. So, how those numbers overlap and change
over development from childhood to adulthood remains to be seen.
Are some of these 5% also diagnosed with bipolar disorder? Are
some misdiagnosed and are really only bipolar disorder? The studies
are being done as you read this, but it will be years before we
have more answers. ~Candida Fink, M.D.
If it is found that a child has bipolar, what is the chance that
a parent also has the condition? And conversely, if a parent is
bipolar, what likelihood is there that the children will have
the condition? Thank you.
Fink, M.D.: Dear
Gayesy: The genetics of bipolar disorder are complex and so there
is not one answer to your question. We know that bipolar disorder
is highly heritable. For example, in identical twins (with the
same genetic makeup) there is a very likelihood that they will
both have Bipolar Disorder. With parents, the risk is lower because
children don't have identical genes to their parents. But it is
still a high risk. These numbers, though, come from people diagnosed
with Bipolar I disorder, the most classical and severe type of
bipolar. We have much less information on genetic risks of Bipolar
II and Bipolar Not Otherwise Specified.
In terms of
understanding early onset bipolar disorder, the data seems to
indicate that it is even more "heritable" (genetic in
origin) than late onset bipolar. In other words, a child can only
develop early bipolar disorder if they have a lot of the genes
needed to create the disorder. Otherwise, the disorder would show
up in more typical form in adulthood.
But we don't
yet have numbers. This information that we have indicates strong
genetic associations between parents and children in both directions.
Better numbers will be available as the genome studies are completed.
The genetic research is moving ahead quickly and will give us
a lot more data on the actual causes of bipolar disorder as well
as the risks of it developing.
If a child is diagnosed with bipolar and appropriate treatment
is found, what does the future hold? Are things likely to improve
and stay manageable, or do things get worse as adolescence and
adulthood approach? I know that my husband's uncle with bipolar
has had many failed relationships and even years unable to work
because of his condition and it worries me greatly that if my
little boy is diagnosed with bipolar his future will be a big
Fink, M.D.: Dear Cindy: Prognosis is variable in bipolar disorder.
In adults with classic Bipolar I disorder the symptoms can be
managed well in over 50% of patients, with good function being
maintained. In even more patients the episodes of mania and depression
can be reduced in severity and frequency with treatment. Suicide
risk in these patients is dramatically reduced with the use of
Lithium as a maintenance drug.
the diagnoses are still very poorly defined, and prognosis is
not well studied. We have no large scale studies looking at these
children as they grow up. A tiny study was done in Australia that
showed boys with ADHD and manic symptoms did not typically have
bipolar disorder at age 21 but they did have lower levels of function.
We know that children who are struggling with mood instability
and significant behavioral disturbances have higher risks of problems
What we don't
know yet is how protective it is to have early diagnosis and treatment
of bipolar and mood disorders in children. In ADHD treatment we
have some data - ie that children who are treated for their ADHD
show lower risks of substance abuse in adulthood. We don't know
yet what treatment for pediatric mood disorders will offer.
based on what we do know is that untreated mood disorders clearly
have higher risk of problems later on. Judicious, careful treatment
is unlikely to make things worse and may well make things better.
In response to your concern that if your son is diagnosed his
life will be a mess--remember that the disorder is present
with or without the diagnosis. If he has a mood disturbance--his
life will suffer from it--regardless of whether or not he
is "labeled." Lack of appropriate support and treatment
will create a mess. Identifying it and seeking intervention is
your best bet for preventing more difficulties later on. ~Candida
Judith and Candida, I'm not sure if you deal with adults, but
here goes... I'm 27 years old and have one child. When I was younger
I looked after myself, my house, everything. I now have gained
a lot of weight, have a bad temper, and am just not motivated.
I'm a SAHM (stay at home mom) but the computer rules me. I'm sad
to say that I don't do housework. My house is a mess, beyond a
mess. I'm neglecting my husband and my child and I feel awful.
I even tried Flylady's
suggestions once and I did really good for a bit--then that
was it--it stopped. I'm not happy with who I am or what I'm
doing. I hate where we live and what I've become. I'm also dealing
with a special needs child which really is hard. I guess I'm contacting
you as a last ditch effort. Sometimes I think I might have a disorder,
but I want to be normal. I don't want to go on meds and see a
shrink. Please, any advice would be great.
Fink, M.D.: I am so sorry to hear how much you are struggling.
You sound very tired and sad and overwhelmed. I hope that you
will speak to your physician about these symptoms immediately.
Your low energy and other symptoms could be caused by medical
diagnoses such as low thyroid or vitamin deficiencies. Depression
is also a medical illness. And your physician can diagnose this
and treat it effectively. It is not a weakness or a lack of willpower.
If it is depression, you are suffering from a major medical illness
that carries risks of other complications (depressed people suffer
from more heart disease for example). Depression is no less of
an illness than something like diabetes. You wouldn't think someone
was weak for treating their diabetes, would you? Diabetics have
to manage their illness with medication and diet and lifestyle
adjustments. It is identical with depression and other mood disorders.
And, like diabetes, if depression is untreated, many more complications
will develop. If only for your child, who clearly needs you around
and healthy to get through his challenges, please seek medical
attention for this serious condition immediately. Sincerely, Candida
Since our 10 year old son has been put on medication he's gaining
weight. Is this normal, and what can we do? He's active and we
don't allow him to just sit and watch TV or play video games.
Should we try another med? My wife doesn't seem to be concerned,
but I am. William
Fink, M.D.: Hi William. Weight gain is a common side effect
of medications for mood disorders. Sometimes it is so much of
a problem that you have to change medicines. Sometimes it is manageable.
The decision is really based on the balance of good effects and
side effects. If your son is having a great, positive response
to his medication, you may want to push harder to find ways to
manage the weight gain, or you may tolerate a little weight gain
as a side effect. If the medicine isn't giving him a lot of benefit
for his mood disorder, you may want to discuss with your doctor
the idea of changing medicines. Unfortunately, weight gain is
a side effect of almost all of the medicines, but there are some
newer options without this risk. So speak to your doctor about
this difficult issue. Good luck.
I have a 10 year-old who has been diagnosed with depression and
possibly bipolar. The psychologist, and child psychologist she
has been seeing for the past two years, are very concerned about
her. I have been dealing with her ups and downs for so long that
I have been wondering what I am doing wrong with her. I am divorced
from her father and she doesn't have a real good relationship
with him. Her father has a history of bipolar himself, and it's
in his family. My daughter is currently on Zoloft and it helps
control her outburst and she is able to focus on doing her homework
to a point. The doctors have given me literature to read about
medication treatments to prepare me for what she may have to go
through. The doctor thinks we may be able to control her with
medication for awhile, and then she may get worse and need other
types of medication. Are there any other things I need to talk
to her doctors about? Anything else I need to be looking out for?
Thank you. Ann
Hi, Ann. First
of all you are doing nothing wrong with your daughter.
You are doing everything right! You are getting her help
and for that you should be congratulated. <applause!> Whether
her moods are situational or biological, you should not judge
your parenting by her ups and downs. That is unfair for any parent
but especially for one like you who is obviously trying to get
your daughter treatment. My co-author Dr. Fink can tell you more
about the medications, but I will tell you this: many children
with bipolar disorder don't do well on SSRI's (like Zoloft) or
stimulants (like Ritalin or Adderall) unless they take a Mood
Stabilizer first. Make sure that your daughter's docs have a good
familiarity with all the meds out there and don't be scared if
they start experimenting with them until they find the right cocktail
(the mix that will hopefully get your daughter into a better state).
Monitor your daughter's moods (There are some great mood charts
on the CABF site) to see
how the medications are working and to assess their value. Make
sure that she continues in therapy with a trusted therapist because
the therapy/medication combo has been shown to be far more effective
than drugs or therapy alone. Be there for her and remember that
you ARE a good mother. Let that become your new mantra. Good luck!
My husband has been diagnosed as bipolar, type 2. I've been
told there is a genetic factor in developing bipolar disorder.
Exactly how significant is the genetic link? What is the probability
that my precocious four-year-old daughter will develop this disorder?
(By the way, her pediatrician said she was precocious, not me
She has not
had any significant behavioral problems to date. What types of
behaviors or changes in behavior should I watch for? I hope and
pray that she doesn't develop this disorder, but if she does,
I want her to get help right away. Looking back, we believe her
father actually fell into the category of early onset, but wasn't
diagnosed until his late 30's. I'm sure you can imagine
the trouble he got into before he was diagnosed, and we don't
want that to happen to our child.
onset bipolar disorder, are there any developmental milestones
that are considered triggers? My husband's psychiatrist told
us that the onset of puberty would often trigger the first depressive
cycle. He didn't really seem to know much about early onset
bipolar disorder. Are there other points in my daughter's
life that we should be particularly vigilant about watching for
disorder is congenital and if one parent (or grandparent
or sibling) has it, a child has a chance of having that gene.
It is widely believed that even if you have the gene, it may not
necessarily express unless an environmental trigger makes it happen.
So there is nature as well as nurture involved when a child develops
bipolar illness. What that trigger is, can vary from one child
to the next and will depend on the psychological makeup of the
child. It sounds like you are very worried about your daughter
developing bipolar disorder.
Try not to
put her under a microscope but DO keep an eye on her moods. When
something is wrong, you as a mom will usually be the first one
to know it. Many of the moms I interviewed for my book said that
they knew by intuition--a gut feeling--that their child
wasn't reacting the way "normal" children reacted. Many
children with the illness had SEVERE separation anxieties. Many
parents had been through ridiculous numbers of childcare providers
because no one could handle their child. Many witnessed extreme
tantrums that seemed to never end and some very young children
even threatened themselves or others--had very poor impulse
control. Mind you, none of these things in and of themselves means
that your child has bipolar disorder. Only a good and experienced
child psychiatrist is qualified to make that determination. Regarding
puberty, shifting hormones can trigger or exacerbate the mood
swings. But if you're not seeing anything but a precocious four-year
old, RELAX! Enjoy your beautiful child and give her your all!
And trust your own maternal instinct. Mother almost always knows
My husband is bipolar and he takes quite a cocktail of medications
to control his disorder. However, sometimes during times of stress
or illness, the medications aren't enough and he has a "breakthrough"
cycle. So far, my toddler hasn't shown any signs of the disorder,
but I would like some suggestions on how to talk to her about
her dad's occasional erratic behaviors. His manic phase tends
to be more on the aggressive, angry side. It clearly upsets her
when daddy is angry and she doesn't understand. Do you have
any suggestions for helping her understand the situation?
How do you
explain to a child why Daddy gets angry? Tough question. There
is a brand new children's book that is a MUST-READ for any child
with a Bipolar parent. It is called Sometimes
My Mommy Gets Angry by Bebe Moore-Campbell and it discusses
just this sort of situation in words and illustrations that a
child can easily relate to. Even an older child (and spouse) may
have trouble understanding that moods are driven by something
other than anger targeted at them. When your child gets a little
older she may need therapy to help her realize that it is the
illness, not her Daddy that says mean things and loses control.
I realize that this is a tough situation for both of you, and
it may be doubly hard for you because there will be times when
you will have to "take over" in terms of letting your
child know that she IS good even if Daddy is having an off day.
Good luck. ~Judy
Hello and thank you for being here! I'm just a bundle of nerves.
My daughter is 9 years old. Over the last year I've noticed her
emotions at a high or a low, but decreasingly in between. At first
I thought it was changing hormones already, but her body isn't
changing. So now I'm worried. My mother is diagnosed bipolar,
but she is so far, the only one in our family. I don't suffer
from mood disorders, nor does my brother. Back to my daughter...
she is increasingly going "over the edge" over small
things like having to go on errands with me, losing at a game,
if a friend forgets to call her, being asked to get back to her
homework, just about anything. She cries easily, and her anger
is just getting out of hand. Then other times, she's like someone
else - calm, happy, and easy to talk to. I never know which person
I'm going to meet. I keep thinking this is prepuberty, but then,
I don't know. I'm very scared as her mother. Judith, please tell
me what it is like, and if you have any tips. Candida, should
I have her diagnosed? Do all kids who go get checked for this
turn out to be bipolar? Worried and scared. Rachael
Fink, M.D.: Dear
Rachel, You are in the middle of a developmental "storm"
that can be tough to navigate with or without a mood disorder.
Even though your daughter's body isn't changing yet, her hormones
are changing rapidly. So at least some of this is "pre teen"
moodiness. Also, as children approach adolescence, not just hormones
change but the brain itself changes. Patterns of communication
between brain cells reorganize and the brain takes on (gradually)
more adult like patterns. But this is a very difficult period
because change is happening so quickly.
is a time when mood disorders can present - because the brain
looks more adult - and so adult disorders can become visible.
Just like diabetes, the genes for mood disorders can lie dormant
until a certain developmental period is achieved - then the illness
not all children who are evaluated are diagnosed with mood disorders
- bipolar, depression or otherwise. Keep in mind that mood shifts
from moment to moment don't equal bipolar disorder. They can by
symptomatic of many things, including typical adolescence.
to ask yourself include whether or not her mood swings are interfering
with her function at school or with friends. Or are you just getting
this at home. How long does she take to settle from an "episode"
of upset? Check with other parents to get some sense of how much
of this is typical in your daughter's peers. Does your daughter
present with mood symptoms in between her "reactions?"
Is she less interested in activities or friends, has her sleep
or appetite changed, is her energy different, is she having trouble
concentrating, or is she suddenly involved in too many things
or thinking she can manage too much or that she is overestimating
Talk to your
daughter. Ask her if she has noticed that her moods are sometimes
difficult for her to control or tolerate - that she sometimes
seems to be having a hard time. She may reject the conversation
outright, or she may be relieved to talk to you about it.
- if you are concerned about her function--and her moodiness
is becoming more and more of an issue--you should see a child
psychiatrist for a thorough evaluation. Even if she isn't diagnosed,
you will then have more of an idea what to look for in the future.
Sincerely, Candida Fink M.D.
I was just diagnosed a year or so ago with Bipolar disorder. Its
not extreme. I was just having major cycling at one point
when my stress was high and it was affected by my sleep patterns.
I seem to have found the magic combination of pills--I am
taking Wellbutrin and Lamictyl. My question is, is bipolar hereditary?
I know depression seems to be. My son is 9 and I see signs of
some emotional issues. I am worried about him because obviously
I would not wish this on anyone. But I just want to be prepared
for any future setbacks he may have.
Fink, M.D.: Dear
Liz - Great news that you are taking such good care of yourself
and managing your own mood disorder effectively. That will benefit
you and your family. Yes, mood disorders have a genetic connection--so
that if you have a close relative with a mood disorder--you
are more likely to have mood disorder. Not every child with a
parent with bipolar or unipolar depression will develop a mood
disorder. But you are right to have an eye out for any indications.
If you are concerned, you should see a child psychiatrist who
can do a comprehensive evaluation. From there you will be able
to decide if your son needs treatment (which could include therapy
or medication or other interventions) or if you should just continue
to keep an eye on things. The psychiatrist could also recommend
further testing as part of the evaluation.
You will be
much more prepared to help your son with whatever comes his way
if you are active in getting information and support. You have
done so for yourself, and I know you will do so for your son.
You could ask your own psychiatrist about a referral to a child
psychiatrist. Wishing you the best. ~ Candida Fink M.D.
My four-year-old daughter has times when she will be very depressed
and quiet, and hang out in her room a lot. She is being really
mean to her sister. She has taken to hitting her, pulling her
hair and not talking nicely to her at all. She talks back to her
father and me, and doesn't seem to care how she treats anyone.
Another thing is that she is constantly either in tears, very
happy, or very sad. And other times she talks so fast it comes
out as jibberish! This summer she was just fine and now that Fall
is upon us she is like another person! Do seasons play a role
in their behavior? And if so how and what can be done to help
my little one? I should add that her father was just recently
diagnosed bipolar. What steps do I need to take? It has been one
thing to have my husband diagnosed, but to now look at my daughter,
it just overwhelming in itself! I think what you guys are doing
is just wonderful!
Hi Debsy. Wow, it sounds like you've got a lot on your plate.
Yes, the moods in a child diagnosed with bipolar disorder can
certainly be exacerbated by seasons. There are numerous therapies
that can help this, including medication and carefully monitored
"light therapy" (carefully monitored because too
much light can make a bipolar child more manic).
If you suspect
that your daughter's moods are extreme, here are some steps to
take. First of all, identify a good Child Psychiatrist in your
area who is knowledgeable about various mood disorders in children.
Make an appointment to meet. Before your appointment, carefully
record your daughter's moods. If you would like, download a mood
chart from www.bpkids.org.
They've got several on the site. There are also some in our book,
The Ups & Downs of Raising a Bipolar Child. When you visit
the psychiatrist for the first time, show him/her the mood chart
and give him your family history, especially the part about your
husband being diagnosed bipolar. He will be able to determine
based on the information you give him and bring him, and on his
observations and testing of your daughter, whether this might
be a case of early onset bipolar disorder or some other problem.
He will also be able to recommend a course of treatment. Good
Member: At what age would you expect a child to benefit from
"talk therapy"? I
realize that bipolar is a physical disorder and medications are
needed to control it. However, I also feel that talk therapy has
a place in the treatment plan. Both for the person affected with
the disorder and for his/ her family members. My daughter has
not shown signs of the disorder; however my husband has the disorder.
Also we are the primary caretakers for my mother-in-law who lives
with us and is suffering from Alzheimers.
On top of
this my father lived with us when he had cancer until his death.
It's been two years since his passing, but my 4-year-old still
talks about how much she misses her grandpa. She remembers every
hospital he was ever in and regularly asks to visit him at the
hospital. To add to her sense of loss her favorite cat died. Then
her other grandfather passed away in April. I think she is keying
off my depression, grief, and stress levels.
in talk therapy for my own issues and I see a psychiatrist for
antidepressants and anti-anxiety medication. My marriage is not
a very healthy one (for reasons besides my husband's illness.)
I'm making plans to leave and take my 4-year-old daughter.
I (if at all) get my daughter involved in therapy? Her pediatrician,
preschool teachers, and dance class teachers all tell me she is
well adjusted and a high achiever for her age. I just worry because
she has so much than Barbie on her tiny little kiddy plate. She
seems to worry a lot about me, her daddy, and her grandma. She
also misses my father and her cat a great deal.
she told me she was really sad that my father had died, but she
was afraid to talk about it because she didn't want to make
me cry. I tried to explain that crying wasn't bad, and that
it was good to share sad feelings with each other. She has also
expresses a great deal of fear about dying. She is so worried
that she is going to die or that I'm going to die in the
very near term.
if she needs an outside person to talk to and if she's old
enough to benefit from it.
Fink, M.D.: I
would absolutely encourage you to bring your daughter into some
form of counseling at least briefly. First of all, she may be
a "high achiever" but these high functioning kids are
often very sad inside. Sounds like she wants to protect you from
being sad - she needs to have a place to talk where she isn't
afraid her thoughts and feelings will hurt someone. In addition,
will learn early on that talking and sorting things out is acceptable
and a good way to solve problems and to learn how to feel better.
She can develop "prophylactic" emotional skills that
will help her navigate what lies ahead for her. She is a high
risk kid - due to the family stress and her biology. Helping her
feel strong and active in her emotional life will be extremely
valuable to her as she grows. Take care of yourself and your little
girl. ~Candida Fink MD
therapists that specialize in younger children and different kind
of therapies that work for them. Play therapy, for instance, encourages
a child to play and as she does, she will express her feelings.
Given the stress that your daughter is under, the instability
of your household and your own stress level, it is probably a
good idea to find her someone to talk to on an occasional basis.
If she is doing well and seems to like it--and the therapist
feels she is benefiting--keep it going. I also recommend that
you find yourself someone to talk too, besides the psychiatrist,
because the optimal treatment for most psychiatric stresses and
disorders is medication along with therapy. If you don't want
to see a therapist, then join a support group to help you get
through this difficult period in your life. Things will get better
for you and your daughter. Good luck! ~Judy
Some of our readers have asked for feedback regarding a FDA
public health advisory released on October 27th 2003 that
discusses reports of suicidality in pediatric patients being treated
with antidepressant medications for major depressive disorder.
One specific woman asked because her daughter is having some outbursts.
Here is what Dr. Fink has to say:
This is a recycled issue - it was popular in the early days of
Prozac. One of the possible side effects of the antidepressants
is a paradoxical agitation. I have seen it on a number of occasions.
It is not clear if there are certain types of kids who are more
prone to this type of agitation - but there have been some suggestions
that bipolar kids are at more risk. We know bipolar adults have
some risk of becoming manic when they are given antidepressants.
The most important
thing to remember is that all medications have benefits and risks.
The idea is to outweigh the risks with the benefits. Depression
and anxiety in children present risks of suicidal ideation when
they are not treated. While suicidal ideation is possibly a serious
risk of the medicine--although I think the data is still quite
preliminary on this question--we have to be careful about
all the serious risks when we give medications to children. Careful
monitoring and judicious dosing are essential.
of course, discuss these questions and concerns with your child's
doctor. But if overall things are a lot better on the medication,
be careful not to throw out the effective treatment because of
a possible side effect seen in some kids - if your child isn't
exhibiting these effects. Important questions are whether or not
there were self-harm thoughts before the medication? Is the overall
picture better or worse?
numbers of outbursts over medication trials. It is hard to remember
accurately frequency and severity - so you are dealing with more
'objective" data if you have charted the episodes when they
occur and then compare this to what dose of medication or what
medication your child is taking. Always stay in contact with your
child's doctor. Regards, Candida Fink M.D.
Hi. My husband was diagnosed with bipolar disorder about eight
or nine years ago when he was 16. He now takes medicine every
day and night. I have known him for almost four years and have
been married for about a year and a half. I really had no idea
what bipolar was until I met him. A few months after we got married,
he decided he didn't need his medicine anymore and went off of
it. He acted soooo different. It was actually very scary! He would
never sleep, and was very hyper. I was only 18, now 19. I really
don't know how to explain how I was feeling except I was so scared
he was never going to be 'normal' again. He didn't want to take
his medicine again. It was so hard getting him to. We stayed at
his parents while he was acting like that because I didn't know
what to do. He had a very good job and lost it. We had to move
because we couldn't afford the rent. It was just so awful. (By
the way, it's been over a year, and we are doing so well, he has
a very good job once again!) Anyway, we just had a baby in July.
I really hope he isn't bipolar, but sometimes I do wonder. He
is always very wiggly, never still unless he's asleep. It is so
hard to get the little booger to nap, and he's only 3 1/2 months.
He is already rolling over both ways. (Since before three months.
He started one way at 6 1/2 weeks.) Maybe he's just very strong
and active. At six weeks his doctor said he was very alert and
strong. So what are the chances that he is bipolar? Does it sound
like he might be? Or am I just worrying like first time moms do?
Thanks in advance.
Dear Bridget - It sounds like you and your husband have conquered
some big challenges already in your young lives. Good for all
of you that he is getting treatment and doing well.
In terms of
your baby - it is probably too early to tell anything at this
time - except that he is active and strong. The most important
thing for you to do is to be with him and love him and interact
with him as much as possible. Babies learn how to soothe themselves
from their parents soothing them and holding them. He will learn
these skills from you now. If he does develop bipolar later in
life - these skills will help him to manage the disease successfully.
By being brave
and facing the illness you and your husband have created a positive
legacy for your son - that will allow him to seek help if he needs
it and to understand that mental illness is nothing to be ashamed
of. Good luck to you - and keep holding that baby close to you!
~ Candida Fink M.D.
My 10 year old son has some issues that involve attention, anger,
anger toward siblings, anxiety, distraction, organization, and
mood swings. His father was diagnosed as bipolar a few years ago,
so naturally I worry that it will trickle down to my two boys.
What should I be aware of and when should I seek a more formal
Shawn, Since your son is exhibiting some mood symptoms and life
difficulties, and his father is diagnosed with bipolar, you should
get a complete evaluation to understand what is going on with
your son. Keep an eye out for sleep problems - times of extremely
high energy and little need for sleep. Also notice if he is "grandiose"
in his thoughts - does he think he can run the universe or that
he is better than everyone at everything or does he have huge
projects going on that he can't possibly accomplish? Is there
sadness or a lack of interest in things that he usually enjoys?
Does he seem sluggish at times? Any hopelessness in his thinking?
Does he still play with friends? Most importantly - take these
types of observations and bring them to a child psychiatrist for
a complete workup. Good luck to you and your son ~Dr. Fink
Hello. I have a six-year-old child who hasn't actually been diagnosed
with bipolar (yet, anyway) but has been described by his psychiatrist
as having "mood instability." It is thought that this
is due to anxiety rather than bipolar, but I am hoping that you
could give some advice/tips for helping me deal with the mood
swings and behaviour. The hardest things to cope with are the
raging tantrums, the silly, risk taking behavior (we get a lot
of injuries around here unfortunately), and the extreme negativity
at times. I am finding "normal" discipline only works
sometimes, when his mood is "normal." Thank you!
Meredith - You hit the nail on the head when you say that typical
parenting only works when your child is in a regular mood cycle.
When the rages are close to the surface, it is important to shift
your expectations - expect that almost every request or correction
will be met with an outburst. And then, before you make the correction
or request, ask yourself if it is really important enough to trigger
an outburst over. Since the child is not able to control these
outbursts, it makes sense to reduce the frequency however you
can, even if it means dropping some things that you would always
expect from a non-bipolar child. The child may have to leave the
house without matching socks or wearing a crazy outfit that they
picked out. They may have to have peanut butter and jelly for
every meal for a week. They might not share well during those
With the risk
taking behavior your best bet is creating an environment with
as few risks as possible, and then supervising as well as possible.
There is a limit to how much you can do this. But with a child
who does not yet have good "self-control" wiring, you
can't expect him to make those judgments for himself. His judgment
is more like a two-year-old's rather than a six-year-old's. Good
luck! ~ Dr. Fink
I m bipolar II, currently not cycling and not medicated. I gave
birth to my son on 8-22-03 and was wondering what are his chances
of becoming bipolar also? I know he's too young to tell now, but
are there signs in young children I should look for? If I do see
some signs at what age do I start trying to do something about
it, and what would I do? Thanks, Lisa
Lisa: Of course you will be anxious about the possibility that
your child may eventually develop a mood disorder. But you are
way ahead of the game by being knowledgeable about your own illness
and the genetic connections of mood disorders.
As I told
another member - it will be hard to define a specific mood disorder
in a very young child. Unmanageable mood episodes--when a
toddler or preschooler doesn't seem to be learning how to soothe
himself--would be a possible clue. Severe separation anxiety,
sleep disturbances, or night terrors are other possible indicators
of future mood disorder. I would develop a strong working relationship
with your pediatrician and let her know of your concerns early
on. This way you can work together to monitor your child's emotional
and behavioral development. If your pediatrician seems uninformed
about this area, try to educate her. If she isn't willing to learn,
find one who is. Best of luck to both of you - Dr. Fink
Thank you for coming to StorkNet to help clear away some of the
"mud" surrounding mental illness. Growing up, I had
some friends with bipolar. As a high school teacher, I've had
children in my classes with bipolar.
My son is
in preschool, age 3 1/2, and his best friend at preschool is bipolar.
The parents are still looking for the magic pill to medicate him
with and all I know is that there have been a lot of trials with
meds and nothing is doing what they hope.
How do I teach
my son to deal with the emotional outbursts and keep him from
emulating them? This child swears and really flips out when he
is "manic."(When I say "swears" I mean that
he is usually yelling while in that state.) He is such a sweet
little boy otherwise, and I don't really want to discourage the
friendship because learning how to deal with this is really a
lifeskill for my child.
about how to teach a "normal" child to deal with his
have really stumbled into such an important area for your son
and for his friend. The compassion you express for your son's
peer will come across loud and clear to your son and he will model
that approach since that is what you have shown him. As your son
becomes more verbal you can use words to talk about his friends
"anger" troubles or "feelings" troubles. It
is helpful to identify that there is a problem but also being
clear everyone has problems and this little boy can still be friend's
with your son.
usually short-lived - even in siblings. Since children almost
always want to do well and be successful with adults they will
do what they can to meet your expectations. If your son doesn't
get positive reinforcement for the behaviors he will stop doing
them quickly. The problem with a bipolar child is that they don't
know how to stop the behaviors so they just keep repeating the
to avoid triggers and how to walk away from an escalating peer
are lessons that your son can learn more of as he grows - assuming
he continues this friendship. Those concepts are more abstract
and will require a later developmental stage for your son to appreciate.
Best of luck
to you and your son's friend's family. They are lucky to have
you in their lives ~Dr. Fink
I have been following your interview with great interest and firstly
would like to say a big "thank you" to you both for
your wonderful information and support.
I have a question:
I read in one response that bipolar children don't do well on
drugs such as Ritalin and Zoloft. What actually happens if a bipolar
child takes such medications? The reason I am asking is that my
8-yr-old boy with ADHD had a terrible reaction to Ritalin some
time back (made him even more hyper and violent, and he started
talking about killing himself and the rest of the family). He
is presently on a trial of a low dose of Zoloft for depression
and anxiety. His behavior at home has seemed better but his teacher
tells me that at school he has been particularly defiant, rude,
hurting and being nasty to the other children, refusing to do
his work, climbing on the furniture, etc, etc. Previously he was
quite well behaved at school but very difficult at home.
I am very
concerned! Am I right to worry about bipolar or does the problem
sound like something different? Thank you.
Dear Sophie - There are conflicting sides to this discussion in
terms of if certain medicine actually create mania in children.
Both the stimulants and the antidepressants such as Zoloft can
have side effects that include agitation. Sometimes these are
temporary - while the medication is being adjusted, other times
it is not. It sounds like the Ritalin response was quite intense
and not something to "tough out." The Zoloft response
is harder to know - I would definitely review your concerns with
a child has agitation as a side effect to these medicines doesn't
mean the child is bipolar. But it may be that bipolar kids have
some higher risk of these side effects. It is important to discuss
this possibility with your doctor and to look at other symptoms
that your child is experiencing to look at the possibility of
a bipolar diagnosis. Best of luck to you -Dr. Fink
My 15 year old son was diagnosed when he was 12. He will be 16
in March. He has been in and out of treatment for about five years.
He is in denial of the illness and most of the time refuses to
take any medication. He currently is taking (when he takes it)
Ambilify. When he takes it, it seem to help. His biggest problem
is school. Although he is very bright and has already passed the
High School Qualifing Exam in our state, he does poorly on his
report cards and his attendance is very poor. He is currently
enrolled in an alternative high school which he hates. He calls
it the "retarted school." My question is how do I get
him to understand his illness and how important it is for me to
take his medication on a regular basis. His father is bi-polar
and our marriage has been, in the past, very unstable. In the
last two years, his dad has made a huge breakthrough in dealing
with his illness and therefore, our relationship is much better.
We have two other children who do not have the illness. We love
him dearly, but he is such a strain on the family and personally
I am exhausted! Any suggestions on how to get him to accept his
illness? Thank you.
Hi Sherri. Your problem is not uncommon. First of all, know that
you are not alone. Many other moms of teens are grappling with
to me like there are many things keeping your son from accepting
his illness. First of all, with a bipolar father, he probably
has always seen the "abnormal" bipolar behaviors of
his father as "normal." Perhaps his father's acceptance
and treatment can help your son better understand the illness.
you find support groups, either locally or online, for your son
and for you. Sometimes bipolar kids run their own "kids only"
support groups which helps them relate to each other on a "kid
level" and accept their own illness.
It is hard
for anyone to accept a bipolar diagnosis. It means that a person
has a lifelong condition and will likely be on meds and in varying
states of mind, for the rest of his or her life. Before acceptance,
there is a grieving process to go through and denial is part of
that process. With therapy (in school and out of school) and support
(within your family and beyond it), he can get through it. Keep
doing what you're doing and make sure you take time for yourself
too! Happy holidays! Judy
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