Kids -- Normal or Not?
by Victoria Clayton, MSNBC, March 9, 2004
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children, bipolar disorder could be the culprit.
Consider this scenario: At 8 a.m. your 12-year-old is so
irritable and hard to wake you nearly have to drag her out of
bed, dress her and roll her on a skateboard to make the bus. By
11 she’s a prodigy, delivering the most poignant speech her
sociology teacher has ever heard on the civil rights movement.
At 2, though, her English teacher claims she’s the class clown,
refusing to sit still and focus on her assignments. And by
bedtime she often acts as if she’s downed a gallon of espresso.
As a parent, do you chalk this up to normal prepubescent
moodiness? If so, you may be right. Then again, warns Dr. Kelly
Botteron, you could be in denial.
“Parents sometimes try to explain away a psychological problem,”
notes Botteron, an associate professor of psychiatry at
Washington University School of Medicine in St. Louis, who
specializes in juvenile mood disorders.
“They’ll say, oh, kids can be erratic and kids can be moody and
difficult," she says. "But in fact they aren’t as moody and
difficult and erratic as their reputation. Most studies show
that they aren’t as unusual and strange as they sort of have
this cultural myth as being.”
Indeed, at times most children can go from irritable, easily
annoyed, angry moods to silly, goofy, giddy elation but, says
Botteron, there’s an easy way to determine if you have a
problem: persistent trouble-making.
“If you have a child who is moody to the point of causing
problems in school, at home or with friends, that’s usually not
a normal thing,” she says.
One possible explanation is drug use. Another is that the child
is suffering from a serious psychological illness, and one
that's woefully underdiagnosed: bipolar disorder.
Could there be a problem?
Attentive parents are a bipolar child’s best chance at getting
vital treatment. If you answer yes to the majority of the
following questions, consider having your child evaluated by a
child psychiatrist or clinical therapist who specializes in
Does your child have rapidly alternating moods that fluctuate
numerous times a day from being elated to being extremely
Is your child incredibly hard to wake up and equally hard to get
Have other parents warned you that your child tends to be
aggressive with their children or does your child get into
Is your child explosive at times?
Would you describe your child as unstoppable once he or she gets
a notion to obtain something? (i.e. Have you ever gone out to
pick up pizza, ice cream or a video just to stop the tension
your child is causing in the home?)
Does your child often describe activities that are enjoyable to
most children as boring or not stimulating enough?
Have others described your child as withdrawn?
Is your child often sad without a reason?
Does your teen drive erratically or engage in other highly risky
behavior (i.e. Promiscuity or substance abuse)?
Has your child been diagnosed with attention deficit
hyperactivity disorder or depression, but doesn’t seem to
respond well to treatment?
Does your child have trouble maintaining friendships?
Has your child been in trouble numerous times at school?
Has your child ever been in trouble with the law?
Is there any family history of mood disorders and/or substance
* Remember, no one of these symptoms by itself constitutes
bipolar disorder. And, most importantly, in order for any
problem to reach the level of a psychiatric disorder, it needs
to be interfering with the child’s life. The bottom line is that
parents must ask themselves if their child’s behavior is causing
him or her not to function at home, at school or with friends.
Sources: Dr. David Fassler & Dr. Demitri Papolos
Much more common than thought
Also called manic-depression, bipolar disorder is a mental
illness that causes a person to cycle through abnormally high
and low moods. It was once thought to be rare in children, so
little attention was paid to the issue. But the latest research
shows that not only can bipolar disorder begin very early in
life -- as early as age 5, though it typically manifests in kids
around the onset of puberty -- it’s much more common than ever
imagined. In fact, according to the Juvenile Bipolar Research
Foundation, the condition is now diagnosed in close to 1 million
children and adolescents in the United States each year.
The most shocking revelation, however, is that because many
healthcare professionals haven’t been trained in childhood
bipolar, kids afflicted with this illness may be misdiagnosed
and given medication that actually worsens their symptoms or
doesn't help them at all.
“At least 20 percent of kids initially diagnosed with [attention
deficit hyperactivity disorder] actually turn out to have
bipolar disorder,” says Dr. David Fassler, a child and
adolescent psychiatrist in Burlington, Vt., and a clinical
associate professor of psychiatry at the University of Vermont
College of Medicine.
In addition, between 20 percent and 40 percent of kids diagnosed
with depression ultimately turn out to have bipolar disorder, he
It’s a situation Dr. Demitri Papolos, an associate professor of
psychiatry at Albert Einstein College of Medicine in New York
City and director of research for the Juvenile Bipolar Research
Foundation, says amounts to a national healthcare nightmare.
“You have algorithmic increase of the prescription of stimulants
[which are used to treat ADHD] and antidepressants and you have
these kids who are undiagnosed as bipolar but diagnosed with
everything else being treated with these drugs,” says Papolos,
who is co-author with Janice Papolos of "The Bipolar Child."
The wrong medications, he says, can be dire, causing increased
cycling that spells rapid and profound mood fluctuations,
increased aggression and often psychosis.
“This is the sort of thing that really makes life horrible for
these kids," he says. "It’s clear to me, although we don’t have
data to support this, that it’s much, much harder to stabilize
kids with the usual mood stabilizers after they’ve been through
these trials of [antidepressants and stimulants].”
Left untreated or mistreated, bipolar children and teens can
face a lifetime of trouble. They have an increased likelihood of
failing in school, alienating friends, developing substance
abuse problems, getting in trouble with the law, becoming
pregnant and even committing suicide.
Getting the right help
With the correct diagnosis and treatment, bipolar children can
have a bright future even though the illness is chronic and
requires a lifetime of treatment.
Papolos calls bipolar children “national resource treasures”
because of their creativity, intelligence and drive. American
explorer Meriwether Lewis, in fact, is thought now to have
suffered from bipolar disorder. “If you channel it in the right
direction perhaps it can pay off, which is what we try to help
parents do with these kids. But they have very little control
over their impulses and it can become a horrendous scene [if
untreated],” he warns.
Talk therapy may be used to help bipolar children and their
families deal with the illness and its fallout, but
mood-stabilizing medications such as lithium and tegretol are
the cornerstones of treatment.
Botteron, who does brain imaging research, says parents
shouldn’t be fearful of the proper medications. Her research has
found that untreated psychological illnesses can reduce gray
matter in certain areas of the brain but proper medication can
help counter this damage. The sooner treatment starts, the
better, she says. “It looks like some of the damage may be able
to be prevented or is less the more treatment and the longer
treatment you’ve had.”
The first step is for parents to recognize the potential problem
and seek proper medical attention.
While a trip to the pediatrician or family practitioner may be
the first stop, parents should realize that he or she probably
isn’t trained to pick up on the symptoms of bipolar disorder,
many of which mimic other more common disorders. Since bipolar
has a strong genetic link, they should ask for a referral to a
child psychiatrist or a psychiatrist who specializes in bipolar
disorder, particularly if they know the illness is present in
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