Early Onset Bipolar Disorder in Children

[Anonymous]

o you know anything about bipolar disorder?

My husband is bipolar. He is on great medications and is able to lead a more or less normla life, does fine at work, etc. The effect of the meds on his personality kids of mutes his personality though, so we have our issues at home but that's a separate issue.

Our son is 7. He has at times been very difficult to deal with and I have consulted with his pediatrician, with concerns about whether our son would also turn out to be bipolar. She didn't think his actions at the time sounded up there with the level of mania that comes in bipolar kids.

But I recently have been wondering if what we are seeing isn't low-level bipolar/mood disorder. I just found this list of frequent symptoms -- and he has a lot of them. Not to the highest degree in a lot of cases, but I see more of him in this list than not.

http://bipolar.about.com/cs/kids_diag/a/red_flags4.htm

Do you have a child with bipolar disorder? Do things get worse over time? Is there such a thing as low-level bipolar?

Are there doctors who really specialize in this are, in young children (under 10)?

[Anonymous]

The only answer I have to the questions that you ask is the last- Danny Pine is a psychiatrist that was recommended to me by our pediatrician and a psychiatrist friend of mine. He is THE guy for kids- he works in both private practice (only 1-2 days a week) and at NIMH (or something like that). I waited 6 months to get an appointment but decided it was worth waiting for- I had similar concerns to you.
http://intramural.nimh.nih.gov/research/pi/pi_pine_d.html
http://www.rosscenter.com/the_ross_center/ross_center_staff/
Good Luck.

[Anonymous]

There is low-level bipolar called Bipolar II. The manic symptoms aren't as intense, but the depression is still there. I'm a therapist that works with adults and I've known a few that were diagnosed as kids. That said, Bipolar is the new trendy diagnosis for kids. Kind of like ADHD was a few years ago. I'd contact Children's or the Keller Center to find a specialist. Good luck!!

[Anonymous]

Dr. Paramjit Joshi at Children's National Medical Center is an internationally-renowned expert in this area and is fantastic. She will also have a long waiting list, most likely, but worth it. Danny Pine would also be an excellent choice.

[Anonymous]

Sorry OP I have no advice for you. Just wanted to share that I have a friend who is Bipolar, her dad was too. She had symptoms since she was 2yo (tantrums lasting over 5 hours, holding her breath until she passed out to manipulate her parents i.e.). Her dad was never committed to the treatment and he ended up committing suicide at age 36. Her mom passed away with cancer shortly after that. My friend found her dad's body and became so scared that she's the most responsible patient I've ever seen in my life. She doesn't miss one pill even tough the side effects and the personality changes suck!!!
The list of symptomatic behaviors you posted is very accurate. Thank you for sharing.

[Anonymous]

Seven is very, very young -- too young -- for diagnosing a major psychiatric illness. Especially since you yourself admit that bipolar is the trendy new diagnosis. I would avoid anyone who wants to pigeonhole or diagnose your child's behavior from a "checklist" and doesn't know your child EXTREMELY well.

[Anonymous]

Anonymous wrote:Seven is very, very young -- too young -- for diagnosing a major psychiatric illness. Especially since you yourself admit that bipolar is the trendy new diagnosis. I would avoid anyone who wants to pigeonhole or diagnose your child's behavior from a "checklist" and doesn't know your child EXTREMELY well.

Schizophrenia can be diagnosed in children as young as 5yo; the numbers are higher in boys and there's nothing new about it.
OP I thank you for seeking professional help and trust your mommy's instinct! Always!

[Anonymous]

Anonymous wrote:Seven is very, very young -- too young -- for diagnosing a major psychiatric illness. Especially since you yourself admit that bipolar is the trendy new diagnosis. I would avoid anyone who wants to pigeonhole or diagnose your child's behavior from a "checklist" and doesn't know your child EXTREMELY well.

OP here . No I didn't admit that bipolar was a trendy new diagnosis.

I don't want any kind of diagnosis, actually, or to pigeonhols my son in any way. However, his dad is bipolar and has been for many years. My son has had many serious issues his whole life. It is reasonable to question whether there is a connection, and most importantly, what I want to know is, is there anything I can be doing now, to prevent bipolar from developing in a child who may be susceptible to it?

For instance, he has had temper tantrums that could last easily 2-3 hours, maybe more -- but I learned when he was very young how to prevent, diffuse them. So he doesn't have them now -- if I hadn't done what I did, though, he'd probably be having them and a lot of other things.

[Anonymous]

Anonymous wrote:There is low-level bipolar called Bipolar II. The manic symptoms aren't as intense, but the depression is still there. I'm a therapist that works with adults and I've known a few that were diagnosed as kids. That said, Bipolar is the new trendy diagnosis for kids. Kind of like ADHD was a few years ago. I'd contact Children's or the Keller Center to find a specialist. Good luck!!

Thanks -- that exactly describes what I am noticing -- manic symptoms maybe there but not as intense.

His pediatrician said that with bipolar in kids, she'd see things like kids jumping off of rooftops thinking they could fly, running into traffic. He doesn't do that; but he does have some racing thoughts, hyperfocus when he sets his brain on something, and things of that nature.

[Anonymous]

Anonymous wrote:Dr. Paramjit Joshi at Children's National Medical Center is an internationally-renowned expert in this area and is fantastic. She will also have a long waiting list, most likely, but worth it. Danny Pine would also be an excellent choice.

THANK YOU for all these recommendations.

[Anonymous]

I'm a special educator who has seen similar behaviors (severe tantrums, injuring self/others, destroying property, intense concentration and frequent mood swings) in children who were diagnosed with Sensory Integration Dysfunction as well as Asperger's syndrome.
It definitely sounds like it is worth getting help from a specialist, but I suggest you do some research on other things as well. Good luck to you and your child and may he thank you one day for getting him the help he needs.

[Anonymous]

Hi OP --

My kids also come from a family with a history of BP. Their dad has BP, but doesn't consistently take meds. Dad and I split up (due to impact of manic behavior and undiagnosed/mistreated illness). But, kids still see Dad frequently. Although I am almost always there, his manic/depressed behavior does still have an impact on them. Fortunately, his illness is relatively mild so far (that is to say, no florid psychosis or delusions). I say "relatively" because the symptoms of illness & the lack of commitment to treatment were enough to destroy our marriage, so it's not really "mild" in my view. Also BPXSO's mom was seriously bipolar (catatonic depression, mania w/delusions, psychosis, etc.) and not too responsive to treatment.

I too wonder about my kids sometimes. I have read the symptom lists you reference, and sometimes thought like you "is this my kid?" I see social anxiety, sillyness, impulsivity, out of control tantrums, etc., although I would say that doesn't characterize the majority of my kids time.

Here is what I have decided -- so many of the behaviors on the list are in the range of normal kid behaviors, that my strategy is to work hard at being a good parent in terms of social, emotional and behavioral teaching/modeling. Please note, that I am NOT implying you are a bad mom. But, for example, one of my kids went thru a period of severe social anxiety and separation anxiety. Getting her thru that required a lot more thought and research on my part and talking with her than with any other kid I know. Kids need a lot of modeling to identify and deal with their emotions in a health way. Maybe her problems could have been solved with some mood stabilizer or klonopin, but I think the risks of those at a young age are huge (not to mention the unknowns due to lack of research in kids). My kids get more structure, more discussion, more explicit modeling of emotions and how to manage them than any kids I know. So far it is working. There may come a time when it is not working -- when the behaviors are causing more damage in their life than medication would -- and I am very open to medication for kids. I guess I look at BP in kids like a learning disability in a way, maybe like ADD. The degree will vary and thus the need for medication, but the child will also benefit by explicit adaptations in terms of behavior/social/personal management (like you mentioned learning to defuse the tantrums). Note, I don't mean to suggest by this outlook that therapy or parental management can serve as a substitute for medication for many kids with BP, I'm just trying to say that when they're young, and the dysfunction isn't so bad that maybe meds should be a later resort.

I don't think it would ever hurt to consult a pdoc who has extensive experience treating BP in kids and who is open to prescribing meds AND therapy, to see how your kids are doing, how your family is doing, and what might make things go better. Family-focused therapy and Interpersonal Social Rhythm therapy are two therapies for BP that have been clinically shown to improve outcomes, and I think probably offer some concepts that apply to mitigating risk (learn to deal with conflict calmly, keep regular social rhythms, maintain sleep patterns/quantity, etc.)

good luck.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Seven is very, very young -- too young -- for diagnosing a major psychiatric illness. Especially since you yourself admit that bipolar is the trendy new diagnosis. I would avoid anyone who wants to pigeonhole or diagnose your child's behavior from a "checklist" and doesn't know your child EXTREMELY well.

OP here . No I didn't admit that bipolar was a trendy new diagnosis.

I don't want any kind of diagnosis, actually, or to pigeonhols my son in any way. However, his dad is bipolar and has been for many years. My son has had many serious issues his whole life. It is reasonable to question whether there is a connection, and most importantly, what I want to know is, is there anything I can be doing now, to prevent bipolar from developing in a child who may be susceptible to it?

For instance, he has had temper tantrums that could last easily 2-3 hours, maybe more -- but I learned when he was very young how to prevent, diffuse them. So he doesn't have them now -- if I hadn't done what I did, though, he'd probably be having them and a lot of other things.

What techniques did you find successful in preventing and diffusing the temper tantrums?

[Anonymous]

Anonymous wrote:

What techniques did you find successful in preventing and diffusing the temper tantrums?

Stuff from the "Explosive Child" book... Collaborative Problem Solving Approach

http://www.thinkkids.org

[Anonymous]

Anonymous wrote:
I guess I look at BP in kids like a learning disability in a way, maybe like ADD. The degree will vary and thus the need for medication, but the child will also benefit by explicit adaptations in terms of behavior/social/personal management (like you mentioned learning to defuse the tantrums). Note, I don't mean to suggest by this outlook that therapy or parental management can serve as a substitute for medication for many kids with BP, I'm just trying to say that when they're young, and the dysfunction isn't so bad that maybe meds should be a later resort.

I don't think it would ever hurt to consult a pdoc who has extensive experience treating BP in kids and who is open to prescribing meds AND therapy, to see how your kids are doing, how your family is doing, and what might make things go better. Family-focused therapy and Interpersonal Social Rhythm therapy are two therapies for BP that have been clinically shown to improve outcomes, and I think probably offer some concepts that apply to mitigating risk (learn to deal with conflict calmly, keep regular social rhythms, maintain sleep patterns/quantity, etc.)

good luck.

Thanks PP -- I think a lot like you do! I had never heard of Interpersonal Social Rhythm therapy.