My nine-year-old niece, Emily, was diagnosed as bipolar at the early age of six. Medically, this disorder is caused by a chemical imbalance in the brain that causes unusual shifts in a person’s mood, energy, and ability to function. Bipolar disorder is very difficult to diagnose in children because it is often mistaken for age appropriate emotions and behaviors. The disease itself is considered hereditary, with the risk varying from 15% to 75%, depending on whether one or both parents have the illness.
What exactly is bipolar disorder (BPD)? Bipolar illnesses are a subset of mood disorders, of which major depressive disorder is the most common. Children with major depressive disorder suffer from periods of persistently low and hopeless moods characterized by apathy, poor energy and concentration, sleep disturbances, and thoughts of suicide. These depressive symptoms represent one side of the bipolar spectrum. An individual suffering from BPD experiences dramatic fluctuations of mood: from depressive symptoms to mania or hypomania behavior, involving pathological mood elevations characterized by grandiose thoughts and behaviors, promiscuity, recklessness, agitated and sometimes incoherent speech and thoughts, and a profoundly decreased need for sleep.
In the United States more than two million people are diagnosed as being bipolar. It is not until recently that children have been diagnosed with this illness. According to “About Pediatric Bipolar Disorder,” “a significant proportion of the 3.4 million children and adolescents may actually be experiencing the early onset of bipolar disorder.” It is astounding to learn that so many children are affected by this illness. Although a child’s conduct may cover a wide array of “bad” behaviors, the underlying principle of the diagnosis is that the behaviors violate the basic rights of other people. These are behaviors that are often vicious, and the child typically shows no sign of remorse or guilt for having performed the violent acts.
Not all children with BPD have violent outbursts. However, the expectation of physically explosive and dangerous behavior has, to some extent, stigmatized these children. In addition, critics question whether this syndrome of behavior can really be a BPD if it fails to conform to the symptoms that have long been accepted for adults. That is why it is so important that parents, grandparents, teachers, pastors, and medical professionals pay particular attention to the behaviors children are exhibiting.
In fact, parents of bipolar children are often doing their best while bewildered, exhausted, frustrated, and in some cases, afraid of their own children’s violent impulses. The parents may become isolated from friends and family, who may be judgmental of the child and the parents’ lack of control over their child’s behavior. The parents may be further isolated if they avoid taking the child into public settings that might become the catalyst for a humiliating meltdown. In The Life of a Bipolar Child: What Every Parent and Professional Needs to Know, Trudy Carlson chronicles the life of her son Ben from birth until his suicide at the age of eighteen. Carlson states, “I thought I was alone in my frustration at not being taken seriously when I reported the symptoms my son exhibited” (1).
Families with bipolar children can also find that life at home revolves around the seemingly endless demands and needs of the children. Some children hold their emotions in check at school, but fall apart in the safety and comfort of their own homes. This discrepancy in behavior can lead outsiders, including school personnel and extended family, to assume that faulty parenting is to blame for the children’s difficult behavior at home.
I found this stigma to be very true during my interview with Lisa Rogge, a single mother of two, whose daughter Emily was diagnosed with bipolar disorder. Lisa spoke about the perception of not being able to control her child. Many people, including friends and loved ones, told Lisa that she needed to be more stern with her daughter, and that she was using the illness as an excuse for her daughter’s unruly behavior. It wasn’t until Lisa moved back to her parents’ home that her parents fully understood the complexity of the situation. As Lisa stated, “Many people thought I was making a mountain out of a molehill. Then they met the mountain!”
When asked how she felt when she got upset, Emily stated she wasn’t exactly sure how she felt other than out of control. Emily’s mother, though, gave an excellent scenario:
“Imagine if the sound of the kids in the next classroom, the hardness of the chair, the scratching of the tag in the back of your shirt, the flickering florescent bulb, and your teacher talking all hits your brain at the same force and ‘volume.’ Emily has no way to ignore all the extra things and listen just to the teacher. There are no ‘filters’ to help separate everything. This also explains why it is so difficult for bipolar children to process what they hear, such as directions or following a conversation. The message gets into the brain, but then it doesn’t know where to go. Or, if it does get to the right place, that place doesn’t know how to process the information and it gets lost.”
Emily’s grandparents noted that, as an infant, Emily did not like to be wrapped tightly in a blanket or to be held too close. As she has grown up, Emily still doesn’t like to be constrained. For Emily’s grandparents, the most difficult challenge in helping to raise Emily has been trying to understand how they can help their granddaughter the most. Medication does help with the mood swings and acts of rage, but keeping that medication balanced is very hard to do with any child who is constantly growing. The disease has also taken an emotional toll on both grandparents. A strict schedule of meals, study time, bath, and bedtime must be adhered to at all times. What happens when Emily is told that she cannot do something? That old phrase “all hell breaks loose” becomes the reality. There is usually screaming, yelling, crying, and slamming of doors, while at the same time trying to keep everyone and everything else calm. Her grandfather said that the hardest thing for him has been learning a new kind of patience. There have been times when Emily’s condition has caused conflict between him and his wife, and with his daughter-especially when it comes to disciplining Emily. Both grandparents agree that they worry about how their granddaughter is doing in school and what they can do to help. They are also concerned about the effects Emily’s actions will have on her younger brother.
According to “Bipolar Disorder,” “bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help to keep the disease under control and reduce the chance of having recurrent, worsening episodes.” So, how does BPD affect the family? It takes the entire family to help raise and understand the bipolar child, or any child for that matter. You take the good days, as many or as few as there are, and enjoy them to the fullest. When the bad days set in, you have to focus and remember it is a disease and separate it from what the child’s normal behavior would be in the situation. Praise the child for the good things and continually remind the child not to use the disease as a crutch or an excuse for individual actions. A bipolar child has to learn to control actions and to know right from wrong. It is a very fine line to follow. BPD is something that can divide a family very easily, if the family lets it happen. Successfully raising a bipolar child boils down to two key components: education and consistency.
“About Pediatric Bipolar Disorder.” Child and Adolescent Bipolar Foundation. 27 Oct. 2002. 19 Jun. 2006. <http://www.bpkids.org/site/PageServer? pagename=lrn_about>.
Carlson, Trudy. The Life of a Bipolar Child: What Every Parent and Professional Needs to Know. Duluth: Benline, 2000.
Rogge, Lisa. Personal interview. 16 Jun. 2006. 17 Jun. 2006.
Rogge, Marvin and Marian. Personal interview. 16 Jun. 2006. 17 Jun. 2006.
Spearing, Melissa. “Bipolar Disorder.” National Institute of Mental Health. NIH Publication No. 3679. 2002. 09 May 2006. 24 Jun. 2006. <http://www.nimh.nih.gov/publicat/NIMHbipolar.pdf>.