Shannon Rawls’s 6-year-old son, Daniel, is a personable, charismatic boy with no shortage of playmates–in his good moments. The trouble is that you never know when the slightest setback will send him into a violent rage.
“It’s almost like he’s possessed,” says Rawls, of Jacksonville, Florida. “You don’t see your child anymore. You see the face of this horrible evil thing raging at you: His face is red, teeth are grinding, he cusses, kicks, hits, bites, throws things… It’s like a seizure, and it can last 15 minutes or 4 hours.”
Rawls’s pediatrician kept dismissing her concerns about Daniel’s explosive behavior, she says. But when he almost drowned a boy in a camp swimming pool at age 4, the doctor sent Daniel to a psychiatrist, who put him on Ritalin (methylphenidate) to treat attention deficit hyperactivity disorder (ADHD).
Although the medicine worked for about 6 months, Daniel’s uncontrollable rages returned. His psychiatrist now strongly suspects that the boy may suffer from manic depression, also called bipolar disorder (which until recently was believed to afflict only teens and adults). In young children, the condition is called “early onset bipolar disorder.”
Overlooked in Children
The label is still too new for there to be a reliable estimate of how many kids have the disorder, although some as young as 2 have been diagnosed and certain signs, like severe sleeplessness, may even begin at birth. Symptoms of the condition often include
* Rapid and extreme mood swings.
* Temper tantrums and violent rages.
* Night terrors and sleep problems.
The problem, experts say, is that bipolar disorder is being overlooked in many children, and the drugs they’re given can actually prompt more aggressive or psychotic behavior. Children left untreated can hurt others and themselves, and they may be at higher risk for drug and alcohol abuse and suicide.
“What we see over and over again is that thousands of these kids are being flipped into mania, probably way before that would happen naturally, as a result of being put on stimulants and antidepressants,” says Dr. Demitri Papolos, associate professor of psychiatry at Albert Einstein College of Medicine and co-author of The Bipolar Child (Broadway Books, 1999).
Reading the Clues
The confusion in diagnosing bipolar disorder in kids is partly because their symptoms don’t fit the usual criteria for adults. For instance, mood cycles can shift daily for kids, but they may last days or weeks in adults. Many early onset symptoms also fit the bill for other conditions like ADHD, depression, and oppositional defiant disorder (ODD).
As many as 10-20% of children diagnosed with ADHD were found to be bipolar, according to a study by Dr. Joseph Biederman, a child psychiatrist at Harvard University who has done extensive research on early onset bipolar disorder. ADHD is estimated to affect some 3-5% of school-age children.
Extremely aggressive children are not likely to have ADHD. “If a child engages in activities that are extraordinary–they’re very aggressive, very agitated, highly explosive, and difficult to control–that is most likely an agitated state and not hyperactivity,” says Dr. Biederman.
Bipolar disorder is believed to be genetic, so it is likely the right diagnosis if other family members have a mood disorder.
Call for Research
Others remain skeptical, calling for more research to document bipolar disorder in children and test the effectiveness of medications. The White House recently ordered similar efforts regarding the use of stimulants (like Ritalin) and antidepressants among preschool children.
“I think that the kinds of kids that we’re talking about have a very serious problem, but I don’t think we know whether they’re really bipolar,” says Dr. Gabrielle Carlson, professor of psychiatry and pediatrics at State University of New York at Stony Brook and one of the first to study the condition about 20 years ago.
Treating Bipolar Kids
News that a child has a serious psychological disorder can be a shock, but the label also can give parents new hope and direction, says Martha Hellander, executive director of the Child and Adolescent Bipolar Foundation.
“Many parents find it a relief to have a name to what they knew was very wrong, and that means there’s a path they can follow to help their child,” says Hellander, whose nonprofit organization also has an online support network for parents at www.cabf.org.
The drugs typically prescribed to bipolar children are the same used to treat adults–mood stabilizers:
* Depakote (generic name valproic acid).
* Tegretol (carbamazepine).
or antipsychotic drugs:
* Thorazine (chlorpromazine).
* Haldol (haloperidol).
* Risperdal (risperidone).
* Zyprexa (olanzapine).
Each of these drugs potentially can cause side effects, which can range from dry mouth and weight gain to liver damage and suppression of bone marrow growth, so treatment should be carefully watched.
Many of these drugs have been prescribed to children for years (Depakote, for instance, is an anticonvulsant used to treat seizures), but it isn’t clear what dose is best for each child, at what age. Nor is it clear how effective these medications are for psychiatric disorders in kids, Dr. Carlson says.
Dr. Biederman estimates at least half the children diagnosed with bipolar disorder will respond to treatment. The rest may need to try different combinations, especially since many have multiple conditions. Some children won’t respond to anything.
The choice comes down to weighing the risks and benefits.
“The condition untreated appears to be associated with a tremendous amount of disability,” says Dr. Biederman. “If treatment relieves the symptoms and the child can begin to function and develop normally, then I think the benefits outweigh the risks.”
Indeed, the toll on Lisa Barr of Corona, California, has been enormous. After 5 years of trying different medications and still not getting her 9-year-old son Joshua’s bipolar condition under control, she is hopeful doctors will find the right combination of drugs.
“This is my little boy. He’s very intelligent and loving, but it’s like having a stranger waiting in the dark,” says Barr. His outbursts have also kept him from making friends. “It’s hard on him, too. He’s told me, ‘Mom, you don’t know how hard it is to live in my skin.'”
Article By: Michele Blecher, Medical Writer