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Understanding the Mind of Your Bipolar Child: The Complete Guide to the Development, Treatment, and Parenting of Children with Bipolar Disorder
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Understanding the Mind of Your Bipolar Child: The Complete Guide to the Development, Treatment, and Parenting of Children with Bipolar Disorder

by Gregory T. Lombardo

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Help and hope for parents of children who suffer from this prevalent and puzzling disorder

Bipolar disorder has an impact not only on children's mood and behavior but on the way they experience the world, and consequently on the way they think. The intensity with which a bipolar child perceives things can be the source of creativity and talent, but it can


Help and hope for parents of children who suffer from this prevalent and puzzling disorder

Bipolar disorder has an impact not only on children's mood and behavior but on the way they experience the world, and consequently on the way they think. The intensity with which a bipolar child perceives things can be the source of creativity and talent, but it can also be a source of confusion and disorganization. If parents can understand the effects of bipolar disorder on their child, they can help him or her to better navigate school, friendships, and family relationships.
Dr. Lombardo provides comprehensive information on:
Professional diagnosis
Developmental issues
Disorders that go hand-in-hand with bipolar, including ADHD and oppositional defiant disorder
Effective treatment – including psychotherapy and medication
Understanding the Mind of the Bipolar Child is essential reading for all parents who want to better understand their child and provide support every step of the way.

Gregory T. Lombardo, M.D., Ph.D., is board certified in adult psychiatry, as well as in child and adolescent psychiatry, and is a diplomate of the American Society of Clinical Psychopharmacology. He is highly trained and experienced in the treatment of children with bipolar disorder. His practice includes biological diagnosis, clinical psychopharmacology, and psychotherapeutic techniques. He also collaborates closely with psychologists and other therapists in the treatment on children with this disorder. Additionally, he has a background in teaching and writing literature at the college and secondary-school level.

Editorial Reviews

From the Publisher

“Childhood bipolar disorder is a devastating illness that affects emotional, social, and cognitive development. In recent years, increased attention devoted to the study of bipolar disorder in childhood has resulted in greater information regarding the cause, phenomenology, and treatment of the disorder. However, despite improved understanding and awareness, the diagnosis of bipolar disorder in children is still plagued by confusion and misunderstanding because of the complex and diverse presentations of the condition, difficulties in diagnosis, and overlap with other disorders.

The aim of Understanding the Mind of Your Bipolar Child is to provide a comprehensive overview of bipolar disorder in childhood, including diagnosis, developmental issues, common co-occurring disorders, and treatment options. What is most unique about this book, in comparison with others that discuss diagnostic issues and treatments, is that it focuses on considering bipolar disorder within a developmental framework, informed mostly by psychodynamic principles. The emphasis on development leaves the reader with a comprehensive and integrated notion of how symptoms of bipolar disorder interact dynamically with other personal characteristics and contextual variables of the child in affecting his or her developmental trajectory.

The book is divided into 3 parts: "Diagnosis," "Development," and "Treatment." Part I focuses on the complexities of diagnosing bipolar disorder in children. The author outlines clearly the types of symptoms that suggest a bipolar spectrum disorder and then discusses the different types of bipolar disorder. A strength of this section is the attention paid to the complications encountered when diagnosing bipolar disorder, including different sources of information, the varying spectrum of the disorder, the varying age at onset, and overlapping conditions.

Part II, the longest and most involved section, undertakes a comprehensive exploration of bipolar disorder within the developmental context of the individual child. This section is organized into the developmental periods of infancy, toddlerhood, school age, preadolescence, early adolescence, adolescence, and late adolescence. For each stage, the important developmental milestones that are optimally achieved are discussed, as well as crucial transitions that the child must negotiate during each stage.

The author impressively integrates information about normative development, individual differences, interpersonal relationships, and identity issues into a fluid and thoughtful account of the development of a bipolar spectrum illness over the course of childhood and adolescence. Concepts are illustrated using detailed case examples and formulations that help the reader integrate and consolidate the information presented. Part II concludes with a detailed explanation of disorders that commonly accompany bipolar disorder and how the co-occurrence may affect development, prognosis, and treatment.

Part III discusses the various treatment options available to children with bipolar disorder and their families. Different kinds of providers are discussed, as well as the types of therapy (individual, group, and family) that are used and how these therapies work to alleviate the suffering of children with bipolar disorder and their families.

This book is highly recommended as an excellent resource for parents of patients and for health care professionals who work with children and families affected by bipolar disorder. In particular, the book will benefit those who want to understand the disorder's emergence within a comprehensive developmental framework.” —Amy E. West, PhD, The Psychiatric Times

Library Journal
Bipolar disorder, or manic depression, with its alternating highs and lows, is one of the most frequently diagnosed mental health illnesses in children and adolescents. It can be harder to diagnose in children than adults and can often be misdiagnosed. While many books and resources exist for bipolar disorder, fewer deal with pediatric bipolar disorder specifically, though this year has seen an increase in titles (e.g., Demitri Papolos and Janice Papolos's The Bipolar Child, 3d ed., and Gianni Faedda and Nancy Austin's Parenting a Bipolar Child). The authors of these books, both child psychiatrists, approach their topic differently. Greenberg assumes the first-person perspective and writes in a conversational style, sharing many stories from her practice, which makes the disorder seem less scary. She describes not only the experiences of her patients but also those of her patients' parents, as well as touches on medication, related illnesses, and therapy.

Drawing on his experiences as both a child psychiatrist and a bipolar sufferer, Lombardo divides his work into three sections: "Diagnosis," "Development," and "Treatment." He addresses various age groups, from infants to late adolescents, and explores broader topics such as family relations. The two appendixes and the glossary do a good job of explaining potentially confusing topics, e.g., common medications taken by bipolar children. Bipolar Kidsis recommended for public libraries. Understandingwould be better suited for academic or health science libraries.
—Leigh Mihlrad

Product Details

St. Martin's Press
Publication date:
Edition description:
First Edition
Product dimensions:
6.00(w) x 9.00(h) x 0.85(d)

Read an Excerpt

Understanding the Mind of Your Bipolar Child

The Complete Guide to the Development, Treatment, and Parenting of Children with Bipolar Disorder

By Gregory T. Lombardo

St. Martin's Press

Copyright © 2006 Gregory T. Lombardo, M.D., Ph.D
All rights reserved.
ISBN: 978-1-4668-5305-8


Understanding Bipolar Disorder

The following portraits will give you a vivid illustration of how differently bipolar disorder can appear in different children and at different ages. I will then go on to explain what connects these very different children to a single diagnosis of bipolar disorder.

RALPH, age eleven, was an excellent student and a creative, talented artist. He was also impulsive, overly excited in groups, often silly and goofy, and subject to sudden aggression. Ralph's inappropriate behavior made him a target for teasing at school, while at home his difficulty in accepting limits was causing his relationship with his parents to deteriorate. His mother brought him to me primarily because he seemed depressed and had difficulty sleeping.

JEAN was first seen at the age of twelve, because of complaints of depression. She cried frequently, had great difficulty sleeping, imagined herself dying, and had recently begun deliberately scratching herself superficially, enough to break the skin but not penetrate it. Jean also had periods of intense energy and high spirits during which she had unrealistically grand ideas. When I saw her, her speech was rapid and her thinking was scattered. While her developmental history was largely normal, she had experienced great difficulty with the word no when she was a toddler and had an episode of depression as early as the fourth grade.

KLAUS was a handsome, sweet, blond six-year-old who was brought to me because of severe tantrums, as well as oppositional and bizarre behavior. He was also highly activated — becoming hyperactive and silly — when he ate sugar. Klaus had been started on Ritalin at age five for what was thought to be ADHD, but when I first saw him he was frankly psychotic: hyperactive, silly, grimacing, and talking incessantly. He drew several pictures in rapid succession in a wild and scribbling style. He had cut up his clothes with scissors after a dream in which he found himself in a "paper world" where a paper tiger had bitten off his head. He told me he cut up his clothes while trying to cut up the tiger that was attacking him. His reaction to the stimulant (and to sugar) made clear to me that his hyperactivity and inattention were symptoms of early onset bipolar disorder.

Each of these children suffers from bipolar disorder, a psychiatric condition characterized by dramatic movements between two poles or extremes of mood. As you may already know, a child with bipolar disorder can go from periods of being overly high or irritable (hypomania) to periods of despair and hopelessness (depression) and back again — sometimes within the space of just a few minutes. These mood changes (oscillations) can be startling and confusing, both to the child and those around him. He may feel happy and content one minute, then suddenly plunge into deep despair or intense rage. He may ricochet between a sense of well-being and personal power and a sense of hopelessness and depression, between feelings of creativity and energy and feelings of frustration and inertia. A manic silliness or an explosive irritability can suddenly be replaced by an anxious withdrawal from the world.

Mood swings can be triggered by stress, monthly or daily hormonal cycles, seasonal changes, variations in blood sugar, or the ups and downs of life. Although mood swings affect all children to some extent, they can be disabling for a child with bipolar disorder. Once set in motion, these swings can develop a life of their own — they can build up a biological head of steam, a momentum that carries well beyond the original insult and cannot be quelled by typical parenting.

Bipolar disorder is also characterized by intensity: intense energy, activity, imagination, anxiety, anger, stubbornness, irritability, shyness, sensitivity, silliness, or restlessness. These two traits — oscillation and intensity — may be present very early in life, appear at a particular developmental stage, or occur in response to certain stressors.

Because of their intense energy, creativity, and perceptiveness, bipolar kids can be wonderfully engaging, inspiring joy and pride in you as a parent. But their intensity and changeability can also make them unpredictable, oppositional, and at times inconsolable. Tasks that are routine for other children — making friends, obeying rules, staying asleep at night, performing well at school, and feeling comfortable in the world — can be very difficult for them, and for you as a parent.

What Causes Bipolar Disorder?

Bipolar disorder is an inherited condition, like hair color or intelligence. There are almost certainly several genes involved, and a child can inherit some from one parent and some from the other. Probably some bipolar patients have a different set of inherited genes than others. In some children I have seen, I don't recognize the disorder in either parent, although there are traces of it in grandparents, uncles, aunts, or cousins. As with other medical conditions, such as cardiovascular disease or emphysema, what is probably inherited is a biological vulnerability that appears more or less severely depending on the influence of environmental stress or biological risk factors.

The first sign of the disorder is often depression, unaccompanied by mood elevation, appearing before or during puberty. The depression may come about in response to a personal loss or a social setback (an environmental stress), or it can begin in response to a recreational or prescribed drug (a biological risk factor). In younger children, however, the disorder can appear in forms of increased arousal: severe temper tantrums, unusual anxiety, intense silliness, or an early sleep disturbance.

How Do I Know If My Child Is Bipolar?

A reliable diagnosis of bipolar disorder requires a thorough psychiatric evaluation, including an examination of the child, a description of current symptoms, history of symptoms, developmental history, and family history. Even then a diagnosis may be tentative, depending on a child's course over time. There are, however, things you can look for.

Contrary to what many people think, bipolar disorder is not just another name for manic depression — although the concept arose from earlier understandings of manic depression, and bipolar disorder includes manic depression. What unites other forms of bipolar disorder with manic depression is the characteristic movements between depression and a state of arousal — irritability, silliness, anxiety, a driven or obsessive pursuit of a particular goal, hypersexuality, or other kinds of compulsive pleasure seeking. Like manic depression, other forms of bipolar disorder also can react unpredictably to some medications used for depression or ADHD. What separates these other forms of bipolar disorder from classic manic depression is the variety and subtlety with which the symptoms can appear.

Surprisingly, bipolar disorder isn't a specific diagnosis: it is not, like other medical diagnoses, the result of a single underlying physical condition. Rather, it is a syndrome, a recognizable group of symptoms that can arise as a result of different underlying physical (in this case neurological) conditions. We know that the underlying biology of various patients must be different because bipolar patients with similar symptoms can react differently to the same medication. In fact, two people can react oppositely to the same medication.

Although our recognition of the disorder is based on a recognizable pattern of symptoms, there isn't one particular disposition or behavioral pattern that immediately pinpoints this disorder. That's because there can be a variety of symptoms in different combinations appearing at different ages. Nor is there yet any blood test or brain scan that confirms the disorder. The term bipolar can be applied to a large number of children, including some who appear to be normal and high functioning and others who are more seriously affected. An accurate assessment of a child ultimately rests on three sources of information: current symptoms, developmental history going back to infancy, and family history.

Although no single characteristic in the checklists below is by itself an absolute sign of bipolar disorder, a number of them occurring together with particular severity should serve as a red flag warning that a child may be disposed to developing bipolar disorder. Notice also that some of these indicators can be recognized only in retrospect. There is no way a parent could appreciate their significance at the time they first appear.

Current Symptoms

Current Symptoms

____ extreme anxiety

____ marked irritability

____ marked impulsivity

____ high level of activity

____ grandiosity

____ excessive talkativeness

____ rapid speech

____ racing or rapidly changing thoughts

____ auditory or visual hallucinations

____ intense oppositional behavior (trouble accepting the word no)

____ deliberate destructiveness

____ extreme silliness

____ shyness

____ separation anxiety

____ sensory hypersensitivity

____ florid imagination and prominent creativity

____ an early or prolonged sleep disturbance

____ vivid nightmares that include violence and death

____ frequent night terrors

____ movement between depression and an elevated mood

____ a prominent rebound reaction, or a sleep disturbance during treatment with any medication used for ADD or ADHD

____ a worsening of symptoms in response to treatment with an antidepressant

____ hypersexuality in the absence of sexual abuse

The symptoms that bring a child to psychiatric attention may be obvious, such as a depression or a manic episode, or they may be less definitive, such as a behavioral disturbance, an anxiety attack, hyperactivity at home or in school, or problems with peer relationships. It is also true that in toddlers and latency-age children (ages eight to twelve), symptoms of mania and depression often occur simultaneously. Even when there are no clear signs of mania or depression, severe irritability or anxiety can be a marker for the increased arousal typical of this disorder. It often takes an experienced clinician to recognize a significant pattern.

Developmental History

Developmental History

____ difficulty being soothed as an infant, not due to some obvious physical problem such as gastrointestinal distress

____ difficulty sleeping through the night for more than six months

____ a tendency toward sensory hypersensitivity or overarousal

____ severe oppositional behavior and difficulty accepting no

____ onset of depression before or near puberty

____ seasonal mood changes

____ hyperarousal, increased anxiety, or mood changes in the evening and marked difficulty falling asleep

____ mood changes with fluctuations in blood sugar

____ severe social anxiety

In some children, certain constitutional traits, apparent from infancy or early childhood, are the first signs of bipolar disorder. These traits include prolonged difficulty sleeping through the night, difficulty being soothed, hypersensitivity or a tendency toward sensory overload, a high level of activity, unusual irritability, pronounced oppositional behavior, marked silliness, frequent nightmares or night terrors, or an unusually florid imagination.

Severely oppositional behavior can be intensified by one of the important symptoms of the disorder — grandiosity — in a form more difficult to recognize than in an adult. The child with bipolar disorder may believe that her ideas or desires are not just more urgent, but are all-important, certainly much more important than rules or what her parents say. She may do what she wants, regardless of the rules, or she may insist fiercely on having something wildly extravagant — an expensive toy or a completely unmanageable pet. Such a child may also have a sense of omnipotence that minimizes danger or the warnings of parents. Grandiosity and omnipotence are normal for a toddler, but the bipolar child continues to exhibit this kind of thinking at a much later age and with unusual intensity.

A bipolar child also often has a history of difficulty getting along with other children. However, this difficulty can take different forms: intense bossiness and inflexibility, intense shyness and sensitivity to insults or aggression, or an overly ardent desire for contact but with a poor sense of boundaries.

Family History

Family History

____ manic depression

____ psychotic depression or depression requiring electroconvulsive therapy (ECT)

____ severe recurrent depressions

____ postpartum depression

____ women who experience prominent mood changes with hormonal fluctuations: the onset of menarche, in the premenstrual period, during pregnancy, following delivery, or following menopause

____ relatives with prominent mood swings, irritability, or anxiety

____ relatives with marked creativity, inventiveness, intense energy and productivity, or grandiose thinking

____ alcohol or substance abuse

____ domestic violence

____ sexual or physical abuse

The family history may include members with obvious bipolar disorder, but various relatives may have one or two traits or behaviors that go along with the disorder: anxiety, creativity, marked success, irritability, impulsivity and violence, physical abuse, hypersexuality or sexual abuse, recurrent depression (especially psychotic depression), suicide, marked mood changes with hormonal flux (in women), substance abuse, a disregard for rules and lawbreaking. Especially when a child's symptoms and developmental history are not definitive, it is important to examine family history.

* * *

It is also important to bear in mind that in psychiatry, diagnosis is sometimes clarified only over time and not with a single evaluation. Even when diagnosis is made accurately, the child's future course cannot be predicted: it will depend on the severity of the condition, the timeliness with which treatment is begun, the comprehensiveness of the treatment, and sometimes on good fortune. The best assurance of comprehensive and effective treatment is a family that is well informed and open to help.

Diagnosis and Treatment

Once again, there is no single trait or item in the current symptoms, family history, or developmental history, nor any particular combination of them, that definitively establishes the presence of bipolarity in a child. But if

· you've marked several of them

· they have persisted over a period of time

· and your child is off track developmentally

you should consult with a child psychiatrist before any medicine is started. This is important because in psychiatry, bipolar disorder is a great masquerader, often appearing at first like other less serious conditions, such as ADHD, simple depression, or an uncomplicated anxiety disorder. However, the medicines commonly used to treat these other conditions can aggravate bipolar disorder.


Excerpted from Understanding the Mind of Your Bipolar Child by Gregory T. Lombardo. Copyright © 2006 Gregory T. Lombardo, M.D., Ph.D. Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Meet the Author

Gregory T. Lombardo, M.D., Ph.D., is a board certified pyschiatrist who specializes in child and adolescent psychiatry. He maintains a private practice and is an Associate Clinical Professor at St. Vincent's Hospital and a Clinical Assistant Professor at New York Medical College.

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