Since it first appeared on bookshelves, The Bipolar Child has made an indelible mark on the field of psychiatry and has become the resource that families rely upon. Now, with more than 200,000 copies sold, the first book about early-onset bipolar disorder is completely revised and expanded.
Bipolar disorder—manic depression—was once thought to be rare in children. Now researchers are discovering not only that bipolar disorder can begin early in life, but that it is much more common than ever imagined. Yet the illness is often misdiagnosed and mistreated with medications that can exacerbate the symptoms. Why? Bipolar disorder manifests itself differently in children than in adults, and in children there is an overlap of symptoms with other childhood psychiatric disorders. As a result, these kids may be labeled with any of a number of psychiatric conditions: “ADHD,” “depression,” “oppositional defiant disorder,” “obsessive-compulsive disorder,” or “generalized anxiety disorder.” Too often they are treated with stimulants or antidepressants—medications that can actually worsen the bipolar condition.
Since the publication of its first edition, The Bipolar Child has helped many thousands of families get to the root cause of their children’s behaviors and symptoms and find what they need to know. The Papoloses comprehensively detail the diagnosis, explain how to find good treatment and medications, and advise parents about ways to advocate effectively for their children in school. In this edition, a greatly expanded education chapter describes all the changes in educational law due to the 2004 reauthorization of IDEA (Individuals with Disabilities Education Act), and offers a multitude of ideas for parents and educators to help the children feel more comfortable in the academic environment. The book also contains crucial information about hospitalization, the importance of neuropsychological testing (with a recommended battery of tests), and the world of insurance. Included in these pages is information on promising new drugs, greater insight into the special concerns of teenagers, and additional sections on the impact of the illness on the family. In addition, an entirely new chapter focuses on major advances taking place in the field of molecular genetics and offers hope that researchers will better understand the illness and develop more targeted and easier-to-tolerate medicines.
The Bipolar Child is rich with the voices of parents, siblings, and the children themselves, opening up the long-closed world of the families struggling with this condition. This book has already proved to be an invaluable resource for parents whose children suffer from mood disorders, as well as for the professionals who treat and educate them, and this new edition is sure to continue to light the way.
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About the Author
Read an Excerpt
Voices from the Front
In 1992 Tomie Burke, a young mother in Pullman, Washington, developed a listserv (called BPParents) for parents of children with bipolar disorder. She was motivated to do so because when her six-year-old son first began experiencing the baffling and frightening symptoms of the illness, she searched community and university libraries, bookstores, databases, and Internet pages in her desperate desire to become educated about the illness and to help her child. She found little to check out, purchase, or download.
But eventually she did become extremely knowledgeable about the illness, and she wanted to reach out to other families--to provide information and assure them that they were not alone. She soon had an address on the World Wide Web called Parents of Bipolar Children. The site consisted of a home page, links to information about the disorder, and a guest book where parents could describe how they found the site, note whether they had a boy or girl with a diagnosis of bipolar disorder, and comment a bit about their situations.
The messages left by parents who visited convey a desperate need for information and sheer relief when they discover that they are not alone-that the illness is not uncommon and that it isn't caused by bad parenting. That first year thousands of parents came to the site seeking help for their children.
What is early-onset bipolar disorder, and why is it such a little-known illness? Most people have never heard of the expression, but it is actually psychiatry's phrase for manic-depression that occurs early--very early--in life. (Adults who used to be diagnosed manic-depressive are now also referred to as having bipolar disorder.)
Bipolar disorder in children is a neglected public health problem. It is estimated that one-third of all the children in this country who are being diagnosed with attention-deficit disorder with hyperactivity are actually suffering from early symptoms of bipolar disorder. Since close to 4 million children were prescribed stimulants such as Ritalin in 1998, that's over 1 million children who eventually will be diagnosed as bipolar. According to the American Academy of Child and Adolescent Psychiatry, a third of the 3.4 million children who first seem to be suffering with depression will go on to manifest the bipolar form of a mood disorder. Researchers in the field of early-onset bipolar disorder peg that figure closer to 50 percent. Amid all the dry statistics stand several million suffering children as well as their mothers, fathers, brothers, sisters, and grandparents.
This illness is as old as humankind, and has probably been conserved in the human genome because it confers great energy and originality of thought. People who have had it have literally changed the course of human history: Manic-depression has afflicted (and probably fueled the brilliance of) people like Isaac Newton, Abraham Lincoln, Winston Churchill, Theodore Roosevelt, Johann Goethe, Honoré de Balzac, George Frederic Handel, Ludwig von Beethoven, Robert Schumann, Leo Tolstoy, Charles Dickens, Virginia Woolf, Ernest Hemingway, Robert Lowell, and Anne Sexton.
But until recently, manic-depression was thought to affect people in their early twenties or older. It was not viewed as an illness that could occur among children.
This has proven to be myth. The temperamental features and behaviors of bipolar disorder can begin to emerge very early on--even in infancy. But because a vast majority of bipolar children also meet criteria for ADHD (and the focus of drug treatment strategies becomes the symptoms of ADHD), the bipolar illness is typically overlooked. As a result, drugs are prescribed to deal only with the symptoms of hyperactivity and distractibility. And, since many, many children initially develop depressive symptoms as the earliest manifestation of the illness, bipolar disorder may again be discounted as the primary diagnosis.
Childhood bipolar disorder can overlap or occur with many disorders of childhood other than ADHD or depression: panic disorder, generalized anxiety disorder, obsessive-compulsive disorder (OCD), and Tourette's syndrome, to name a few. And this mixed-symptom picture can be perplexing and confound diagnosis. Moreover, only in the past few years has bipolar disorder become the focus of research inquiry.
The Illness in Adults
Bipolar disorder in children presents very differently from how it presents in adults. Adults typically experience a more classical pattern of mood swings. In the manic phase, the person experiences an increased rate of thinking, has surges of energy, and describes him- or herself as feeling more active, creative, intelligent, and sexual than he or she ever thought possible. The need for sleep diminishes as one idea after another bursts into consciousness and the person develops the expectation that he or she will be able to execute all the ideas that are flowing effortlessly into the mind. For many, a mild hypomania (less than manic state) is a period that brims with physical and mental well-being. It is often a time of great creativity.
Unfortunately, this enviable state does not last. A person experiencing the "highs" of manic-depression may make reckless decisions, go on buying sprees, commit sexual indiscretions, or bring financial ruin upon self and family. The mood of someone in a manic state is brittle and irritable; it may shift back and forth quickly, and the person may become very paranoid. If the hypomania escalates into a full-blown mania, the person can lose all touch with reality and become psychotic. In this stage (called stage-three mania), a doctor may be unable to tell whether the patient is schizophrenic or manic-depressive without having the family history and other information about the patient's previous functioning.
Typically, after the manic energy is spent, the person plummets into the depths of depression. The mind slows down to such a degree that any decision seems almost impossible to make. Some depressed people will experience insomnia and early-morning awakening; others will begin to sleep excessively and yet never feel rested. In addition to mood, energy, and sleep disturbances, a person in a depression may feel bodily pains such as headaches, backaches, and stomach problems.
Some adult patients will feel inordinate amounts of guilt; some will feel irritable, anxious, and hopeless. Depressed patients may feel they deserve only punishment and can become fixed on all the small mistakes they have made in their lives--losing any sense of past accomplishments. In the depths of depression, a person's thinking can become delusional and psychotic.
It is not unusual for adults to experience several weeks of hypomania or mania-very often in the spring or summer months-only to find their energy level ebbing as the days shorten in autumn. Individuals who experience depressions alternating with intense or psychotic manias are referred to as having the Bipolar I form of the disorder. Those who suffer depressions and experience only hypomanic episodes (they never get psychotic or lose total control) are referred to as being Bipolar II. Most adults will have well intervals in between the periods of heightened or lowered mood.
Bipolar Disorder in Children
Children rarely fit this recognizable pattern. They have a more chronic course of illness where they cycle back and forth with few discernible well periods in between. Some tend to cycle rapidly (more than four times a year); some cycle within the week or month (and may be called ultra-rapid cyclers). Many cycle so rapidly that they fit a pattern called ultra-ultra-rapid (ultradian) cycling: They may have frequent spikes of highs and lows within a twenty-four-hour period.
Almost all bipolar children have certain temperamental and behavioral traits in common. They tend to be inflexible and oppositional, they tend to be extraordinarily irritable, and almost all experience periods of explosive rage. They tantrum for hours at a time. Holes get kicked in walls, and parents and siblings and pets can be threatened or hurt.
Bipolar children don't often show this rageful side to the outside world. And because parents don't wish the outside world to see the child in this light, or to learn of their lack of control over the child--most people couldn't possibly imagine what actually goes on anyway--the illness stays behind closed doors as the parents try desperately to find some solutions to the fact that their lives are being turned upside down. As one woman described it: "We feel like we've been thrown into a tornado that is big, black, and powerful."
No one symptom identifies a child as having bipolar disorder, but if hyperactivity, irritable and shifting moods, and prolonged temper tantrums co-occur--and there is a history of mood disorders and/or alcoholism coming down either or both the mother's and father's line--the index of suspicion should be high.
Indeed, our study sample showed that over 80 percent of the children who developed early-onset bipolar disorder had what is known as "bilineal transmission"-substance abuse and mood disorders appeared on both sides of their families.
Perhaps the best way to get a "feel" for what the illness looks like in childhood is to listen to the voices of parents describing the temperaments and behaviors of their children.
From the Trade Paperback edition.
Table of Contents
Preface to the Third Edition vii
Diagnosis and Treatment
Voices from the Front 3
The Diagnostic Dilemma 27
How to Find Good Treatment 58
Prescriptions for Treatment 75
The Genetic Aspects of Bipolar Disorder 150
Inside the Brain and Mind
The Psychological Dimensions 173
What Causes This Condition? 200
Living and Coping with Bipolar Disorder
The Impact on the Family 245
School: A Child's World Beyond Home 284
The Neuropsychological Testing of a Bipolar Child 336
Navigating the Shoals of Adolescence 361
When a Child Is Hospitalized 382
The Insurance Maze 405
Life Goes On
Agenda for the Future 425
The Bipolar Child Questionnaire 433
Most Helpful Customer Reviews
After trying many parenting techniques and being very consistent and clear about rules and boundaries, and looking to a psychologist for help, it finally became clear that it was not our parenting skills, but something much deeper in our child. I could relate to the stories from parents about incidents with their children and appreciated the candid discussion on what helped their children and what did not. The book gives a lot of basic information for a parent facing this diagnosis. I highly recommend it.
this book is not intended as a diagnostic tool but as a primer, a sourcebook, a source of encouragement and education. Pay no attention to the trendy denial types who snort in misinformed derision. A child or teen with bipolar disorder has a serious brain disorder and the diagnosis, once made, is an all-hands-on-deck proposition. Learning to deal with the raging, the over-reaction to the word 'no' and the carb craving - to name but a few common symptoms, was like a lifeline to my family. Fewer than half of kids with this disorder are thought to be correctly treated and diagnosed. Parents - take heart and arm yourselves with info. This book is an excellent start. Do not be cowed by those who 'decide' that you are making this up, and seek help. It can take years to find help but with some direction, these young lives can be set to rights and they can thrive and learn alongside other kids.
I found this book about Bipolar Disorder to be very helpful. I have found it helpful to read as many books as possible about this disorder as my daughter has Bipolar 1. Another new book just released I found inspiring and has given me great hope is a new memoir called "I just want my daughter back - coming to terms with Bipolar 1? by BC Levinson that I found on Amazon.com . Seeing how others cope with bipolar disorder has made a big difference in our journey. It gives hope to those of us walking in these shoes. I actually found the new book through Twitter.com.. you can even chat with the author @BIPOLARSMOM2 . Very nice lady.. Hope this helps Sue
This book was recommended to me by my child's psychiatrist. My child has bipolar disorder and we are well into treatment. Even so, this book adds a lot to my understanding of the research. This is the third edition and has obviously been updated to reflect research published between editions. The section on schooling is particularly full of detailed information and I wish I had had it earlier in this school year when we were coming up with an IEP for my child. I definitely think this book is a resource for parents (and older children/young adults) dealing with bipolar children. I would not suggest it before you've seen a therapist, psychologist, or psychiatrist, however. As the authors note, diagnosis is NOT easy with this condition and a person reading this book should NOT use it 'diagnose' their child, or any other child. The only annoying thing in the book to me is a repetition of the possible seasonality of the illness. Some people with bipolar disorders experience seasonal changes in the illness course--the authors repeat this excessively. I especially find this irritating because my child does not appear to have this particular presentation so the repetition is irrelevant and therefore annoying. Otherwise, however, the book is well-written, research-based, and focused on treating this illness, not treating the child as though they are otherwise than ill. I would stress to anyone dealing with bipolar disorder to seek the assistance of professionals. This book can give you a foundation of information, but it can't do everything. Use it as an excellent tool and get help.
I'm not an avid reader, so when I saw the size of the text in this book, I was immediately intimidated. However, once I started reading, I realized that it was written so that laypersons can understand the subject matter. My son has recently been diagnosed bipolar and after my initial panic, I am working hard at educating myself. I found this book to be very easy to read and full of helpful information for me, as a parent. I highly recommend it.
As a researcher in the field of the mind and as a parent myself, I feel it needful to report that this volume is a total fabrication. Since when is childhood a disease? I have never found a child, whether my own or another's, no matter how unruly, that did not respond to love and to having his/her needs and concerns addressed-- the same as the rest of us. The idea of medicating a toddler is not only non-functional, it's pretty much of a crime. Love your children and listen to them. I did, and my daughter and I have have lived in mutual respect and admiration for 25 years.