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Bipolar disorder has recently been identified as one of the most misunderstood and underdiagnosed conditions affecting children and it is dramatically on the rise. The Ups and Downs of Raising a Bipolar Child gives parents the sound advice and expert information they need to cope with this challenging diagnosis, and shows how to provide essential care and support for a bipolar child as well as for the rest of the family.
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About the Author
Judith Lederman, a freelance writer and public relations consultant, has written for The New York Times and a number of national magazines, and hosted two weekly radio shows in the New York area. She is the parent of a bipolar child and lives in Scarsdale, New York.
Read an Excerpt
The moment I discovered that I was the mother of a child with bipolar disorder, also known as manic-depression, my life became the ultimate learning curve. I knew something was terribly wrong one summer day in Mystic, Connecticut. My son, then five years old, stood on the edge of a pier at the seaport museum and, under a sparkling summer sky, threatened to kill himself. What horrible incident triggered the outburst? An ordinary parental limit-setting moment. I'd just informed him and his brother and sister that we were headed inside the museum. He wanted to explore another ship, and when I said no, he stomped to the edge of the pier, where he teetered over the smashing waves below. His blue eyes clouded with tears as he threatened to jump into the angry sea. A crowd began to gather as my husband and I tried to talk him away from the edge. We were afraid to charge at him and grab him, afraid he might jump. I helplessly led the other children away as my husband moved closer and spoke to our sobbing child in low tones.
We waited for what seemed to be hours but was actually only about ten minutes. Finally, my husband reappeared, hand in hand with our son. I said a silent prayer and vowed to find out what was wrong. It would be three years before I got an answer.
Unlike his brother, who as a baby was always squalling and fussing, this son was an even-tempered infant a baby who gave me his first smile the morning after he was born (it wasn't gas!). He seemed exceptionally bright and would lie quietly in his crib or playpen for hours on end, amusing himself with toys and life swirling around him.
He was unusually sensitive to others' feelings. He knew instinctively how to rest his head on the shoulder of a friend who needed a cuddle, and loved sharing toys, food, anything at all with just about anybody.
As a toddler, he was very attached to me. When I tried to leave him with babysitters, he clung to me and refused to let me leave. I did what all the books suggest: developed a good-bye ritual, said good-bye firmly, and left without looking back. But the crying, pounding, and kicking echoed in my heart long after I left. According to the sitters, it took him a long time to get over my leaving much longer than it took other children his age.
Before his sister was born, my son, then two and a half, kicked the Lamaze teacher as she worked with me on the floor. His angry outbursts continued after his sister was born. He adored her but got angry at her, and his aggression got worse as she grew older. The emotions were normal but the expressions of them extreme. He was genuinely bent on inflicting harm one minute, then gentle and loving the next. As he got older, these behaviors were more pronounced.
I worked from home most of the time when he was small always nearby, but with babysitters in place to care for him and his sister. The babysitters just couldn't manage him. One reported that he charged after her and his sister with a stick. Upon tendering her resignation, another said, "In all my life, I've never heard a child curse like he does." The whirlwind of babysitters was taking a toll on my son, but we needed my income. It became harder to focus on my work as his behavior escalated.
One day I came home from a meeting to find my daughter with a deep gash down her cheek. The babysitter was devastated.
"It happened so fast he scratched her for no reason at all," she stammered.
I blamed the sitters. I blamed my career. I blamed my horrible parenting skills. And I blamed my husband. I read every parenting book I could get my hands on and tried every system of discipline, from charts to tickets to marbles. All the blaming brought me no closer to an answer. I knew I needed help.
After the suicide attempt, I brought my son to a psychologist recommended by the school district. I was surprised when the psychologist shrugged off the incident, chalking it up to "attention-getting tactics." "He's a very manipulative child," the psychologist told me. He said I should ignore the outbursts and implement a good reward-based system. I went back to the books and looked for a method that I hadn't already tried and abandoned.
School was becoming a problem. Getting him there was half the battle. At night, he stayed up later and later, no matter how early we began his bedtime routine. In the morning, he refused to get out of bed and routinely missed the school bus. I tried to let the consequences of his decisions rest on his shoulders; when he missed the school bus, we walked to school. On really bad days when he would hide under the bed and refuse to get dressed, I'd grab my pajama-clad son in one arm, his clothes in the other, and drive him to school half dressed. One day the principal had to climb into the minivan, pry him from the backseat, throw him over his shoulder, and deposit him in his first-grade class.
When my son managed to tow the line at school, his behaviors at home got worse. The situation affected everyone in the family. My older son, going through his own teenage turmoil, didn't understand how his brother "got away" with such terrible tantrums. My daughter, who vacillated from being his best friend and caregiver to being the victim of his anger, was starting to imitate his behaviors. My husband and I argued about parenting, about the money it would cost to bring our family to therapists, and about the budding awareness that something was seriously wrong.
Worse yet, our struggle was alienating us from our friends, our community, and even our extended family. His antics on the community baseball team stomping off the field, refusing to go up to bat, accusing coaches of mishandling him raised more than a few eyebrows. We felt isolated. People blamed us for our son's strange behavior.
At age eight, he slept just a few hours at night, but he had boundless energy. Then he would become sad so sad he would cry and say he wanted to die. One morning, I woke up at 4:00 a.m. to find him marching around the house, banging on a tambourine. He said he couldn't sleep and was bored so he decided to have a parade. His aggressive behavior was worsening as well. We battled daily threats. He lay down on the railing of the deck, about eighteen feet off the ground, and threatened to roll off. He pointed a kitchen carving knife at his older brother, then later against his own wrist.
"I don't want to be here," he would cry as I tried to put him to sleep.
"Here where?" I asked.
"Here on this earth," he whispered. "I don't want to live."
In desperation, I searched our health insurance plan and called several psychologists. Few got back to me, and the earliest appointment any of them could give me was two weeks away. When one of them finally took the time to listen to the symptoms, he suggested that I bring my son to a psychiatric hospital. He gave me a few numbers, and I made an appointment for that night. My husband was opposed to the idea, but I couldn't take yet another sleepless night followed by a day of rage. I was mentally, emotionally, and physically exhausted.
Although my husband was in denial about the seriousness of the problem, I felt I had to get my son help. Leaving my husband in charge of the other two children, my son and I drove to the hospital.
The psychiatric facility, housed in an old stone mansion on the crest of a windswept hill, was eerily lit by the setting sun. We were asked to sit in a library with floor-to-ceiling shelves piled with dusty old books. A nurse brought us some markers, and we played umpteen games of tic-tac-toe. My son was relaxed, but not at all sleepy, even though it was getting quite late. As the nurse asked me detailed questions about my son's sleeping habits and rages, my son got angry that I was "telling" on him. Markers flew. He refused to listen when the nurse politely told him to stop. He kicked her when she tried to restrain him.
The nurse reached a phone, and other staff members arrived to help restrain him. They searched his pockets, inventoried his belongings, and even took away his boots, now considered dangerous since he used them to kick the nurse. I watched in horror, tears springing to my eyes, as they forced my eight-year-old child out of the room.
A psychiatrist explained to me that they would evaluate my son in the hospital. They would administer medication that would help him, and they would monitor him while he was in the hospital. I called my husband, and he was livid. The psychiatrist explained that if I didn't sign the papers, my son would be committed all the same. Based on his observations, something was terribly wrong.
"If you don't allow us to treat your son, children's protective services will be called in," he warned. "If they take over, you will be forced to forfeit your parental rights to make any decisions for your son."
I reluctantly signed papers enabling the hospital to evaluate my son for seventy-two hours.
By the time I left the hospital, it was 2:00 A.M., and it looked even creepier than before. I wiped away tears of exhaustion as I drove down the empty highway.
As I crawled into bed early that morning, one comforting thought surfaced: even as I was plagued by guilt, feeling that this was somehow my fault, I was relieved that my son was finally going to get help.
Three days later, the insurance company prevailed upon the hospital. With a diagnosis of attention deficit disorder and depression, the hospital reluctantly released my son. I was given prescriptions for three drugs: Ritalin, for hyperactivity; Seroquel, to address the rages; and Luvox, an antidepressant. I made a follow-up psychiatric appointment with a clinic recommended by the hospital. The earliest a psychiatrist could see him was in three weeks. Meanwhile, I filled the prescriptions and waited for everything to get better. To my shock and disbelief, things got worse.
On Hanukkah, my son flew into a rage, and we had to guard the candles to make sure he wouldn't deliberately burn the house down. He was like a feral animal, running outside naked and urinating on the front door. I had bruises all over my body from trying to restrain him. The rages seemed only to intensify. Those weeks on Ritalin and Luvox were three weeks of hell.
On the day he was scheduled for his follow-up, our son threatened to throw a ten-pound weight at my husband's head. Together, we managed to disarm him and carry him to the car. At the psychiatrist's office, he sat backward in a chair, playing with the light switch. He walked out of the office with one of us in tow several times.
The child psychiatrist took a family history and seemed especially interested in hearing about my husband's father, who had been diagnosed many years ago with something called "involutional melancholia." He watched quietly as our son fussed, fidgeted, and mumbled to himself. And then the psychiatrist got angry.
"I can't believe that hospital! Your son isn't ADHD. This is as clear a case of early-onset bipolar disorder as I've ever seen and they released him after only three days? I'm going to call the insurance company right now. We've got to get him treatment."
My husband and I shrugged. The diagnosis meant nothing to us at the time, but anything that would explain our son's behavior was welcome. A few minutes later, the doctor was on the phone with the insurance company, demanding in no uncertain terms that they approve another hospitalization for our son.
We were thrilled to finally have an advocate, as well as a name for our son's illness. Doctors at the new hospital, a teaching hospital, confirmed the diagnosis of early-onset bipolar disorder and explained that this mental illness causes extreme highs and lows. We were told that although the disorder sometimes goes along with hyperactivity, Ritalin can worsen the symptoms of bipolar disorder, sending patients into uncontrollable rages.
But the most amazing thing that the psychiatrist told us was that our son's behavior was not our fault. He assured us that bipolar disorder and its attendant mood swings are very, very real and that time and treatment would help. The treatment is helping. Although my son still gets angry and irritable, his rages seem to have ended and his depression has lifted. With our help, he manages to do most things an ordinary adolescent does. His schedule is modified. He needs special programming in school. We stay in close contact with his teachers, doctors, and other adults who work with him. We make sure they understand that although our son is a highly intelligent child, his behaviors and reactions can sometimes be unpredictable and are not to be taken lightly.
We now know that managing bipolar disorder is a lifetime effort. Mental health professionals say that bipolar disorder is one of the most treatable mental illnesses and that new medication and other breakthroughs are just around the corner. We take it one day at a time and pray that they are right. Days, even weeks and months, pass when we are challenged, but we no longer feel the helplessness that we experienced that day watching our son on the edge of a pier in Mystic.
This journey has been a learning experience; we've come a long way now that we know what we are facing. When I began this book, my son, then ten years old, routinely wore army camouflage togs. He felt safe in his camo a soldier no one could hurt. But the real threat came from within, from inside his tousled, curly head, where his moods festered like brew in a bubbling cauldron. One minute, he smiled a beatific smile that reminded me of his sweet, calm, newborn face. Moments later he was agitated. He will always have his moods, but things have improved with time and treatment. He and my entire family are so much better and stronger now than when I started my research and writing.
I am writing this book from a unique point of view: one of a mother who suffers as she watches her child suffer from a condition that is his alone but affects just about everyone in the circle of family and friends. Over the years, as a mother and primary caregiver for my son, I have seen pieces of myself being stripped away. My career, the work that sustains me, must be set aside when his moods so dictate. His behavior can trigger copycat behavior in our other children. Leisure and entertainment are meted out in contained doses to keep him stable, as are family trips and vacations. What is normal for other families scouting, sports practice, food shopping, a visit to the museum, the occasional movie can, on a bad day, send my son into a tailspin, and so we curtail these activities, closely examining his moods and responses.
In each chapter, "Notes from the Couch" offers the psychiatrist's perspective on the issues being discussed. Candida Fink, M.D., my coauthor and noted child psychiatrist, has been treating children with bipolar disorder for many years. Her notes offer guidance and support.
My hope is that this book will find its way into the hands of people who shake their heads, glare, and "tsk-tsk," as they stand in line at the supermarket watching an eight-year-old bipolar child beating, cursing, and berating his helpless mom. This book is for the teachers who eschew psychologists' endless labels and claim that if given the chance, they could "do a better job" parenting a child who rants, cries, or rages each day in the classroom. This book is for the doctors who, in spite of clinical training, cannot believe bipolar disorder can manifest itself in a small child and wonder if parents are overmedicating their children to make life easy on themselves. If you recognize these people, as so many parents of bipolar children do, urge them to take the time to read this.
Most important, this book is for you, the parent of a bipolar child, who, like myself, has been trying to understand why your child seems so different from other children. Whether you suspect something is wrong or have already received a diagnosis, you'll find both practical guidance and emotional reassurance here. In these pages are information, heartfelt support, and unique coping methods to help you deal with everything from difficult spouses to legal conundrums to blood tests, road trips, camps, and schools everyday situations inspired by the ups and downs of your child's life.
An on-line questionnaire was made available to parents of bipolar children at www.parentingbipolars.com from 2001 through 2002. To date, there have been several hundred responses. For this book, responses were tabulated and sifted through; the information is shared in quotations, through statistics, and with anecdotes. The same site is live now with information and links for anyone parenting a child with bipolar disorder.
Copyright © 2003 by Judith S. Lederman and Candida Fink, M.D.
Table of Contents
Part One: Your Bipolar Child
1. The Diagnosis: What It Means to Be Bipolar
2. Mental Health Care Professionals: Picking Your Team
3. The Moods: Helping Your Child Through Mood Swings
4. The Medications: The Right Prescriptions for Your Child
5. The Structure of Daily Life: Routine Is Everything
6. Hospitalization: When and How to Get 24/7 Care
Part Two: Your Child in the World
7. Day Care, Schools, and Camps: Finding Safe and Appropriate Care and Education
8. Friends and Family: When and How to Explain Your Child's Condition
9. The Law: A Good Lawyer Can Help
Part Three: Your Family
10. You: Caring for Yourself So You Can Care for Your Child
11. Relationships: Meeting the Challenge Together
12. Siblings: Parenting the "Normal" Ones
Part Four: Money Matters
13. Career: Balancing Work and the Biggest Job You'll Ever Have
14. Family Finances: Paying for Special Needs Now and Later