A Mind of Their Own See our articles in Parents & Children’s Central
Bipolar Children ; Disorder Can Show Up Differently in Young…
(Richmond Times – Dispatch)
Jul 23rd 2004
A charmer with brown, doelike eyes and a cherub face, 6-year- old Joe Gallo flits around his family room as deftly as a fly dodging a swatter.
Like other children his age, Joe is inquisitive and eager to join conversations. On the surface, he appears content, but inside churns an emotional storm. Last year, Joe was diagnosed with early onset bipolar disorder.
Diagnosing the disorder was difficult because Joe did not exhibit the extreme symptoms most commonly seen.
“There were days, months when he would be OK. Then there would be weeks and months when he was frenetic and feeling out of control. He would have strange anxieties,” said Joe’s dad, Chris Gallo, who said some symptoms resembled Attention Deficit Hyperactivity Disorder.
“Joe was emotionally fragile, and then you would see ADHD behaviors,” Gallo said. “None of the medical professionals wanted to address the variance between his behaviors.”
Joe’s erratic behavior surfaced when he was 3. “He didn’t want anyone to leave the house,” his father said.
Sally Gallo, Joe’s mom, remembers how he fixated on what frightened him. “He would talk about morbid things like death. They weren’t things he would pick up watching television.”
Physical boundaries also were a problem. “There were desperate sorts of hugging and kissing,” Chris Gallo said.
The Gallos, who live in Chesterfield County, began researching Joe’s symptoms.
“We thought it might be sensory integration disorder, the inability to process sensory input,” Chris Gallo said. But Joe’s behavior was starting to show more classic signs of early onset bipolar disorder.
“He had a lack of empathy,” his father said. “He would attack his sister for no reason. He didn’t have any response to that. He was totally blank. Before, he would have been upset.”
A pattern was taking shape. Periods of contentment and flexibility faded into days and weeks of emotional chaos and anxiety. “It was really disturbing,” his father said. “The only thing that remained constant was the emotional fragility. It was difficult for us.”
The Gallos tried everything from a strict, disciplinarian approach to rewarding good behavior.
“We were doing all the good parenting stuff right and it wasn’t working,” his mother said. “We would give him gold stickers , and that caused more anxiety.”
Nothing worked. Their search for an answer led them to Dr. Bela Sood, medical director of the Virginia Treatment Center for Children and chairwoman of the Division of Child and Adolescent Psychiatry at Virginia Commonwealth University.
“These disorders have always existed , but they weren’t correctly diagnosed,” Sood said, noting that in the past, doctors based a diagnosis on adult symptoms. “They are becoming aware that it is dissimilar to adults. It’s important to educate people about this illness and how it presents in children.”
Dr. Demitri Papolos, co-author of “The Bipolar Child” and associate professor of psychiatry at the Albert Einstein College of Medicine of Yeshiva University in New York, said there has been a myth in American psychiatry that the condition does not exist until puberty.
“That’s perpetuated by the lack of accurate diagnostic material,” he said, adding that all definitions of the disorder are based on adult studies.
* * *
In adults, bipolar disorder is episodic, occurring in cycles. Classic symptoms include mood-disorder disturbances – extreme euphoria or irritability.
“The euphoria comes out in a grandiose presentation,” Sood said. “They think they can take over the world. With this comes hyperactivity, flipping from topic to topic, a flight of ideas.”
Other symptoms include delusional thinking and paranoid thoughts. “The worst side effect is the potential for self-harm,” Sood said. “Suicide is much higher than major depression. Their judgment is impaired and risk-taking so high.”
In children, the biggest distinction of the disorder is constant irritability. “Often people dismiss it as the way the person is wired,” Sood said. “Euphoria is not that common in kids.”
Janice Papolos, who co-authored “The Bipolar Child” with her husband, said a child’s behavior can change every 20 minutes. “They can go from silly to depressed to irritable to silly. They change like Jekyll and Hyde.”
Children may experience night terrors and be difficult to settle. “They have difficulty making transitions of any kind – from being awake to asleep, asleep to awake,” she said. “Usually, they have sleep disturbances, noticeable from early childhood, even infancy.”
Often when you see bipolar disorder in very young children, it tends to be severe. “The word `no’ can evoke a 45-minute rage,” Janice Papolos said.
Doing a simple chore can cause a meltdown. “Parents learn that they have to walk on egg shells and pick their battles,” Sood said. “They have no idea what provokes the kid.”
The Gallos know all about meltdowns. “When we would walk out to go to the mall, for example, Joe would literally dissolve into a crying, screaming mess,” his father said. “This would happen once an hour.”
“We would stop and have to help him put himself together again,” his mother added. “There were times when we would have to sit down and hold him or hug him until he could gain control of himself.”
Conversely, children with early onset bipolar disorder may be extremely charming and creative. To outsiders, everything looks normal. But in the home, the family is drowning in the disorder, especially the mother.
“People would say the mother is making it up,” Janice Papolos said. “The mother may be blamed by the doctor, her husband. … She’s like an abused wife. She doesn’t want the world to see her child in this way.”
Often parents tolerate the behavior for years, thinking it is just the child’s personality.
“The child likes to be bossy,” Sood said. “It’s my way or no way. A bipolar child is looking for a fight. Their irritability gets the best of them. It’s rare for these kids to be in a normal mood.”
During Joe’s second year of preschool, he suffered from extreme separation anxiety, screaming for his mother to the point that she would have to sit with him at school. Children with the disorder are fearful, anxious and phobic, Papolos said. “They have difficulty separating from their mom.”
She said there may be a genetic connection to the disorder. “Based on our studies, early onset children come from families with bipolar and alcoholism on one or both sides. If there is a strong family history and a young child is having mood swings and becoming aggressive, find a psychiatrist or physician who can make a diagnosis.”
* * *
Children with bipolar disorder can’t negotiate normal relationships, and getting treatment is critical.
“These kids can’t go through life without lots of problems,” Sood said. “They could become suicidal or have addictions. You have to do something with it.”
There are a variety of therapies available, such as anger control and cognitive-behavior therapy, where children learn to look at a situation from a different perspective. Medication also may be prescribed for moderate to severe cases.
Prescribing the right medication is crucial to the child’s well- being. “Other conditions are treated with stimulants and antidepressants,” Papolos said. “Our studies with bipolar have shown that treating kids with these drugs can alter the course of the illness. They can develop adverse symptoms. They will have an increase in mood cycling and aggression.”
Joe has been on Risperdal, an anti-psychotic drug, and Zoloft, an antidepressant, for a year. Within a week of starting the medication, the Gallos saw a difference.
“Risperdal lessened the aggression, which was the main problem we were having,” his mother said. “Once that was in his system, he was so anxious all the time he wouldn’t go outside in the daytime alone. That’s when we introduced the antidepressant.”
Family support is essential for bipolar children. “The family has to learn how to handle the child when the child is having a meltdown,” Sood said. “Inconsistency in parenting can split parents up.”
The Gallos admit they sometimes lacked patience, especially in the middle of the night. But they worked as a team. “We helped Joe through it faster by taking him seriously,” his mother said.
Now, even though Joe’s behaviors have not disappeared, they are more manageable, his parents said. He is happier.
Joe admits he was apprehensive about talking to doctors about his feelings.
“I felt a little scared,” he said with a wide grin that exposed two missing front teeth. “Dr. Sood and Dr. Oswald are really good.”
Symptoms of children with bipolar disorder include:
* lack of appetite
* poor concentration
* low self-esteem
* sleep disturbances
* crying spells for no apparent reason
* talk about hurting themselves
* suspiciousness about their environment
* depression, acting more sullen and withdrawn
* catastrophic reactions to minor stresses
* Virginia Treatment Center for Children, (804) 828-3129
* “The Bipolar Child” by Dr. Demitri Papolos and Janice Papolos
* The Bipolar Child: www.bipolarchild.com
* Juvenile Bipolar Research Foundation: www.jbrf.org
* Child and Adolescent Bipolar Foundation: www.bpkids.com
* Depression and Bipolar Support Alliance: www.dbsalliance.org