Yes, Bipolar Disorder Does Occur in Children

Jeremy walks in, wearing a broad smile. He chats garrulously with my staff. He is extremely hyper and starts playing with all the other patients in the waiting area, making rules and bossing them around. Seeing me, he runs up and twists my arm hard as we shake hands. He bursts into laughter as I pull my hand away. His mom, who looks tired and helpless, tells us Jeremy hardly slept the night before. He is chirpy and giggly, talking like a super-express train. He agrees to be videotaped, and my staff goes to get the equipment, but as soon as the camera is set up, his mood changes completely. He starts to direct the filming, then suddenly gets irritable and goes out of control, knocking over the equipment and swearing nonstop.

This is a real example from my clinic. Although somewhat dramatic, stories like these are hardly isolated incidents among bipolar children. Here are a few more examples of things that our patients said or did while in our clinic:

• John (age 10) lifted my research assistants up in his arms; he even attempted to pick up men twice his size and hug strangers, although he would startle and yell if anyone touched him.

• Cindy (age 6) threw herself onto the floor in the hospital corridor and refused to move or get up. She screamed incessantly and turned red in a rage for a half hour before getting blood drawn.

• Jared (age 11) touched everything in sight, talking constantly about things that seemed to have nothing to do with what he was exploring and ricocheting from one topic to the next. "I was thinking that there was this hamster that looked into a mirror and thought there was another hamster and he ran into the mirror!" he said, then laughed hysterically before darting off to another part of my office and telling a story about the time he had "saved" his brother from a dog with "teeth at least a foot long."

• Sylvia (age 9) hid testing materials in our lab in the bottom of a Kleenex box, locked my staff out of the office, threw testing materials away, and jumped up and down in the garbage can.

• Andy (age 7) saw a bird fly against the window of his third-floor playroom and land dazed on the roof below. He climbed out the window and onto the roof in an attempt to help the bird. When his mother retrieved him safely and asked him what he was doing, he responded, "I can fly." His mother reminded him that people can't fly, and he said, "Then God would save me."

• Hannah (age 8) declared, "I'm going to marry you and make you my pretty, pretty princess." She was provocative and overfriendly for a first meeting.

• In the course of 15 minutes during the diagnostic evaluation, Asaad (age 5) went from laughter to yelling and turning red, then broke down crying, unable to articulate his problems given his very young age.

• Joe (age 12) let out a torrent of taunts and criticisms, talking so fast that he was almost incoherent, yelling constantly, rationalizing his anger, and calling his mother a "moron" who had "no brains" as if he were a viciously angry ex-husband.

If your child has received a bipolar diagnosis, or you just suspect that he has the disorder, you may have one of two reactions to these examples. These glimpses of rapid mood swings, irritability, sensitivity to criticism, rapid speech, and difficulty focusing may seem so instantly familiar that you might wonder if someone came into your home and videotaped your child. Maybe your child has behaved in all of these ways at some point. Or you may feel that some of the symptoms match and some don't, that your child is never "that bad," but secretly fear he could get that way. You're not at all sure whether the behaviors depicted above that you are seeing in your son or daughter are indicators of bipolar disorder instead of something else entirely.

Even medical professionals have varying reactions to these types of cameos. Either they think these are accurate depictions of childhood bipolar disorder, or they believe that these are difficult behaviors not specific to bipolar disorder, or they dismiss them all as not really bipolar disorder. One parent was often told there was no such "animal" as early-onset or childhood bipolar disorder, and because she was in the mental health field she was accused of "looking for a problem that simply isn't there."

Let me take a minute to clarify how you should view the behaviors portrayed in these very brief stories. The complex emotional turbulence and havoc caused by these children is obvious and dramatic, but parents and professionals should realize that one size does not fit all—in other words, no one description captures all the typical bipolar diagnostic symptoms. Your child might have the "classic symptoms," which easily lead to diagnosis, and/or some difficult behaviors, like those described above, which occur more rarely but are definitely associated with the disorder. Because at our clinic we treat hundreds of bipolar children and research their brains and cognitive function, we recognize the wide range of symptoms that can lead to a diagnosis of pediatric bipolar disorder. We think in terms of treating a spectrum of problems related to wiring in the brain that cause dysfunction, rather than just hanging a label on a child based on a diagnosis.

Unfortunately, not everyone recognizes the diagnosis, and there is still a lot of controversy over the label. In this chapter, I hope to clear that up. Make no mistake about it; bipolar disorder does exist in children. The answers to...