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Bipolar mood disorder in children
Mental health is scary to talk about, especially when it comes to psychiatric illnesses. What is even more scary is when it happens to ones child, and when the onset is in their early childhood and pre teen years. Those are meant to be the years of happiness and free play, before hormones and peer pressure turn them into moody teenagers. Yet what happens when you notice that your child’s moods and behaviours become extreme? What happens when your child attempts the unthinkable – suicide?

Often misdiagnosed as ADHD, or depression, or both, Borderline Personality Disorder and Post Traumatic Stress Disorder due to similar symptoms being displayed, Bipolar Mood Disorder in children seems to be on the rise. However Dr Ulie Meys, a psychiatrist in Cape Town who has just returned from the World Child Psychiatric Conference in Beijing, cautions that often a diagnosis is given too quickly. A quick diagnosis then hinders correct treatment methods, and would affect the child for the rest of their lives, not only in medication terms, but also in family relations and when trying to get life insurance or immigration clearance later on in life. It essentially could wrongly label someone for life.

As with anything that involves your child, using ones intuition should never be underestimated. You know your child better than anyone, and in order to help in a correct diagnosis, it is helpful to keep a diary of moods, and have as much information about family history, your child’s moods and reactions to certain situation and any cyclical trends that you might notice.

The first hurdle, as a parent, is to realize and accept that your child’s moods and behaviour are extreme, and no longer manageable through normal parenting methods. Nicky’s* daughter started displaying symptoms of extreme irritability from the age of 7 onwards. By 9 years old she attempted suicide for the first time. Depression in children does not display as it does in adults, as they don’t have the words and means to communicate it. Instead Nicky’s daughter became defiant, irritable and anxious. Her irritability would sometimes translate into aggressive behaviour. She hated it when her routine was upset, and after a while her sleep patterns changed and she complained of a constant sore stomach. In retrospect these are all symptoms, yet when one is not aware of Bipolar Mood Disorder these can just be seen as ones child acting out, or ‘going against the grain’. However, children need an opportunity to act out as they cannot correctly express their feelings, and this is usually acted out in a negative way. Children do not enjoy negative attention, so it is vital to look into why they are acting in that way.

By the time Nicky’s daughter was diagnosed as having Bipolar Mood Disorder at the age of 12 she had already spent 6 months in a state facility, as well as changed school a few times due to her teachers finding her unmanageable. Oftentimes should would giggle uncontrollably, forcing the teachers to remove her from the class. Children may act out at school, rather than at home, due to the home environment being their safe space. This is often the opposite in adult bipolar, as an adult suffering from bipolar can at certain times reign in their irritable moods in public, but take it out on those closest to them. When Nicky’s daughter got the diagnosis the whole family felt a sense of relief, as they had been subjected to much judgement about their parenting methods, with people thinking they were overreacting, or not being strict enough. They had also been through various doctors giving their daughter diagnoses that never made sense.

Cindy’s* daughter was only recently diagnosed at age 15. After a car accident when she was 7 years old, which resulted in a head injury, Emma* started displaying signs of early puberty and became extremely precocious. This resulted in social and peer pressure problems, and subsequently isolation, and by the age of 10 she was suicidal. Although her family history is rife with bipolar stories, doctors were waiting for a trend of cyclical symptoms before making the diagnosis. There was also the fact that she could have suffered frontal lobe damage in the accident. Some doctors were all too happy to prescribe a pill and not look at her holistically. In her early teen years Emma began to have hypo manic episodes, which resulted in sexual exploits, cutting and school changes. Then she would become reclusive, not make eye contact, dress in black with hoods or hats covering her head, and spent most of the day in her room. These moods could be explained away as teenage moods, a reaction to a break up with a boyfriend or embarrassment about her sexual behaviour becoming gossip fodder amongst the community. However, after a suicide attempt at age 15 she was admitted to a private adolescent clinic facility. She was asked to leave the facility due to sexual misconduct, even though heightened sexuality and risk-taking behaviour can be symptoms of bipolar. There is no dedicated adolescent facility for psychiatric disorders, so Emma resided with substance abusers and residents with eating disorders.

For any child social participation and interaction are essential for their self-esteem. For a child suffering from a mood disorder social acceptance can be extremely difficult. Other children don’t understand their extreme behaviours, and usually after a manic or hypo manic episode the child will sink into depression not only due to the chemical imbalance, but also due to embarrassment about how they acted during the manic episode. If on medication children also often put on weight, which adds to their low self-esteem. Hormonal changes are also rapid, making a teenagers natural body changes that much more confusing. Clinics and state facilities are not healthy environments to be in, with no dietary or exercise plans for the residents. Substance abuse becomes common as a way of self-medicating. Schooling is missed in big chunks, usually resulting in a child repeating grades or stopping school early. All of these factors impede the recovery process.

Dr Meys will not make a diagnosis before school going age, and even then will usually make a provisional diagnosis only and continue to monitor the child, the family relations and home environment, as well as look at causes and triggers. If there is a family history of mood disorders then he will monitor the child more closely. In order to help ones child holistically he suggests that families create consistency, structure and boundaries in their home life. Discipline should be consequential, and parents can assist in regulating their children’s moods before it gets too late. Dr Meys will also look at how symptoms have evolved in order to see whether or not they are age and environment appropriate. He also mentions that there are a few new disorders currently under review, namely Temper Disregulation Disorder, Mood Disregulation Disorder and Sensory Mood Disregulation Disorder. This illustrates that the psychiatrists themselves are not always entirely confident in diagnosing children with BMD. Since the case in the United States where a 3-year-old child died of an overdose of psychotropic drugs, after having been diagnosed with BMD at the age of 2, the medical professionals have realized that they don’t always have a category in which to explain a child’s behaviour.

New research points to bipolar being epigenetic, indicating that correct nutrition is essential for the brain. Parents can feel more in control of the relentless situation at home by getting involved in their children’s treatment plan. Education and acceptance is essential, not only for yourself but for extended family, carers and educators. Dietary changes may be essential, as well as psychotherapy for the whole family. A support network is useful. The divorce rate of parents of children who suffer from BMD is extremely high, as the child, their behaviour and recovery becomes the focus. Siblings may become resentful. During an episode families’ resources can become stretched to the limit, so it is essential to have a good support system of people who can understand, help and empathize. In extreme behaviour it is important to suicide proof ones home, keeping away dangerous tools and medication, and possibly finding a place of safety for your other children.

Nicky says that the hardest part has been other peoples’ perceptions of her as a parent. When they had to leave her daughter at a state facility at the age of 7, there was no follow up support for them as parents. They essentially went home to nothing. Many people assumed that the situation was due to their bad parenting skills, or were just too embarrassed to offer support. The medical professionals do not have the resources and skills to offer support for the whole family. Nicky felt as if she was constantly being questioned and judged. She also got stuck in the negative cycle of “why me?” and “why my daughter?” Since taking control of her daughters treatment, which has involved a trip to London to the Bio Brain Clinic and attending the Innate Health Conference, she has also learnt to step back and rather ask herself “how?”, a more empowering and solution based question. She has also learnt not to mimic and react to her daughters’ moods, which is extremely difficult when her daughter mentions suicide, after two serious attempts.

Although difficult as a parent, one has to adopt the airline oxygen theory. You cannot look after your child properly unless you look after yourself. The best way to do this is to educate yourself as much as possible if your child is diagnosed with BMD. Surround yourself with empathetic and understanding friends and family, and use any support networks and structures available to you. And never stop searching for and identifying the light in your child, the special shining light that makes your child so special. For even with BMD, your child can achieve and find happiness and create and inspire and love life, and with your help their light can shine brighter than ever.

Nicky is keen to share her knowledge on holistic treatment methods that have helped her and her daughter in their quest to create stability. She and her daughter will be speakers at an Intergrating Polarities workshop that will be aimed specifically for parents and educators of adolescents.

Please email bipolarworkshops@gmail.com for more information on workshops that are facilitated in communities with the aim of sharing knowledge and empathy, de-stigmatizing mental health and creating intentional peer support. Workshops are facilitated by Nina Mensing and Suzanne Leighton.

Helpful websites include:

www.jbrf.org

www.foodforthebrain.org

www.bpkids.org

Dr Ulie Meys can be contacted on 021 689 2196

Written by Nina Mensing author of “A Manic Marriage’ www.bipoarsupporters.ning.com

* Names have been changed.

On the 30/09/2010 Professor Willie Pienaar will be giving a talk titled "My relationship with my child and adolescent" at Stikland from 18:00 - 19:00. For enquiries call Madeleine Swart 021 940 4591 / 082 434 7377. No charge, but donations welcome.