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Bipolar
mood disorder in children
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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. |
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