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Saturday, February 19, 2005

Child and Adolescent Bipolar

There was an article recently in the Washington Post about the increased rate of diagnosis of children and adolescents with Bipolar Disorder. This article has engendered a bit of discussion in my little blog world.

Synergy mentions her sympathy for children so diagnosed. Shrinkette posted portions of a response to the article by an associate professor of psychiatry at the University of Washington who doubts the veracity of all of these diagnoses.

I found the timing of all this to be highly coincidental. And I'm posting a copy of an email I sent to shrinkette as an explanation why.

You know by now that I have bipolar disorder. I don't advertise it: it's not something that is going to get me brownie points with a lot of people.
I'm slowly learning not to be ashamed of it, which I think is important. But I still keep the diagnosis close to the vest with most people, including a good chunk of my family.

It's interesting timing that you posted what you did regarding children with BP. Last night my 13 year old son out of the blue asked "Am I bipolar?"

I was shocked. I asked him why, where was this question coming from? He explained that a boy he goes to school with, Chris, is bipolar. I asked if Chris takes medicine, and he didn't know. So I tried to explain the details of bipolar symptoms. And believe it or not, I struggled to put them into terms that would both satisfy him and protect myself. I was loathe to have him see me as damaged, just in case he found out that I too am bipolar.

So I hit on a solution. We googled "bipolar disorder questionnaire" and came up with a good one I've seen (and used) before at We went through the questions carefully, and the questionnaire said that he did not appear to have the disorder. I then gave him a verbal example of manic pressured speech and he said "That's Chris."

We also went to another website: A statistic appeared there that a study had shown that 59% of adult bipolar patients believed that their symptoms had first appeared during adolescent or childhood. I did NOT read to him the statistics about the likelihood of the inheritable nature of the disorder. I am not going to allow him to label himself with something that may very well never be.

I'm writing this to you for two reasons:

1) My son had heard of a diagnosis and was wondering immediately if the same applied to him. Teens conform. But there's also a "cool" thing about being different. I'm wondering if there's an element to my son that was kind of hoping he was bipolar, so he could be set apart, be unique in a VERY unique way. When I explained to him about the negative thoughts, thoughts of self-harm beyond your control, I think he cooled to the idea. He asked me if I'd ever thought that way and I told him that I did as a teen (I wasn't going to tell him how frequent that happens to me now - he'd worry himself sick).

Teens are caught in a tension of wanting to strike out on their own and still needing the security of conformity. That can result in some very strange behaviour when seen through a parent's eyes. How many families are using the diagnosis as a straw to grasp, not to be cool, but to explain why their teen is no longer that nice young man they could take to church a few years ago? Doctor doctor, there's something wrong with my son! He never listens anymore and is depressed when I force him to stay in his room as punishment.

2) My son can also be pretty irritable. So I also believe he was looking at his mood changes in that direction and wondering if he did have BP. Then, after we'd turned away from the BP diagnosis, he said that his father (from whom I've been divorced since he was a toddler) is really irritable too. "Did I get that from my dad?" he asked. I said "I believe you LEARNED it from your dad. I think you watched your dad all your life and have learned a specific pattern of behaviour." He agreed. And I reminded him that no matter why he was irritable sometimes, it is important for him to monitor that behaviour and not to place it on the shoulders of others. "It's not fair for you to treat other people badly because you have difficulty not getting irritated. It is within your control."

I know that as a bipolar patient that I cannot rely on my disorder as an excuse for behaviour. I am not making light of the childhood BP patients: I am one of those 60% who did exhibit signs as a late teen. But how many are using it as an easy out for bad behaviour and/or bad family dynamics, rather than face an equally difficult problem of a difficult kind head on? Medicate rather than discuss?

It's a difficult line to draw because the sand keeps shifting.

I meant what I said to shrinkette. I am not making light of those children who are so diagnosed. But the rise in its prevalence seems to echo the rise in the ADD diagnoses 10 years ago: every "problem" child was ADD. It was the thing to do to explain why Johnny was so difficult to handle. But once you label someone, you cannot take it back. You cannot unring the bell. Let's be sure that before we commit these children to a lifetime of potentially health-altering drugs (I say as I have images of my upcoming liver biopsy in my mind), let's be sure that we're sure.

Blogger Dreaming again said...
In a brilliant attempt to prove my psych (whom I adore) wrong about me being bi polar, I decided to take the test.

It said it appears I probably do have it!

So I went back and answered all the questions positive and put severe interference with life ... and it gave me the EXACT same answer as it gave for my legitimate answers!

Don't think I'm sharing these answers with Dr. M for him to say "yea, huh, I know that, I told you that!"

I'm just a hyper person!!  

Blogger moodymicello said...
Blondzila, I so agree with you on the subject of labeling these young people BP and then using it for an excuse. This is where behavior modification comes into play, that is therapy to learn coping skills to manage situations in a more appropriate manner.Adam is lucky, you showed him an appropriate way to find out about BP; he is satisfied and not worried. That same approach can be used in changing unhealthy behaviors. I have benefited from this myself. That is the piece that is missing because the parents are already frustrated. I'll admit having been at my wits end with one of mine. Because I was the parent, "I knew nothing" so we engaged a professional therapist to help with behavior modification. No label; no meds. Turns out this kid isn't bipolar; she has recurrent light depression.
She is a licensed attorney and a 3rd grade teacher and a great problem solver; an extremely active parent, teacher, wife and daughter. So there are alternatives before we just label them and IN ADDITION TO the label. In fact, there are kids out there that are just "problem" kids that could benefit from a little therapy. The right kind and the right therapist. Michele  

Blogger Dangerous Mind said...
I agree it is so much easier to label people - be it bipolar or something else - rather than dig a bit deeper.

And I so agree with you when you say:

"I know that as a bipolar patient that I cannot rely on my disorder as an excuse for behaviour."

Personally speaking a manic episode caused me problems in the workplace four years ago because of some things I said to senior management. At the end of the day it was MY fault & had to take responsibility/deal with the consequences. I can't blame the BP since the thoughts were mine and I meant what I said.

Sure it was out of character for me to be outspoken in the workplace ..... but amongst friends it's a different matter.  

Blogger Cliff said...
Blondzila, I think you handled this masterfully, and I can understand why you did it as you did.

I chose another route, and was totally open about my illness. Only one person, a co-worker, didn't receive it well, and that person made my life a living hell for two years.

(No, Cliff, do NOT post his name, address and phone number...)

I'd do it again though. I have never used it as an excuse, but when facing a new challenge there is a period where you are still climbing the mountain. During that period, your performance isn't up to snuff, but when it's clear you are trying your hardest, everyone pulls with you.  

Blogger moodymicello said...
But when the episodes get out of control, it doesn't appear we are trying...then what. I agree with Blondzila. I didn't make it known when I was working. It would have been fodder for the corporate political machine. No, no, no, no, no.  

Blogger Internal Medicine Doctor said...
When there is a spike in diagnosis it is always difficult to interpret the reason behind it. Is it that now we have better definitions and greater knowledge that we are catching these disorders earlier, thus the rise in diagnosis. Or, has it become a default dignosis.
I, for one, a skeptical that psychiatrists would diagnose anone with BP as a default dignosis as we are all well too familiar with the side effects these medications can cause.
I do not know many psychiatrists who don't weeigh pros and cons.  

Blogger Dreaming again said...
Mad House, that commentary does not help my denial about my psych claiming that I have bipolar. It's easier to think of it as a default diagnosis when you're trying to stay in denial!

If one more person tells me that having kids with tourette's has a higher incident of moms with bi polar, I'm gonna scream there too. Yes, I know, I have several on line friends on TS parents lists who have bi polar and TS kids.

I'm hyper that's it I tell ya!  

Anonymous Anonymous said...
"that psychiatrists would diagnose anone with BP as a default dignosis as we are all well too familiar with the side effects these medications can cause."

HAH! I say. Among other things, pediatricians and FPs are making the diagnosis and handing out meds.

I also think kids are being diagnosed with Aspergers who aren't -- they are just quirky. But Mom and Dad are happier with a diagnosis than having a kid who is a little off the charts.

I am deeply ambivalent about this issue, though. I am not myself BP, although my mother was (and some other MIs, too). I had my first depressive episode (that I remember) about 3rd grade. I did not get any help for depression until I was over 30. I wonder how my life would have been different if I'd learned early that the changes in thinking and motivation weren't because I was lazy or spoiled, but an actual change in brain chemistry.  

Anonymous child benefit said...
Hi. Do you by any chance know of any sites which help people to get 'child tax credit' advice? I found this one 'child tax credit' ; do you know of any others? Many thanks  

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