Question:

I have a 7-year-old son diagnosed with ADHD/Bipolar.  After seeing several doctors, psychologists and finally a child psychiatrist, he was diagnosed with Bipolar and put on Lithium.  Evidently, extreme ADHD can often be mis-diagnosed when really  Bipolar.  This has been such a horrible experience.  We are now on our 3rd elementary school in 1 1/2 years.  They just give up until I pull him and demand another IEP meeting.  He is at least 2 years behind academically and  we are still struggling with behavior issues.   These teachers are just not equipped to handle these kind of kids.  I am very frustrated and wondering what advice you could give me in help improve our situation.  Thank you in advance.

Dixie

Answer:

Dear Dixie;

Thank you for your timely question. I am sorry to hear about you and your son’s experience with Bipolar Disorder (BPD), formerly known as manic-depressive illness. However, you are fortunate in having your child diagnosed and treated early. BPD in children is often difficult to diagnose because only the criteria for adult BPD has been formalized. Misdiagnosis or lack of diagnosis and treatment can lead to worsening of symptoms.

Childhood BPD is a serious and sometimes life-threatening condition. Until the last ten to fifteen years, experts did not believe that this disorder occurred in children. Conservative statistics now point to occurrence in about 1% of children. Research has also indicated a connection between AD/HD and juvenile BPD. Children with childhood onset BPD often have AD/HD (98%, Wozniak et al., 1995). Though children with AD/HD are more at risk for developing BPD than the general population, most studies show a significant but small risk (6-20%, Barkley, 1998). Specific statistics vary depending on the source but the existence of childhood BP and the relationship with AD/HD is generally recognized. Bipolar Disorder is hereditary as is AD/HD. Your experience with misdiagnosis is common. Severe AD/HD has many of the same symptoms as childhood BPD.

For those readers who have never heard of the condition, I have listed some of the symptoms of the disorder according to the Child and Adolescent Bipolar Foundation. However, I caution readers not to try to diagnose this illness yourself. Diagnosis of this disorder is a complicated process and should only be done by highly trained professionals, preferably a child psychiatrist who has seen a large number of these children.

• an expansive or irritable mood
• extreme sadness or lack of interest in play
• rapidly changing moods lasting a few hours to a few days
• explosive, lengthy, and often destructive rages
• separation anxiety
• defiance of authority
• hyperactivity, agitation, and distractibility
• sleeping little or, alternatively, sleeping too much
• bed wetting and night terrors
• strong and frequent cravings, often for carbohydrates and sweets
• excessive involvement in multiple projects and activities
• impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
• dare-devil behaviors (such as jumping out of moving cars or off roofs)
• inappropriate or precocious sexual behavior
• delusions and hallucinations
• grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

There are several types of BPD and you should check with your son’s clinician to familiarize yourself with your child’s type.

Addressing specific behavioral concerns faced by you, your son and his teachers is difficult as I have not met your son and you do not list specific concerns. However, as a parent, one of the most important things you can do is to educate yourself, your son and your son’s teachers about the disorder. The Child and Adolescent Bipolar Foundation website has a wealth of information that can assist you in putting together a packet of information to share with your child’s teacher. Included on the website is a handbook for educators and online courses for both parents and educators about educational rights and teaching strategies. Also available is a booklet for children, illustrated by children that describes how it feels to have a mood disorder. In addition to education, you will benefit from the support of other parents facing similar challenges. CABF sponsors online and in-person support groups across the country.

Child and Adolescent Bipolar Foundation (CABF)
http://www.bpkids.org/

Demystification of BPD to those working with your son is essential. The most important concept to communicate is the fact that BPD is a brain disorder. Unfortunately, our society still attaches a lot of stigma to mental illness and many people incorrectly believe that BPD is a character defect or a behavior problem that is potentially under the child’s control. Teachers need to understand that any possible rage attacks that occur are not directed personally at them but may be a symptom of this illness. CABF advocates for the use of the special education classification of Other Health Impaired (OHI) to obtain services because this classification emphasizes the biological nature of the illness. Some school districts may prefer to use the Emotionally Disturbed (ED) classification. Teachers may need to receive training in charting your son’s moods at school to provide feedback to his physician. In addition, you may need to prepare yourself for the possibility that your son may not be able to be educated in the general class setting for his entire school career. Particularly when his condition is not stabilized, he may need a more restrictive setting, such as a special day class or day treatment center.

School problems associated with BPD and medication include sleep disturbance, impaired concentration, memory problems, slow visual fine motor coordination, increase or suppression of appetite, blurring of vision and irritability. Many children with BPD are uncommonly bright but suffer from learning disabililties. Unfortunately, all of the medications used to treat BPD have significant side effects. Some medications can cause cognitive dulling, slurring of speech and physical discomfort such as excessive thirst and nausea. Your son’s educators need to be familiarized with these before making decisions about possible accommodations. Some possible medication-related accommodations are listed below. You will need to discuss the side effects of your child’s medication with his physician to determine which of these might apply to him.

• access to a water bottle
• opportunity to use the restroom when necessary
• reduction in reading assignments due to blurred vision [bullet/indent/block}opportunity to nap at school if the medication causes drowsiness [bullet/indent/block}frequent behavioral and/or medication monitoring reports from the teacher

Sleep disturbance is common in BPD. Your child may sleep excessively during the depressive phase of his illness or seem to have little need for sleep when manic. Some accommodations you may need to consider:

• allowing late arrival
• shortening his school day

Children with BPD are vulnerable to stress and need a curriculum that will teach coping strategies. Some stress-relieving accommodations to consider are:

• consistent routine
• seating away from distractions
• shortened assignments
• prior notice for transitions
• specific planning for unstructured times such as recess
• scheduling of challenging tasks at a time of day when the student is best able to perform.

An extensive list of accommodations categorized by symptoms is available on the CABF website.

A list of resources is also available. Some of my favorites are:

Greene, Ross W. The Explosive Child. Harper Collins, 1998

Papolos, Demitri and Janice Papolos. The Bipolar Child. Broadway Books, 2002.

Steele, Danielle. His Bright Light: The Story of Nick Traina. Delacorte Press, 1998. Danielle Steele tells the story of her son’s life and ultimate death from bipolar disorder.

Waltz, Mitzi. Bipolar Disorders: A Guide to Helping Children and Adolescents. O’Reilly, 2002

For teachers:

What is Childhood Bipolar Disorder? A Resource for Educators An interactive CD created by CABF for teachers.

For Children

The Storm in My Brain. Illustrated by children with BPD, this book details how it feels to have bipolar disorder. The book is available free of charge at the CABF website.

Additional Websites

Juvenile Bipolar Research Foundation
http://www.jbrf.org/

Bipolar Child website
http://www.bipolarchild.com/

Positive Environments, Network of Trainers
http://www.pent.ca.gov/posenv.htm
A California Positive Behavior Initiative, sponsored by the California Department of Education, designed to provide information and resources throughout California for educators striving to achieve high educational outcomes through the use of proactive positive strategies for behavioral intervention.