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Bi-Polar Disorder in kids — Good Parenting

Welcome to Good Parenting, our weekly online series on parenting advice with Annapolis, Maryland, expert Dr. Deborah Wood.

Headshot2011Bi-Polar Disorder in kids — Good Parenting

Dear Dr. Debbie

I have been curious about the behavior of a preschooler in my child’s class. “Tad” talks rapidly, changing his voice between topics. He’s also highly active and often hard to control. He seems to have more conflicts during play time than the others. He definitely argues more with adults than other children. When he gets upset it’s hard to quiet him. But he can also be sweet and calm. Today he made up a song that he sang to me. It was precious.

I had a cousin who died young (suicide in his 30s) who, according to my mother, may have had bipolar disorder. Can bipolar disorder be diagnosed at a young age? And if this child is bipolar, when I substitute in the class, are there strategies I can use to help him?

Intrigued

Don’t miss last week’s column on games kids can play

Dear Intrigued,

There has indeed been a shift in the past 20 years toward earlier recognition of behaviors that could indicate
bipolar disorder. Major strides in research of and treatment for young children have brought helpful interventions into play. Originally termed Manic Depression, the disorder is characterized by extremes of low and high moods that can switch for periods of hours, days, weeks or longer. In children, there are often “mixed moods” or frequent irritability. Below are behaviors that could be observed in a preschooler with bipolar disorder. Sometimes only manic behaviors, alternating with typical behaviors for the age, are observed in early childhood, with the depressive behaviors appearing in adolescence or later. If a child has several of these symptoms, and he or she is experiencing challenges because of them, a professional diagnosis followed by appropriate treatment would do the child, family, and school a lot of good.

Depressive Behaviors: boredom, lethargy, pervasive sadness, distractibility, disregard for personal safety, avoidance of normally enjoyed activities, social withdrawal, violent themes in art/ conversation/ play, extreme irritability, oppositional with adults. Most adults are naturally uncomfortable seeing a sad child which makes us disinclined to label him as depressed. A child might be regarded as “timid” or “reserved” which sounds less like a debilitating mental illness. The acceptance of the notion that a young child could be experiencing depression has delayed diagnosis and treatment for many children.

Manic Behaviors: excessive chatter, impulsivity (including aggression), risk-taking behavior/poor judgment (darting into traffic), hyperactivity/ restlessness, inappropriate silliness or sexuality, “grandiosity” – an inflated self-esteem or sense of power.

“This is different than the ordinary, energetic state of young children, even children with ADHD,” explains Dr. Joan Luby of Washington University School of Medicine (St. Louis, Missouri). “When you ask healthy young children what they’re capable of doing, they are known to inflate their capabilities and say they can run very fast or jump very high or even fly like Superman. What’s different about grandiose children is that they become delusional and actually believe they can do things like run the preschool. An extreme example that I’ve seen involved a manic preschooler who believed that she made the sun rise and set.”

Discuss your observations with the teacher and or director. The school may already be aware of a diagnosis or they may appreciate having specific behaviors to cite when encouraging the family to seek help. Confidentiality with the family may prevent the teacher and director from sharing medical information with you (since you are also a classmate’s parent), however there are helpful classroom strategies to use when you sub whether or not any of the children has a professional diagnosis of Bipolar Disorder.

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