What is Bipolar Disorder?

How can you tell in children?

What should you do now?

Bipolar Disorder

What is Bipolar Disorder? It is a brain disorder that causes unusual shifts in a person’s mood, energy, and ability to function. It affects 5.7 million American adults, and is estimated to be at least as common among youth as with adults. Just like diabetes, bipolar is a long-term illness that must be managed throughout a person’s lifetime. A consistent treatment plan can have a positive stabilizing effect on mood swings and related symptoms.

What are the symptoms of Bipolar Disorder?

How can you tell with children?

Children expressing grandiose behaviors act like the rules do not apply to them. They may believe they are so smart that they tell the teacher what to teach and the other students what to learn. They may believe they have “superman” powers, such as the ability to fly, or stop bullets.

Flight of ideas is when a child jumps from topic to topic in rapid succession and cannot seem to focus or follow one train of thought.

A decreased need for sleep is shown when a child only sleeps 4 to 6 hours and is not tired the next day. They may stay up rearranging furniture or playing on a computer.

Hypersexuality can occur in children with bipolar disorder without physical or sexual abuse being involved. These children flirt in a manner beyond their years and may try to touch the private areas of adults, such as their teacher, and use explicit sexual language.

Children with bipolar disorder will commonly cycle very rapidly having multiple cycles during the day and go from silly highs to gloomy lows. It is important to watch out for these depressed cycles because of the danger of suicide. Any talk of suicide should be taken seriously and needs immediate attention from a professional or doctor.

Commonly Observed Symptoms in Children

• Separation anxiety

• Rages or explosive tantrums lasting hours

• Marked irritability

• Oppositional behavior

• Rapid cycling or constantly changing moods

• Distractibility

• Hyperactivity

• Impulsivity

• Restlessness or fidgeting

• Silliness, giddiness, goofy for no apparent reason

• Racing thoughts

• Aggressive behavior

• Grandiosity

• Carbohydrate/sweets cravings

• Risk taking behavior

• Depressed mood

• Lethargy

• Low self esteem

• Difficulty getting up in the morning

• Social anxiety

• Over-sensitivity to emotional or environmental triggers

• Bedwetting (boys)

• Night terrors

• Rapid or pressured speech

• Excessive daydreaming

• Obsessional behavior

• Compulsive behavior

• Motor or vocal tics

• Learning disabilities

• Poor short term memory

• Lack of organization

• Fascination with gore

• Hypersexuality

• Manipulative behavior

• Extremely bossy or bullying

• Lying

• Suicidal thoughts

• Destruction of property

• Paranoia

• Hallucinations/ delusions (psychotic episodes such as hearing voices)

Suicide

Signs and Symptoms of Suicidal Feelings

• Talking about feeling suicidal or wanting to die

• Feeling hopeless like nothing will ever change or get better

• Feeling helpless, like nothing you do makes any difference

• Feeling like you are a burden to friends and family

• Abusing drugs or alcohol

• Putting affairs in order

• Writing a suicide note

• Putting yourself in harms way or where there is a danger of being killed.

What to do:

• Call a doctor, emergency room, or 911 immediately for help

• Make sure you or the suicidal person are not left alone

• Make sure access is restricted to excessive medications, alcohol or drugs, weapons or other objects that could be used for self harm.

What are the treatments for Bipolar Disorder?

First line treatment for Acute Manic without Psychosis begins with mood stabilizers. These include Lithium, Depakote, Tegretol, and atypical anti-psychotics Zyprexa, Seroquel, and Risperdal, Trileptal, Geodon, and Abilify.

If patient has symptoms of psychosis, then the first line treatment is usually Lithium or Depakote plus an atypical anti-psychotic.

Treatment of Acute Depressive Phase: the use of Lamictal as a mood stabilizer in the depressive phase of bipolar disorder is common. It is NOT recommended that anti-depressive drugs be used unless a good first line mood stabilizer is in place and the child is stable.

Psychotherapies can help give children the tools they need to help them express what is going on inside of them, identify behaviors that control or de-escalate intensity of mood state, and give the child a safe place to practice these tools.

They can also help parents and sibling to recognize triggers and warning signs and give them tools to intervene before escalation occurs. Facilitates communication between parent and child, parent and parent, and parent and siblings and develops teamwork skills that allow for mutual support. Gives parents and siblings a chance to practice these skills and develop confidence in them.

Note: Traditional Behavior Management Techniques are NOT effective in working with bipolar children as their state of mind is not able to comprehend or understand the meaning of reward or consequences. Parents should establish consistent rules and enforce through repetition and establishment as a pattern of behavior. Make it a habit, and practice good habits with your special kid and they will behave that way – most of the time.

The Stages of Rages or The Meltdown Sequence

• Triggers: Transitional changes, Sensory Overload, Being told “No”, Too much stuff, Too much information, Being Tired or fatigued, over extended, and Hunger. STOP and Be Aware of Mood Changes: Anger, Confusion, a confused or dazed look, Whiny/crying for no apparent reason, changing facial expressions from happy to sad or angry, body language changes, and this is the time to REDIRECT. Intervention at this stage can be very successful, but it needs to be noted that the child could be experiencing neurochemical changes that can cause the fight/flight/freeze reactions and that a meltdown is possible.

• Escalation: Mild escalations show slow anger outburst, name calling, startled responses(verbal/physical), quick rapid verbalization, voice getting louder, pitch increasing, arms-hands-body tensing. Rapid escalations showing a mental-physical-behavioral mood change, body tensing/throwing, quick temper, hostility, anger words (i.e. Hate, you never…, leave me alone…), profanity, voice escalation, red face, clammy body, making fists, and either backing away or moving into your personal space (proximity changes). These are the beginning of Panic Behaviors, Anxiety Behaviors, and Hostility Behaviors. Intervention at this stage is possible, but understand that the fight/flight/freeze response is probably underway and it is important to be calm, relaxed, and non-confrontational. Speak in a slow, quiet voice and be firm and simple with directives, or what you are asking them to do. If it is possible – walk away.

• Rage/Meltdown: In progress – allow the child space to go through the physical manifestations of the meltdown. Do NOT try to restrain, bully, yell, scream, or make them understand. Allow them to go through the cycle of fight/flight/freeze reactions.

• Post Rage or After the Meltdown: the child will be tired, passive, exhausted, spent, calm, sorry, apologetic, headache, may be remorseful or not, ready to do something positive, may not even be aware of behaviors, may not be willing to talk about triggers. They may even fall asleep for a while. Intervention is to allow them to put the behaviors behind them. Discussing consequences of behavior will not work at this point, It is time for consoling, releasing anxiety and pain and letting them know you are there for them. Help them understand what happened – (ie you just had a meltdown and when you are ready we can talk about what set you off…)

Rage or meltdown behaviors are NOT cognitive for the most part, and are not done through conscious thought on the part of the child with bipolar disorder. Behavioral expectations at this point need to be very basic (by parent, professional, therapist, teacher, etc.) as you cannot expect complex communication and understanding with a child going through a neurochemical event that is causing the manic depressive shift.

Keep the child calm, reduce distractions and stimulus while allowing the child to come down from the rage. Do NOT speak loudly, with anger, negativism, sarcasm, or a taunting tone. Stay back – DO NOT RESTRAIN! Your child may or may not remember what just happened – they may not even know they just had a meltdown!

Note: These four stages of rages are technically referred to (you may see this someplace, like in your child’s psychological evaluation) as: Dysphoric affect, provocation, explosion and exhaustion. 

Important Safety Note

Anielei Rose