MY 9-YEAR-OLD son has pediatric bipolar illness. Psychiatrists, psychologists, pediatricians, social workers, and teachers have all weighed in on his diagnoses. When he was 6 months old, even a baby sitter offered her opinion: "There's something not right about him," she muttered.
Since the age of 6, my son has been on three different atypical antipsychotics, along with other medications. He is in a substantially separate classroom at school, and not long ago was hospitalized in a pediatric psychiatric unit for three weeks. He had done fairly well for a time, and I convinced myself the problems were a phase, but it came crashing down. As one of his teachers says, "He gets this look in his eyes, and I know he can't cope." I know it, too.
My son is suffering, and I, as his mother, seem unable to make it better. He rages, and if you think this is a generic kid tantrum, you have another thought coming. At other times, he completely shuts down. Transitions are hell, and he is often glued to me. Trying to wake him in the morning is a Herculean task. Early mornings are so stressful that we are often both exhausted by 9 a.m.
Yet he can be the kindest child, with a smile that could light the planet. He is physically beautiful, so graceful, and lives in the world in a way that is deeply different than many humans. Some have called him gifted.
I am convinced that because he feels pain so deeply, he identifies deeply with the pain of others. At age 5, when we were reading a children's book about God, he said, "I don't think God is a man or a woman, because God is too big for that." His words took my breath away. That is a concept some adults never get to, never mind a 5-year-old.
Just as God is far too complex an idea to limit to one category, I ask that question about my son. His mood swings and behaviors seem to fit within the pediatric bipolar spectrum, but is it possible to assign these children a sole diagnosis of bipolar? Does such a condition even exist in children? I have no idea. His psychiatrist believes deeply that it does, but the current debate -- perhaps "war" is more accurate -- over pediatric bipolar and the use of psychiatric drugs in children fills me with uncertainty, guilt, and fear.
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Recent findings from the multi-site, NIMH-funded Course and Outcome of Bipolar Illness in Youth (COBY) study are helping to shape the understanding of three major subtypes of bipolar disorder that affect children and adolescents and how this diagnosis may affect them as adults. Also known as manic-depressive illness because of its recurring episodes of mania and depression, bipolar disorder is a serious, chronic illness which causes shifts in a person's mood, energy, and ability to function. Before the COBY study, there had been few studies on the symptom patterns and course of the disorder in the pediatric population. Understanding the effects of bipolar disorder early in life may lead to better treatments and improve long-term outcomes as these children and adolescents become adults.
Overall, bipolar disorder appears to affect children and adolescents more severely than adults. Study participants had comparatively longer symptomatic stages and more frequent cycling (changing from one mood to another) or mixed episodes. Children and adolescents also converted from a less severe form of bipolar disorder to a more severe form at a much higher rate than seen in adults.
This study comprises the largest pediatric bipolar population to date, following the course and outcome of 263 children and adolescents, ages 7-17 years. These findings were published in the February 2006 issue of the Archives of General Psychiatry. Future reports will cover in more detail the characteristics of bipolar spectrum disorders in children and adolescents, the longer-term disease progression, predictive factors of disease outcome, such as co-occurring disorders or family psychiatric history, and the effects of different types of treatments.
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