HomeParenting Dilemmas

Bipolar at 5?

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By Dorothy O'Donnell

The B-word

During our meeting to review the results of Sadie’s evaluation, the school psychologist said Sadie scored high on portions of the test related to ADHD.

“But these could also be symptoms of something else,” she warned. “And ADHD doesn’t explain some of her behavior. You should talk to her pediatrician about getting a psychiatric evaluation.”

At home, I fought back tears as I read the full report. Sadie’s teacher noted that she veered from excessive silliness one minute to excessive rage the next. She was known as the “weird girl” and “the naughty girl” for her habit of blurting out random remarks. Both her teacher and the school counselor checked boxes for “severe” in response to questions related to Sadie’s risk for depression, anxiety, and atypical behavior. But it was reading what Sadie said about herself that hit me like a punch in the gut: “I feel sad most of the time.” “Nobody likes me.” “I’m a bad person.

A few weeks later, I followed Dr. Olson, a child psychiatrist, into his office. After multiple sessions of being grilled about my daughter’s behavior, I was about to find out what was wrong with her. I held my breath as he picked up a manila folder with Sadie’s name on the tab and opened it. The room felt like it was spinning. Based on reports of her behavior, our family history, and what he’d observed in Sadie, Dr. Olson believed she had early-onset bipolar disorder.

“Bipolar disorder?” I croaked. “Are you sure? What about ADHD?” Suddenly the earlier diagnosis didn’t seem so bad.

"I'm sorry,” he answered softly “I only diagnose one percent of the kids I see with bipolar disorder. And it’s very common for bipolar children to also have many ADHD symptoms.

Unwelcome reckoning

Mental illness, including bipolar disorder, is as deeply embedded in the DNA of both my family and Jim’s as the genes for brown eyes. My brother was diagnosed with bipolar disorder when he was 19. Over the years, relatives afflicted with bipolar disorder from both sides of our family have attempted suicide.

And then there’s my dad. Bipolar is among the mental illnesses he’s been labeled with since he was a young man. A talented musician, during his up spells, he loved to throw hootenannies and jam and drink the night away. He was also prone to buying exotic cars on a whim. When he came crashing down, his latest toy was always deemed a piece of crap and sold for a fraction of what he’d paid for it. After my mother divorced him, Dad spiraled into a suicidal depression and checked himself into a mental hospital. I flashed to the day I’d visited him there as a teenager and found him slumped like a rag doll in a room with walls the color of pistachio ice cream, surrounded by a group of equally listless patients. Now in his eighties, his mood swings have mellowed with the help of medication and sobriety.

There had been a few instances, especially after reading an article in The New Yorker about bipolar disorder in children — the first time I’d ever heard of such a thing — that I wondered if Sadie could have it. Some of the characteristics the author attributed to bipolar kids sounded like Sadie: “early talkers,” “extremely precocious,” “disruptive behavior.” And I knew that bipolar disorder often has a genetic link. But the idea that Sadie could really have it was too terrifying for me to contemplate — I pushed the notion away whenever it surfaced. It was so much easier to side with mental health experts who doubted pediatric bipolar disorder existed at all.

Between 1990 — the year some psychiatrists first proposed the disease could occur in young kids — and 2000, diagnosis of children with bipolar shot up 40-fold. Medical journals began publishing articles focusing on bipolar children. A listserv for parents of bipolar children — started by a mother whose son was diagnosed when he was 8 — helped spread the word. In 1999, psychiatrist Demitri Papolos and his wife, Janice, wrote The Bipolar Child. For families that had been seeking answers to explain their children’s debilitating mood swings and suffering, The Bipolar Child was a godsend. Critics of the book accused parents of kids with relatively minor behavior problems of rushing to see unqualified doctors to get a bipolar diagnosis — and medication to make their children easier to control at home and in school.

While some experts regarded the recognition of pediatric bipolar disorder as a great breakthrough, others argued that like many recently “discovered” mental illnesses, it was just the latest diagnosis du jour. They claimed that too many kids were being over-medicated with potent drugs intended for adults.

Sitting in Dr. Olson’s office, whatever I thought I knew about childhood bipolar disorder disintegrated in the crushing weight of the moment. I tried to listen to what he was saying. Something about starting Sadie on a regimen of Depakote as soon as possible to stabilize her moods. I snapped to attention when he casually rattled off a list of side effects she could experience: weight gain, nausea, sluggishness, and — oh, yes — in rare cases, serious liver damage or pancreatitis.

As horrifying as these side effects sounded, I worried about other effects he didn’t mention — what if medication erased Sadie’s creativity?

I thought about all the times she’d raced into our house after school and headed straight for her art supplies, bursting with plans for a project.

“I’m going to make a book, Mama!” she announced, standing at the kitchen counter because she was too excited to sit, chattering happily as she rapidly filled page after page with an illustrated story about two little girls who lived inside flowers.

Would Cowie, the stuffy she brought to life with a distinctive Scottish brogue, stop talking? “Hey — did you know the milk for Sadie’s mom’s latte came from my udders?” Cowie once quipped to a stressed-out Starbucks barista as Sadie held the stuffy over the coffee counter. The barista grinned and visibly relaxed.

Not joining

“Do you think she really has bipolar disorder?” I asked Jim that night after filling him in on my appointment with Dr. Olson.

“I don’t know,” he said. “You can tell her mind’s just zooming some times. But giving her medication scares the crap out of me.”

Later, unable to sleep, I went to the kitchen and turned on my computer. I forced myself to type the address of a website for families of children with pediatric bipolar disorder that Dr. Olson told me about. I clicked on a forum where parents discussed their bipolar kids and the medications they took. I felt queasy as I read about side effects of medication: the 9-year-old who packed on 20 pounds in three months, the kindergartner whose fits of anger escalated to murderous rages. Some of the posts were from mothers who’d been lucky enough to find a medication that worked. But many had tried drug after drug with no success.

I hated the cute acronyms they used: BP DD (Bipolar Darling Daughter) or DS (Darling Son). Even more disturbing was the way they signed their posts: their online names followed by the drugs their children were on and the dosages they took. There weren’t any signatures with just one medication. Most of them included a list of three, four, or more drugs.

I was nowhere near ready to join their club. I wanted to hold onto the belief that neither Sadie nor I qualified for membership.

A week later, Jim and I returned to Dr. Olson’s office. “You know, you can replace just about any body part these days,” Jim said, staring down the doctor. “But when your liver’s gone, that’s it — game over.”

Dr. Olson nodded. He understood our concerns but insisted that such serious side effects were very rare and could be prevented with careful monitoring.
“What about therapy alone?” I asked.

“Well, that’s always an option,” he replied. “But research shows that when you don’t intervene early with medication in a bipolar patient, the brain experiences what we call ‘kindling.’”

He explained how the first episodes of the illness are like the scraps of wood and paper needed to start a fire. Once that fire is blazing, you don’t need a trigger to spark future bipolar episodes. And they tend to be more intense and to occur more frequently over time.

As we got up to leave, Dr. Olson handed me a prescription. “It’s for the baseline blood work Sadie needs before she can start the Depakote,” he said. “If that’s what you decide.”

Dorothy O’Donnell has written about travel, health and business for a variety of publications. Her essays on motherhood have been featured in the Marin Independent Journal, Mothering and on KQED radio. She is working on a memoir about raising her daughter.