Thursday, October 25, 2007

Bipolar is so five minutes ago


I've been writing this post for over a month now. See, the thing is, when I write about my feelings regarding diagnosis and psychiatry, my opinion changes constantly. If I don't publish as soon as I write? My mood, my opinion, my knowledge about the subject, will change. So. Here's a highly UNFINISHED post about how I feel about the high incidence of bipolar in children, which hit the airwaves in a big way about a month ago...

So. The diagnosis of bipolar disorder in children. Two weeks ago, I linked to only one of the many articles that have been appearing in many news outlets in the last couple of months, outlining a recent report on the increase in the bipolar diagnosis in children. I asked you to read it, and promised an opinion at the end of that day.

Um, well, you see... I've been distracted.

Nothing is going on, in any historic sense. I've been working on organizing my DVR for the fall TV season, doing homework with The Kid and getting attacked by my kitten. Lather, Rinse, Repeat. Also, my sister had a baby. And my best friend came to visit. And I find this difficult to get out because my mind changes often.

I've also had a difficult time organizing my thoughts in my response to all of this talk of childhood-onset bipolar disorder... Believe me, I think about this stuff as much as a 17-year-old boy thinks about sex (which is sad, I admit), but actually getting it all written down has been a feat lately.

See, I've come a long way on this 'coming to terms with having a child with difficulties' thing, and I've just realized that fact.

I've been blogging for two years now. I started right before The Kid started Kindergarten, when I knew the shit was just about to hit the fan. I knew public education and The Kid were going to bump heads. Sure enough, the first day, I went home in tears. Not because I could not believe my baby had gotten so big that he had started school, but because I knew that his personality, behavior and social skills were going to present issues. Two months later, I shelled out the money for the big neuropsychological testing and he was given a diagnosis of bipolar, more technically 'mood disorder, not otherwise specified, on the bipolar spectrum.'

I honestly didn't expect a bipolar diagnosis. I've written this before, but my boss's son is was diagnosed bipolar at 7 or so. I was conversant with it, but didn't think that was what was going on with The Kid. I wrote this post, then, terribly confused about the DSM-IV criteria. At that time, The Kid had certainly displayed every possible ADHD symptom. The 'mania' symptoms, however, we had not seen the majority of. The 'depression' symptoms, we had seen none of. But at the same time, my difficulties with my son had a name. We identified something, we could set a track and a plan. I was relieved with that. Over the intervening years, I've joined support groups and now moderate one online and see this reaction by parents all the time. A confirmation that it is not just your parenting skills, or the amount of TV you let your child watch, or the myriad ways parents of children with emotional/behavioral disabilities are made to feel inferior as parents, or, not just inferior, but to blame for every action their child makes. It is a huge weight off of one's shoulders.

I never thought I'd give The Kid medications for behavior at all, let alone at the age of 5. I had the sneaking suspicion of ADHD for many years, and believed that there were accomodations and diets and supplements I could give him before I moved to psychiatric medications. But here's a fact I can't shy away from, and that my e-friend Philip will find interesting: With the diagnosis of bipolar, it seemed as though he had more of a disease. A disease that nothing but meds would fix. And it would mean a lifetime of them. And at that time, that was okay, it was something that, if we just found the right combination of meds, we could solve, and The Kid would be alright.

Then last year, he was given a cocktail of meds, Concerta and Risperdal and Depakote, that shot him straight into the most unstable mood and behavior I've ever seen. He developed tics, he didn't sleep, he was so physically violent I was scared for his safety, mine, my family's, the school staff's. He was kicked out of public school.

At the time, I thought, poor kid. He's SO sick with bipolar.

We hospitalized him. He was inpatient for 10 days, and in the hospital's day treatment school program for four months. During that time, the psychiatrists there started saying, it might not be bipolar. It might be autism.

The paradigm of moving from a mental illness to a developmental disorder is huge. It moved me out of a 'he's sick' frame of mind into a 'he needs skill development and therapy' one. It took me out of the thoughts of 'thank god for these meds' way of thinking and into one that questions his need for them, for the long term (he certainly needed something when he was in the hospital, if for no other reason than to reverse the effects of the risperdal and the concerta, which were horrible). His current psychiatrist, who I trust a great deal, supports us in this new way of thinking, and is helping taper him from the three highly active medications he's currently on.

And yet, I'm convinced that the autism thing, Pervasive Developmental Disorder and/or Ausperger's, is yet another misnomer for him. Some of his behaviors fit their categories, and many do not. He misses social cues but he is not un-sociable. He perseverates on things, but not in an overriding way (perseveration is concentration on one thing, and is typical of autism... An autistic person may know every fact possible to know about baseball, for example. The Kid does not do that in a universal way, but he does immediately perseverate: He wants to play with someone, or something, and must do it NOW!!!! and won't take no, or not now, as an answer, and this is not necessarily being bratty, it smells of obsession with the thought to do whatever it is he's perseverating about, if that is even the correct term, but I digress.)

But, read around the internet just a little bit, pay attention to the newspapers and the news broadcasts that continue to be on and around us all of the time, and you will see a change going on with the idea of what a bipolar child is. It is a misnomer. A bipolar child today may not grow up to be a classically bipolar adult, and therefore, it is not the right thing to call a child. It's a simple as that.

And so, doctors need a new diagnosis to name for these defiant and difficult children. In our case, it's shifting to autism. The funny thing is that I'm far more comfortable telling people that The Kid has a diagnosis of Autism than I ever did telling people about the bipolar or even ADHD. I think this has to do with all of the awareness campaigns and Jenny McCarthy, and even the gorgeous girl on America's Next Top Model. Autism is the thing to talk about now.

But I think it's another misnomer for The Kid specifically, but only time will tell.


Mr Lady said...

A few things. One: I have always struggled with the Kid's diagnosis simply because I've never seen the behavior that goes with it. He has never struggled socially with my boys, he is by far the sweetest, most lovin' child I know. The way he loves 3of3, well, it makes it hard to accept an issue, mental or developmental, with him. That kid loves and emotes. But, you know what, I totally see his tendency to perseverate. I see how more amped it is in him than other children his age. So thanks for writing that bit. It helps me get my main man a but more. Two: I couldn't agree more about childhood bipolar not necessarily growing into a classic bipolar adult. My brother? Perfect example. My brother really reminds me of the Kid, and that gives me hope for the Kid. A lot of hope. Three: I would really like to peek at the group you moderate. See (and this is a big ol' confession I may not ever repeat) I think something is up with 2of3, along these lines. I have for a long time. I'd be interested in your input. Four: I hope you realize what a fabulous job you're doing with the Kid. I hope you know that he will be just fine, because he has you by his side. Every day, I am more proud of you. You, dear, are an amazing mother.

caty said...


I am really glad you updated me on this. I'm not sure why but even i am more comfortable with an autism diagnosis. Perhaps it is for the reason you state above about these children not really evolving to be bipolar adults. Also, from anecdotal experience, often times therapists use bipolar (and the omnipresent "not otherwise specified") as a real "catch all" diagnosis. Ok, so you have a kid who shows signs of mania. All you ever have to do is look for ONE episode of depression (who doesn't get depressed now and then? esp. a child as bright as The Kid, who knows the shit storm going on around/inside/about him). Anyway, some mania (which could be linked to so many autism disorders) + even one episode of depression and BINGO, bipolar diagnosis. It's a crap way to go about getting someone services, which is what most therapists are aiming to do but you're right, the label needs to be's a heavy label to put on a child. Asperger's kids, on the mild end of the spectrum, learn how to adapt to their environment and just end up being the slightly odd but brilliant scientist/engineer two houses down.
I read a review of a book by Augusten Burrough's brother who has aspergers and it sounds wonderful (his last name is not Burroughs--but i bet the clerk at the book store knows about it). It might be a good read, if you haven't already read it. It still might be in hardback though.

Love you and glad you like the Kid's new psychiatrist who it sounds like takes a balanced view of things. Amen to that and you, huney, you are marvelous. You have advocated for him so much and despite the torment, it sounds as though it may start paying off. Hang in there and know i love you.....

Diane said...

This sounds positive if they are correct about all of this. It appears that it would explain quite a bit if all of this pans out.

I know nothing about Ausperger's. Autism, I know more about, but not a great deal.

I saw Jenny McCarthy on The View. Autism education and coverage is way up due to her and other celebrities that have children that were diagnosed with it.

As always, I wish you the best with The Kid. Hang in there and keep fighting.

Leslie Dillinger said...

I have to echo everyone and agree that Autism makes more sense, if we have to assign labels. And I have to applaud you for insisting that it's still not the right diagnosis, at the end of the day. And even though you still don't know exactly what it is, you sound more positive about thinking of creative solutions.

You and The Kid are both amazing. I am always in awe of you as a mother--you've had to make incredibly difficult decisions but you are always poised about it (even if you don't always feel that way.) I lurve you both!