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Friday, March 7, 2014
Bipolar Disorder (Children and Adolescents)
Children's Behavior with Bipolar Dsiorder
My 12-year old daughter has been diagnosed with ADD and bipolar disorder, with little to no success with all classes of medication, except Lithium. Her father was an addict and took his own life when she was 3. Shortly before his death, I was told he had been diagnosed with bipolar disorder. His family tree is riddled with mental illness, schizophrenia and addiction being the most common, as well as several suicides, besides his own. She is quite immature for her age, lies constantly, steals from family and has taken a few things from stores. We have to tell her to do the simplest, everyday things, EVERY day; buckle up, brush your teeth, wash your hands, etc. It`s like having a 3 year old for the past 9 years. She will not take any responsibility for her actions. She has now begun playing with her own feces. She does see a counselor, a developemental & behavioral doctor & recently had four-hours of psychological tests. We will get the results of the tests on Wednesday, from a child psychologist and will then go to a child psychiatrist. I am so frightened and frustrated. I feel like I`m trying to get her on the right track, but this latest issue has got me really scared. Any information or ideas would be greatly appreciated.
Thank you for your e-mail and excellent question. Sounds like you are doing the right thing in getting detailed psychological testing, as the only way to find out if someone has bipolar or any psychiatric disorder is to get a comprehensive and detailed psychological assessment from a trained mental health professional. This is particularly important as most people with psychiatric disorders also have one, two, or three additional disorders, which usually all require treatment of some sort.
If the latest testing confirms the diagnoses of bipolar disorder and ADD, the first-line of treatment for both of these disorders is medication, primarily either lithium, Depakote or a mood stabilizer (e.g., Tegretol, Neurontin, Topamax, Gabitril, Lamictal, Trileptal, Zyprexa, Risperdal, Seroquel, Clozaril, Geodon or Abilify) for her bipolar symptoms. Then, after her mood is stable, either a stimulant (e.g., Ritalin, Metadate, Concerta, Focalin, Dexedrine or Adderal) or a non-stimulant (e.g., Strattera, Wellbutrin, Tenex) will be needed for her ADD symptoms.
Because bipolar disorder and ADHD are both biopsychosocial disorders (i.e., they involve biological, psychological and social factors), their treatment also requires a biopsychosocial approach (i.e., medication, psychoeducation, therapy, school/community interventions). As "knowledge is power," (i.e., the more "knowledge" you and your child have about their disorders the more "power" you will have in managing it), I'd suggest the following books:
1. For Parents/Teachers:
- "Taking Charge of ADHD – The Complete Authoritative Guide for Parents" (second edition) by Russell Barkley, Ph.D.
- "Raising a Moody Child: How to Cope with Depression and Bipolar Disorder" Mary A. Fristad, Ph.D. and Jill S. Goldberg Arnold, Ph.D.
2. For Children:
- "Putting on the Brakes: Young People's Guide to Understanding Attention Deficit Hyperactivity Disorder" by Patricia O. Quinn, Judith M. Stern.
- "The Storm in My Brain" - Child & Adolescent Bipolar Foundation (CABF): 1-847-492-8519, http://www.bpkids.org/site/PageServer
Playing with feces is not a symptom of bipolar or ADHD, and the purpose, or function, of this behavior will need to be explored further, if it hasn't been in recent testing. For instance, your child psychologist, your child and you should discuss when this started, if there were any related triggers, why does it continue, and what purpose does it serve for your child. Such behavior might be related to encopresis (problems with defecating), eating difficulties, anxiety or psychosis, all of which need to be evaluated.
I hope this is helpful.
Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University