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Wednesday, May 22, 2013
Bipolar Disorder (Children and Adolescents)
Bipolar Son and Hypersexuality
My son is eight yrs. old and diagnosed with ADHD, ODD, axiety disorder and early onset of bipolar. He is going through a "high" currently and I`m not sure how I should handle all of it. He talks about things that just surprise me...and they come and go..often lasting 2wks to a month...it bothers me greatly as he talks about sexual content so openly infront of people... says and does inappropriate things...which make people think he is "sick in the mind", and making them fear him..so they keep their children away from him. I talk to him often about this how it`s not exceptable behavior and people will not like what he has to say and/or his actions. He takes Risperdal 3mg daily, Depakote 250mg daily, Strattera 40mg daily and Tenex 2mg daily. He`s at the point where his behaviors are getting worse and uncontrollable once again. Do you have any suggestions to help me guide him away from these off colored topics? What advice do you have on disciplinning this type of child? It seems as if I`m always telling what not to do and what is right...I ground him,try to talk to him, take things away...this helps for a brief time but then he seems not to care...and will do whatever he wants...the "word" NO causes major tantrums....I`ll welcome any advice....thank you
Hello and thank you for your excellent question,
My apologies for not replying sooner. As you may know, hypersexuality is a common symptom of pediatric bipolar disorder, occurring in as many as 43% of children/teens. Probably because of the taboo nature of discussing sexuality in children, it is a subject that is not often discussed. However, as you and many parents report, it is a symptom that still occurs and causes problems for parents and families alike.Please take a look at the following newsletter from the Child and Adolescent Bipolar Foundation (CABF) about this symptom.Regarding your question of, "Do you have any suggestions to help me guide him away from these of-colored topics?" As you observed yourself, "He is going through a 'high' currently," which suggests to me that perhaps his medications may need adjusting to help stabilize his mood. Usually, when medications are adjusted, symptoms like hypersexuality caused by mood cycling often decline.In the mean time, I think you need to talk with him about these behaviors, how they are symptoms of his bipolar disorder ("roller coaster" mood) and why this symptom is not "helpful" (try to avoid, "bad" or "wrong") as it may cause people not to want to be around him and neither of you want that.Talk with him about the symptom and his bipolar disorder, as Dr. Mary Fristad recommends, in terms of "It's not your fault, but it is your challenge," the challenge being to recover from the symptoms so they don't get in the way of his and others' lives at home in school and with friends.I'd probably not consider disciplining this behavior just yet as it is may be a symptom which he doesn't yet have the tools to control (it's a "can't" do it rather than a "won't" do it). Instead, talk with him about what are the first signs in his brain and body that suggest he's going to start talking/acting in a hypersexual way (you could use that term or have him come up with another name), then what things can he do or say to himself, where can he go and/or who he can talk with to help him take control over this symptom (as opposed to the symptom taking control of him). Try role-playing this to give him practice in these skills before he actually has to use them.You could even draw a visual "play-by play" solution sheet to put on the wall to remind and guide him with these tools. Then when he uses them to control his hypersexuality, make sure to give him lots of specific praise and even token rewards (e.g., stickers leading to reward) but when he doesn't use his tools, initially, empathize with him and tell him that you noticed he wasn't able to use his tools, what happened and what ways he could gain more control of his hypersexuality in the future.Once you feel he is able to use his tools very well then I think it would be appropriate to discipline (e.g., 8 minute time-out, followed by a "time-in", i.e., an opportunity to go back into the situation to show he can use his tools) this behavior when he chooses not to use his tools (i.e., it's now become a "won't" do it rather than a "can't" do it).Having said this, if he is acting on his hypersexuality with other children and continues to do this after talking with him and teaching him the above skills, it will be important to restrict him from access to these children, to protect them and him, until after his mood stabilizes.Additionally, you may want to talk to those around him about this symptom being part of his bipolar disorder to help them understand that "it's not his fault, but it is his challenge," that he's trying to recover from this behavior, rather than him being "sick in the mind" and to be feared/avoided, and that you are working with him to learn how to control it. You could even enlist their help.Finally, unless you're already doing this, I would highly recommend you obtain help from a cognitive-behavioral therapist who is skilled in working with children with bipolar disorder. To find such a professional, I'd recommend calling your local university, community mental health center or National Association of Mentally Ill chapter to ask for names, locations and phone numbers of mental health professionals who have expertise treating bipolar disorder in children.I hope my response helps answer your questions and helps you and your child. Best of luck and warm wishes.
Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University