"Ever since my son Tommy was born he was different from my other two children.  It seemed to take forever to get him to sleep and once he was sleeping he frequently woke crying for no reason.  I was exhausted and at my wits end trying to settle him down…all the advice given to me by mother, grandmother and friends was to no avail.  I began to think there was something wrong with me.  As Tommy grew older there were more signs that something was wrong."

Hyperactivity, fidgetiness, problems with making changes and high levels of anxiety (particular with separation anxiety from mom) began to appear.  In addition there were signs that frustration, impulsiveness and poor anger control were leading to prolonged and violent temper tantrums. 

What is Bipolar Disorder?

Everyone can relate to the word mood. We are all happy, excited, sad or depressed at some point in our lives. Bipolar Affective Disorder (Manic Depressive Illness) is a biochemical imbalance that
causes gross mood changes from the high reaches of mania to the lows of severe depression. For the one percent or twenty million Americans who have this condition it can mean hospitalizations, a
life time of medication, disability at an early age and the reduced income associated with it.  Bipolar Affective Disorder can be life threatening.

What is COBPD?

COBPD is the abbreviation for Childhood Onset Bipolar Disorder.  Bipolar Disorder is an illness of mood, or affect.  In adults moodswings usually last for weeks or months before remitting or changing to the opposite pole (thus the term bipolar: having two poles).  Children often cycle many times during one day, a condition known as ultra-ultra rapid cycling.

What Causes Bipolar Disorder?

The exact cause of bipolar disorder is unknown.  Recent studies have shown that heredity plays a major role.

Diagnosing COBPD

Diagnosing COBPD can often be a difficult process.  Attention-deficit/hyperactivity disorder (ADHD), Obsessive-compulsive disorder (OCD) and Oppositional defiant disorder present many of the same symptoms.  In addition, fifty to 80 percent of those individuals diagnosed COBPD have concurrent ADHD.  The symptoms of Bipolar Disorder are not the same as those in adults other than the alternating mood swings, and these may be overlooked.

The following symptoms are often seen in BOTH ADHD and COBPD.

Distractibility
Lack of Attention to Details
Difficulty Waiting One's Turn
Interrupting or intruding on Others
Motor Restlessness
Destructiveness or Misbehavior
Physical Outbursts or Temper Tantrums

In addition, the mood fluctuations, sleep disturbances (night terrors and nightmares) and irritability are commonly seen in COPBD but not ADHD. 

What is the Difference Between COBPD and ADHD?

Although many of the symptoms of the two disorders are the same, their origins differ.  A child with COBPD often seems to intentionally misbehave and destroy, while an ADHD child with the same symptoms appears to be careless and inattentive.  Physical outbursts and temper tantrums seem triggered by sensory and overstimulation in an ADHD child, but a simple "NO" (limit setting by a parent) will cause the same effect in a child with COPBD.

Children with ADHD usually calm down within 15-30 minutes, while it may take the COBPD child several hours to be relieved of his anger.  In addition COBPD children often show remorse for their temper tantrums and express that they were unable to control them.

Treatment of COBPD

Due to the difficulty in diagnosing COBPD caution must be taken with prescription medications.  Some drugs prescribed for ADHD (stimulants like Dexedrine, Adderall, Ritalin and Cylert) may escalate mood fluctuations, especially in a child who is genetically predisposed to bipolar disorder. 

The COBPD must be treated first by stabilizing the child's mood and treating any sleep disorders and psychotic symptoms present.  Once the child is stable, therapy to help him understand the nature of the illness and how it affects him is critical. 

Medications used for stabilizing mood include lithium, depakene and tegretol.  New mood stabilizers such as neurontin, topamax and lamictal are currently being tested and used for children.  Psychotic symptoms and aggressive behavior are often treated with anti-psychotic medications such as risperdal, zyprexa, mellaril, trilafon and haldol.  Klonopin and ativan are also used to treat anxiety, induce sleep and slow rapid cycling.

Antidepressant medications are very risky and not recommended as they may induce mania and hypomania in children with bipolar disorder.

How Can I (as a parent) Help?

The first thing you must do is never give up!  The second thing is to learn all you possibly can about COBPD!  The Bipolar Significant Others web site at http://www.bpso.org has links to many excellent sites and articles about Bipolar Children.  Bipolar Parents is another site with information and plenty of warm support for parents of bipolar children.  Visit them at http://bipolarparents.virtualave.net

In addition there is a brand new book called The Bipolar Child by Dimitri Papolos M.D. and Janet Papolos.  Read all about it at http://www.bipolarchild.com

You are the voice for your child.  Ensure that he/she keeps all doctor appointments, remains compliant with medications and all treatment plans prescribed by the doctor.  Do your best to keep your child on a regular routine including eating, sleeping, exercising and school.  If you are not happy with your child's progress obtain a second…or a third opinion.

Your child is young.  Hope and pray that a cure for this illness will be found!

Know that your child loves you and is not intentionally putting you through hell…bipolar disorder is too big for anyone to control on their own.  Support your child as much as you can, but know your own limits at the same time.  Taking care of yourself will help your child.