Preschoolers and tantrums go together like Bert and Ernie. Young kids get spastically silly. They flip out when a friend snatches their toy, or become Mr. Hyde when they’re tired or hungry. They imagine themselves unstoppable superheroes and elegant princesses.
But when does normal childish behavior veer into something different, something more extreme and unsettling?
“There are a lot of children with ‘terrible twos’ and tantrums,” says Muffy Walker. But her youngest son’s fits of kicking and throwing things were not like the outbursts she’d seen in his two brothers. They were scarier.
“He had a lot of rages, a lot of threatening behavior – threatening to hurt himself,” she says. “He was very angry all the time, unprovoked.”
By age 4, Walker’s son was seeing a psychiatrist and taking anti-depressants. But something was still wrong.
After checking into a hotel while on a family ski vacation, the boy – about 5 at the time – began leaping between two beds. When told to stop, he raced to the bathroom, locked the door, filled the bathtub with water and told his parents he would drop a hairdryer into it. They broke down the door to stop him.
By 7, after the boy showed clear signs of manic behavior, a pediatric mental-health expert confirmed what Walker and her husband suspected: Their son was bipolar.
Bipolar disorder is an incurable disease defined by episodes of extreme moods and behavior, swinging between dark depressions and mania. Over recent decades, doctors have grown to accept the idea that younger teens and prepubescent children could have the disorder, but whether preschoolers – kids as young as Walker’s son – could be bipolar remains controversial.
While bipolar adults and children can experience many of the same manic traits – sleeplessness, scattered and restless behavior, irritability, feeling overly joyful, a sense of grandiosity – these symptoms can be harder to recognize in kids.
“Being happy and silly is part of being a kid. The question is where you draw the line,” says Dr. Boris Birmaher, director of the Child and Adolescent Anxiety Program and co-director of Child and Adolescent Bipolar Services, both at the University of Pittsburgh Medical Center.
Medical experts distinguish between normal highs and lows and more serious manic episodes by observing the severity of the symptoms, the presence of multiple traits associated with bipolar disorder, how long the episodes last and if they keep coming back. In the more severe cases of bipolar disorder, episodes of depression, mania or a mix of both will last most of a day for a week or more. Some bipolar kids cycle very quickly between extremes, and sometimes the episodes are milder.
To muddy things further, bipolar disorder can look similar to other mental-health problems such as depression, attention deficit hyperactive disorder (ADHD) and autism. And recently, mental-health experts have added a new category of disease: temper dysregulation disorder with dysphoria, which includes a syndrome that makes kids chronically irritable.
It’s a complicated field of ailments, and a correct diagnosis is critical because the treatments can be radically different. If a child is misdiagnosed, a doctor could prescribe a medication that actually makes his bipolar symptoms worse. Approximately 2 percent of American children have symptoms of the disease.
“Parents really should be looking for someone who has expertise and experience assessing children, particularly children with severe mood disorders and who will take time with them. This is not the sort of thing you sit down very briefly with the child and come out with a diagnosis,” says Dr. Ellen Leibenluft, chief of the Bipolar Spectrum Disorder Section at the National Institute of Mental Health in Maryland.
It takes 10 years on average to travel from the first symptoms of bipolar disorder to diagnosis of the disease and effective treatment, Birmaher says.
Walker says she is certain that her son, now 19, was correctly identified as bipolar as a young child. After his diagnosis, it took another seven years to find the right cocktail of drugs to treat his disease.
Walker, who lives in San Diego, went on to co-found and lead the International Bipolar Foundation, which provides education, resources and support for people living with the disorder.
It’s critical, experts say, that bipolar kids get help as quickly as possible. Without treatment, they are more likely to have problems in school, find it difficult to make and keep friends, abuse drugs and alcohol, engage in risky behavior and become suicidal. The right medication can stabilize their volatile brain chemistry.
“There is help,” Birmaher says. “These kids can have a completely normal life.”
Bipolar Spectrum Disorder Section at the National Institute of Mental Health: A program studying kids with bipolar disorder or severe, chronic irritability to better understand the causes and effective treatment of these diseases. To participate, contact the program: firstname.lastname@example.org
University of Pittsburgh Medical Center Bipolar Institute: An institute providing diagnosis and treatment of bipolar disorder. It also conducts basic science, clinical and mental health services research, and is an international training center for research-based treatments.
International Bipolar Foundation: An organization working to eliminate bipolar disorder that provides referral services, supports research and aims through public education to remove stigmas associated with the disorder.
Depression and Bipolar Support Alliance: An organization facilitating support groups in communities nationwide that also provides up-to-date, scientifically based resources and information about bipolar disorder for the general public.