C THE Q How does bipolar disorder aff ect learning? Is there a cure? Is this a fad H diagnosis? How do I handle manipulation? How can I prevent relapses? I CHILDHOOD L Should I use alternative treatments? How can I parent eff ectively? D H & “We are certain that all parents whose children struggle with O BIPOLAR A bipolar disorder will fi nd this book indispensable.” O D —Demitri F. Papolos, MD, and Janice Papolos, authors of Th e Bipolar Child B Co-written by a doctor and a mother whose children live with bipolar I DISORDER P disorder, The Childhood Bipolar Disorder Answer Book explains confusing O medical lingo and provides straightforward answers to all your pressing A L N questions about treatment, parenting strategies, and everything else. A ANSWERBOOK R TM S (cid:2) How is childhood bipolar (cid:2) How young can these symptoms D W disorder diff erent from an adult manifest? I S E onset? (cid:2) Should all family members be O R (cid:2) What are the earliest symptoms? evaluated for bipolar disorder? R B D O (cid:2) Why is my child so irritable? (cid:2) Will my child lead a normal life? E Practical Answers to the Top 300 R O KTM Written in an easy-to-read Q&A format, The Childhood Bipolar Disorder Answer Book A Questions Parents Ask helps you understand and accept your child and develop a plan for success. N S W Tracy Anglada is the founder and (cid:2) How do I know if president of BPChildren and the E mother of two children with bipolar www.sourcebooks.com R my child has bipolar disorder. She has authored several B disorder? works on bipolar disorder in children. Parenting/Special Needs O $14.95 U.S./ $15.99 CAN/ £7.99 UK (cid:2) Will medication O Sheryl M. Hakala, MD, provides both ISBN-13: 978-1-4022-1177-5 ISBN-10: 1-4022-1177-5 K change who my child psychotherapy and pharmacotherapy in private practice. She is active in TM is as a person? N organized psychiatry and has authored EA Anglada (cid:2) How can I improve several scientifi c publications. and Hakala my child’s functioning? TRACY ANGLADA and SHERYL M. HAKALA, MD Susan Ashley, PhD CChhiillddhhoooodd BBiippoollaarr__FFIINNAALLccvvrr..iinndddd 11 66//44//0088 33::4488::5577 PPMM ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page i THE CCHHIILLDDHHOOOODD BBIIPPOOLLAARR DDIISSOORRDDEERR ANSWERBOOK TM TToopp 330000 PPrraaccttiiccaall AAnnsswweerrss ttoo tthhee QQuueessttiioonnss PPaarreennttss AAsskk . , TRACY ANGLADA AND SHERYL M HAKALA MD ChildhoodBipolar_int:Layout 1 6/3/08 4:19 PM Page ii Copyright © 2008 by Tracy Anglada and Sheryl M. Hakala, MD Cover and internal design © 2008 by Sourcebooks, Inc. Cover photo © iStockphoto.com/Jani Bryson Sourcebooks and the colophon are registered trademarks of Sourcebooks, Inc. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems—except in the case of brief quotations embodied in critical articles or reviews—without permission in writing from its publisher, Sourcebooks, Inc. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional service. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.—From a Declaration of Principles Jointly Adopted by a Committee of the American Bar Association and a Committee of Publishers and Associations This book is not intended as a substitute for medical advice from a qualified physician. The intent of this book is to provide accurate general information in regard to the subject matter covered. If medical advice or other expert help is needed, the services of an appropriate medical professional should be sought. This book does not establish a doctor-patient relationship. All brand names and product names used in this book are trademarks, registered trademarks, or trade names of their respective holders. Sourcebooks, Inc., is not associated with any product or vendor in this book. Published by Sourcebooks, Inc. P.O. Box 4410, Naperville, Illinois 60567–4410 (630) 961–3900 Fax: (630) 961–2168 www.sourcebooks.com Library of Congress Cataloging-in-Publication Data Anglada, Tracy. The childhood bipolar disorder answer book : practical answers to the top 300 questions parents ask / by Tracy Anglada and Sheryl Hakala. p. cm. ISBN-13: 978-1-4022-1987-0 Includes bibliographical references. 1. Manic-depressive illness in children—Miscellanea. 2. Manic-depressive illness in children— Popular works. I. Hakala, Sheryl. II. Title. RJ506.D4A54 2008 618.92'895--dc22 2008022928 Printed and bound in the United States of America. BG 10 9 8 7 6 5 4 3 2 1 ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page iii Contents Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Chapter 1: Understanding Childhood Bipolar Disorder . . . . . . . .1 Chapter 2: Spotting the Symptoms . . . . . . . . . . . . . . . . . . . . . .17 Chapter 3: Evaluation and Diagnosis . . . . . . . . . . . . . . . . . . . . .31 Chapter 4: Working with Doctors . . . . . . . . . . . . . . . . . . . . . . . .49 Chapter 5: Medication Trials and Tribulations . . . . . . . . . . . . . .67 Chapter 6: Living with Meds . . . . . . . . . . . . . . . . . . . . . . . . . . .85 Chapter 7: Complementary and Alternative Treatment . . . . . .103 Chapter 8: Pros and Cons of Alternative Treatments . . . . . . . .117 Chapter 9: Learning and Development . . . . . . . . . . . . . . . . . . .131 Chapter 10: Your Child at School . . . . . . . . . . . . . . . . . . . . . . .147 Chapter 11: Hospitalization . . . . . . . . . . . . . . . . . . . . . . . . . . .167 Chapter 12: Intense Parenting . . . . . . . . . . . . . . . . . . . . . . . . . .185 Chapter 13: Helping Your Child Find His Way . . . . . . . . . . . .207 Chapter 14: Parental Emotions . . . . . . . . . . . . . . . . . . . . . . . . .227 Chapter 15: Teens and Difficult Behaviors . . . . . . . . . . . . . . . .245 Chapter 16: The Path to Adulthood . . . . . . . . . . . . . . . . . . . . .259 Appendix A: Reading Lists . . . . . . . . . . . . . . . . . . . . . . . . . . . .273 Appendix B: No-Suicide Action Plan Template . . . . . . . . . . . .275 Appendix C: Action Plan Template . . . . . . . . . . . . . . . . . . . . .276 Appendix D: Crisis Plan Template . . . . . . . . . . . . . . . . . . . . . .277 Appendix E: Self-Care Plan Template . . . . . . . . . . . . . . . . . . . .278 Appendix F: Child’s Action Plan Template . . . . . . . . . . . . . . . .279 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .297 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .302 About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .312 ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page iv ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page v Acknowledgments This book was the result of collaboration between a dedicated physician and an advocate mother. We would like to join in giving thanks to our families and friends who support and inspire us. We would also like to thank our publisher, Sourcebooks, Inc., for printing this important infor- mation. Thank you to Shana Drehs for bringing this project to us. Thank you to Peter Lynch for his efforts to make it a reality. Thank you to our editor, Erin Nevius, for smoothing out the rough edges, and to our proofreaders for their wonderful suggestions. Finally, we would like to thank our readers, who make it all worthwhile. ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page vi ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page vii Introduction Bipolar disorder has long been recognized in the adult population; and yet, more than half of these adult sufferers report the onset of symptoms before age eighteen. Despite this recognition, childhood bipolar disorder continues to be hotly debated, and it can be hard to find real, helpful answers. Whether you are worrying that your child may have bipolar disorder, are dealing with a newly diagnosed child, are worried about misdiagnosis, or are an old hand at the disorder who is simply looking for some fresh ideas, you have tough issues and questions that deserve straightforward, no-nonsense answers. This book has been written to give you those answers based on the most up-to-date information the field has to offer. The questions and answers were a joint effort by a mother who has been in nearly every parenting stage of bipolar disorder, from very young children to teenagers, and a medical doctor who treats the condition and sees a wide variety of patients with the illness. This combination of personal experience and medical expertise has resulted in a medically accurate picture with a first- hand intimate knowledge of what parents really want and need to know. Each author adds a unique perspective and a wealth of usable information to the book. If you have ever wanted to sit with an experienced mother and a physician side by side, to ask them endless questions, and to get real answers for your everyday life, this is the book for you. It will serve as a reference for years to come as you go through various stages of your child’s life and illness. Whenever possible, the authors have sought to give you tips, suggestions, and advice that have been proven to work for others. Please note that for ease of reading and writing, pronouns in the book are in the male gender but apply equally to females. No discrimination is intended by this usage. Please refer to Appendix A and the References section for more information on books, studies, and journals mentioned throughout the text. The book contains plans to assist you in taking what you have learned and moving your child toward success. The authors recognize that each ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page viii viii The Childhood Bipolar Disorder Answer Book plan is very individual, but the goal should always be for the personal assessments to help you examine your own child’s situation and put into place both short-term and long-term goals to help your family. The answers in this book were written with the recognition that your time is precious. We know you may be reading in between dealing with difficult situations. In respect for this, we have tried to be extremely concise and to the point. The book may be read from cover to cover, but it has been designed so that you can pick it up, read an answer to any question that concerns you, and have immediate access to the specific information you need. It is our hope that this book will prove to be a constant resource for you. ChildhoodBipolar_int:Layout 1 6/3/08 12:23 PM Page 1 UU Chapter 1 NNDDEERRSSTTAANNDDIINNGG CC HHIILLDDHHOOOODD BB IIPPOOLLAARR DD IISSOORRDDEERR ■ What is childhood bipolar disorder? ■ How does it differ from adult onset? ■ How is onset in late teens different? ■ How might my child exhibit mania? ■ How might my child exhibit depression? ■ How might my child exhibit a mixed state? ■ Is my child hallucinating or imagining? ■ Why does my child draw gory pictures? ■ Why is my child fearful? ■ Why is my child so irritable? ■ Why is my child angry? ■ What is a “rage”? ■ Do rages and temper tantrums differ? ■ Why does my child have trouble getting out of bed in the morning? ■ Is suicide a real risk?