"Mood swings are part of most any bipolar disorder, and this is one of the easiest symptoms for parents to pick up on."

"Mood swings are part of most any bipolar disorder, and this is one of the easiest symptoms for parents to pick up on."(MANI PAVULURI, MD)

Mani Pavuluri, MD, PhD, is director of the Pediatric Mood Disorders Program and associate professor in psychiatry at the University of Illinois at Chicago. She is the author of What Works for Bipolar Kids.

Q: What symptoms signal that my child may have bipolar depression?

A: First, look for severe mood swings. Then determine, through close observation, if the child is behaving in a manner that is out of character—switching from being depressed or normal to very excitable, displaying extreme irritation and not requiring sleep, exhibiting abnormally high energy. Bipolar disorder is a mood disturbance characterized by cycling episodes of mania and depression that are peppered with irritability and aggression, decreased need for sleep, constant talking, and even hypersexuality. So when you suspect that, based on these symptoms, something serious is going on, you must take your child to a psychiatrist or psychologist. In the general population, between 1% to 3% of children suffer from bipolar disorder.

Q: How do you find a qualified expert?

A: If someone is working as a mental health expert with children, he should be qualified to diagnose and treat pediatric bipolar disorder. But of course there are people who are not up-to-date on this, so as a parent you should ask: Do you generally see bipolar children in your practice? If you are not satisfied with your child's progress with a particular doctor, then you should get a second opinion.

Q: Are severe mood swings always associated with bipolar disorder?

A: Mood swings are part of most any bipolar disorder, and this is one of the easiest symptoms for parents to pick up on. Without mood swings, it is not bipolar disorder.

Q: It can be difficult for children with bipolar disorder to behave in social situations. Is it appropriate to punish them?

A: No. These are what we call reactive kids—they react explosively—and this is in excess of what you see in normal children. If you punish them, the situation can get even worse. Sympathy and compassion are what they need. This is a tall order for parents, but its more effective in the long run.

[ pagebreak ] Q: What about the risks of medication for bipolar children?

A: If your child is bipolar, he or she will need to take a mood stabilizer, such as lithium, and maybe other drugs. It's best for parents to be collaborators rather than passive responders to their child's psychiatrist. There may be mismanagement and overdiagnosis, and children react to medication in different ways. Fortunately, there are often options. The problem is usually not good doctor/bad doctor, but it is you and your doctor getting together, developing a mutual understanding, and treating the bipolar the best way possible, by obtaining the best information based on the evidence out there.

Q: What are the odds that the illness will abate as the child gets older?

A: Unfortunately, this is very hard to predict. The children who have the best odds have three things going for them, some of which parents can control: 1) high intelligence; 2) good daily social support; and 3) effective treatment, including medication.

Q: How can I provide practical support for my child?

A: You can do what's called a mood chart. Every day, write down issues that upset you and your child, and rate his overall mood. Keep close track of medications and how they affect your child. This is helpful to clinicians.

Q: What else can a parent do?

A: Exercise is fantastic for channeling energy—not just for bipolar disorder, but also for overall health and relaxation—and this is what these children need. Another advantage is that many experience weight gain with mood-stabilizing medication, so keeping the metabolism up is important.

Q: Is there anything I can do concerning diet?

A: Avoiding foods that are high in fat and sugar might be good—everything in moderation, in my opinion. Good nutrition can help bipolar children avoid weight gain from the medication.

Q: Will my child have to take medicine forever?

A: Without being familiar with an individual case, it's hard to say, but in many cases, yes.

Q: Are boys more likely to get bipolar disorder than girls?

A: No. The incidence is equal in both sexes.

Q: What are the chances that my bipolar child will have a normal quality of life?

A: As a pragmatic scientist and a practicing clinician, Id have to say that it is likely to be difficult. There will be cognitive problems and interpersonal problems. With the right amount of care, however, you can see a lot of improvement.

Q: Is overdiagnosis still a problem?

A: Its a huge problem. So is underdiagnosis. I cant cite statistics, but it is visible from running a specialty clinic serving these children. That's why good training remains so important. It's also vital that doctors and parents understand and communicate with each other very well.

Q: Where can I find more information on bipolar depression and a directory of physicians who specialize in it?

A: You can visit the Child & Adolescent Bipolar Foundation's website or reach the group at 847-256-8525.