Child Involvement in Bipolar Treatment

Many young patients talk about having "bad brains" or "two brains"—one that says to do "good things" and one that tells them to do "bad things." They're struggling with trying to explain to themselves why they do the things they do and act the way they act. These kids know something is not right; they want to please their parents and teachers and do the right thing, but somehow, they end up acting inappropriately and getting themselves into hot water.

Such was the case with William, a nine-year-old boy who, above all else, loved his dog, Marshmallow, a gentle Maltese. When William's mood was stable, he would make a special bed for Marshmallow out of pillows. He liked to hold his pet on his lap, sometimes for half an hour at a time, and dress him up in his baseball hat or his sister's sweater. "I love you Marshmallow, you're the best doggie in the world," he would say. When William's mood was elevated to a worrisome degree, however, he would sometimes handle the dog too roughly and pull at its legs to get the sweater on quickly. Then, when the dog snapped at him, he'd become furious: "You stupid dog; I'm going to bite you back."

William's inconsistent behavior represented his internal tug-of-war with the world and his emotions. When he felt good, he was the kindest, gentlest, most wonderful child imaginable. When his mood was unstable, he could seem insensitive or overly sensitive to everything and everyone. Afterward, when he was calm and more reasonable, he felt horrible about hurting something that he loved so much. "I'm so sorry, Marshmallow," he said with tears in his eyes. "I love you. I didn't ever mean to hurt you. Sometimes, I just act crazy. I don't know why."

Even small bits of conversation can yield important clues to what is going on inside a child's mind. Sunny, a bright eight-year-old, noticed one day that another child was accompanied by a specially trained service dog. Her mother explained that such dogs, similar to seeing-eye dogs, can help kids with lots of different problems. "I need a paying-attention dog," Sunny said matter-of-factly. This remark showed that Sunny not only had a good sense of humor but also that she was highly aware of her distractibility issues.

Spoken language isn't the only thing to pay attention to in a child; observing a child's nonverbal cues is also extremely important. The proverbial sparkle, for instance, is often missing from a depressed child's eyes. A child with an elevated mood can be so distractible and busy that he looks like a whirling dervish—on the go and not thinking too much (the truth is that he may be thinking about too many things). At times, simply observing a child's reactions and facial expressions with the "sound" turned down can be a very helpful tool for assessing his moods.

Yet even after careful listening and observation, it can still be difficult to interpret what's going on in a youngster's mind. If he complains that other children give him strange looks or don't like him, this maybe paranoia or a reaction based in reality or a mixture of both. Perhaps the child is acting so strangely that he is pushing other children away: One youngster I know would stare at other people and then complain that they were staring at her. One of the important things to take away from this situation, however puzzling, is that the child is telling you how uncomfortable he feels, no matter where reality lies. I'm convinced that in many cases, listening carefully can make all the difference in the world in a young patient's quality of life, especially if it means helping to tease out symptoms of Bipolar Disorder early on.

Such was certainly the case with Ben, the pharmacologically savvy seven-year-old. During the months we worked together, he continued to be a partner in his treatment. When he said, "Doc, I think those little pink pills help me more than those big white capsules," I paid attention. There were times that his mother and I looked at each other in disbelief because his assessment of his responses to the pills was soon target.

It took some time and lots of trial and error, but Ben's Bipolar Disorder is now controlled with medication and therapy. He's becoming successful in school and an eager participant in his treatment plan. He deserves applause for demonstrating a maxim that any child psychiatrist—and anyone else who works with children—should take carefully to heart: Listen to the words, not just the music.

Excerpted from: