Misinterpreting Bipolar Behavior

In my practice, I've found that children with Bipolar Disorder are often especially bright, self-aware, and adept at revealing their emotional and physical states, in either a direct or an indirect fashion. For example, you might think your child is kidding when he tells you, "If I don't wake up in time for cartoons in the morning, throw a bag of ice on me." But, in fact, parents of bipolar children report an uncanny similarity in the way in which their bipolar kids talk about the extreme measures necessary to awaken them in time for school. The reason is that these kids often have changes in their sleep/wake pattern that make it difficult, if not impossible, for parents to rouse them when it's time to get up. Many parents report that when their kids really want to make certain that they'll get up in time for a special activity, they'll beg for a wake-up call that involves either ice or cold water or multiple alarm clocks.

Bipolar kids are also frequently great planners and list makers. Six months before her birthday, a bipolar child in an "up" mood may regale you with detailed plans for her party, obsessing over the smallest details of what present Grandma may buy her. Of course, childhood enthusiasm might account for some of this behavior, but it may also be indicative of an elevated mood in a bipolar child who carries it to extreme lengths.

Kids who are "up" are busy, driven, and thinking of grandiose things. When this kind of energy interferes with a child's functioning, it can play havoc with daily life. But sometimes, it can also be channeled—with proper treatment and the caring guidance of a parent—into academic or creative activities such as artwork, musical presentations, and science or literary projects. One of my patients, a six-year-old boy named Henry, wrote and illustrated an entire book, all while sitting in my office waiting room. It was about a superhero he called Shirt Man. After he read it to me, he described his plans for the sequel, "Beyond Shirt Man," as well as a movie version. I was convinced that with the proper treatment, he could wind up as the next Steven Spielberg.

It's fairly easy to listen to your child when he's in a creative, expansive mood like Henry was. But in difficult times when a bipolar child is irritable or acting up, parents often block out the child's words and remember only the turmoil. I'm reminded of a phrase I heard in the movie Beyond the Sea, the story of the late Bobby Darin. At one point in the film, his wife, Sandra Dee, tries to comfort him after a failed comeback performance at the Copacabana nightclub. Unlike his previous shows, which included a visual feast of spotlights, a full orchestra, and dancers, this one consisted of Darin alone singing folk songs and playing his guitar. The songs were beautiful and well performed, but the nightclub audience, accustomed to glitz and fanfare, uncharacteristically booed his performance. "People hear what they see," his wife told him. The same is true regarding parents and children. When a child is having a mood swing that results in rage, what you hear is tremendous hate and anger. It is only when you carefully focus on the words that it becomes clearer just which feelings the child is struggling with.

At the same time, parents tend to sanitize episodes that seem too painful, too embarrassing, or simply too bizarre to share with a stranger or even the treating doctor. For example, instead of saying, "Ricardo mooned his teacher yesterday and then told her 'I know how to do math better than you,'" they might say only that "Ricardo was really out of control in school yesterday." But hearing the details is crucial in helping a doctor come up with the proper diagnosis, prescribe the appropriate pharmacological treatments, and devise day-to-day plans forgetting the support the child needs at home and in school. In this case, for instance, Ricardo's language clued me in to the fact that he was exhibiting inappropriate social behavior and an I-know-better-than-the-grown-ups attitude, common in bipolar children in the "up" phase.

Even when it seems that a child is simply being annoying and oppositional, there may be clues in his language that he is, in fact, despairing. The child who pestered his mom for a taco at the Italian restaurant, for example, may really be crying out for help with his depression. He's saying, "I might just as well ask for the impossible because I know that no matter what anybody does, nothing is going to help me feel better."

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