Impulsivity in Bipolar Children

Samantha was a young patient of mine who decided she would find out whether she could swim after she jumped into the deep end of the pool. (She was fortunate to have others nearby to rescue her.) Such impulsivity can get bipolar kids into hot water. Their motto seems to be: Act first, think later. I've had parents tell me that their children have gotten upset and tried to run away from them at the mall or tried to run away from home. It's not as though these kids knew where to go; they were simply angry and decided to leave. Other kids threaten to open a car door while riding down the highway. (I recommend child locks in general but especially in such cases and, if necessary, pulling off the road until the mood storm has passed.)

Impulsivity may also be seen in other forms of risk-taking behavior. An impulsive child may steal something from a friend or a store simply because the opportunity arises. When seven-year-old Joan was asked why she took a doll from her friend's house, she responded, "Because I wanted it." By the same token, kids may decide to satisfy their sexual curiosity by suddenly taking off their clothes and talking a friend into playing doctor and patient.

Spurred by a bad mood, an impulsive child may become angry enough to pick up a kitchen knife or another sharp object and threaten to harm himself or someone else. A parent should not—I repeat, should not—say anything such as, "Go ahead, if that's what you want to do." These are children who can act impulsively and irrationally. The parent has to be the rational one in these situations. Parents often say they feel that their child is being manipulative and trying to get attention. This may or may not be the case, but it's critical to be extremely cautious before assuming any outburst is the child's way to control the situation. Even if this is the case, a child may be foolish or stubborn enough to rise to a parent's dare or challenge. It's necessary for the parent to try to remain calm and diffuse the situation by gently but clearly telling the child to put down the object. As the parent, you may need to explain that you know he is very upset but that he is a good kid, and waving around something heavy or sharp can accidentally result in someone's getting hurt: "Even if you feel mad right now, you know that you'd be so upset if you hurt someone in our family. So put it that back in the drawer, and let's talk."

Of course, if you really feel that the child may do something dangerous, carefully taking the object away is the right move. In extreme circumstances, you may need to get the other parent to assist you, or you may need to call the police. Your response depends on the circumstances at hand. But not taking the child seriously is seldom the best approach.

Indeed, the most effective remedy for a situation of this type is prevention. If you worry about your child doing something dangerous, put away anything he might use to carry this out—kitchen knives, medications, guns, and so forth. If a youngster seems to be in a volatile mood (and granted, this is sometimes hard to predict) and has threatened to open the car doors while the car is moving, don't venture out on the highway. If there are weapons in the house, lock them up or, better yet, banish them from the house altogether. Accidents can happen—and they do.

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