Newsweek Examines Bipolar Disorder in Children Through Experience of One
Family Disease Hard to Pin Down; at Least 800,000 Children in U.S. Diagnosed
Unclear How Drugs Work; No Studies on Long-Term Effects in Children
NEW YORK, May 18 /PRNewswire/ -- As Newsweek General Editor Mary Carmichael reports in the May 26 cover, "Growing Up Bipolar" (on newsstands Monday, May 19), childhood bipolar disorder is hard to pin down. At least 800,000 children in the U.S. have been diagnosed as bipolar, no doubt some of them wrongly. There are many drugs, but it's unclear how they work. Often they don't work at all, and they may interfere with normal brain growth. There are no studies on their long-term effects in children. Yet untreated bipolar disorder can be disastrous; 10 percent of sufferers commit suicide.
Parents must choose between two wrenching options: treat their children and risk a bad outcome, or don't treat and risk a worse one. No matter what they do, they are in for uncertainty and pain. Carmichael reports on the dilemma by telling the wrenching story of one family, Amy and Richie Blake and their 10-year-old son Max, who was diagnosed with bipolar disorder when he was two years old.
She reports that Max was seven the first time he tried to kill himself. He wrote a four-page will bequeathing his toys to his friends and jumped out his ground-floor bedroom window, falling six feet into his backyard, bruised but in one piece. Children don't really know what death is, as the last page of Max's will made clear: "If I'm still alive when I have grandchildren," it began. But they know what unhappiness is and what it means to suffer.
On a recent Monday afternoon, Max, now 10, was supposed to come home on the schoolbus, but a counselor summoned his mother at 2:15. When Amy Blake arrived at school, her son gave her the note that had prompted the call. "Dear Mommy & Daddy," it read, "I am really feeling sad and depressed and lousy about myself. I love you but I still feel like I want to kill myself. I am really sad but I just want help to feel happy again. The reason I feel so bad is because I can't sleep at night.
And dad yells at me to just sleep at night. But, I can't control it. It is not me that does control it. I don't know what controls it, but it is not me. I really really need some help, love Max!!!!! I Love you Mommy I Love you Daddy."
At 10, Max Blake has been on 38 different psychoactive drugs, Carmichael reports. The meds have serious side effects. They have made Max gain weight, and because he's still growing, they frequently need to be changed. The Blakes are aware that many people think their child -- any child -- should not be on so many drugs. They aren't always happy about it either. But to some degree, they have made their peace with medication.
"He's oppositional-defiant, he's dyslexic, he's ADHD, he's OCD," says Amy. "Give me an initial and he has it." Bipolar children, especially those diagnosed early, often have such a litany of disorders. The bipolar brain tries to compensate for its weak prefrontal cortex by roping in other areas to help; these areas may now become dysfunctional, too. Child psychiatrists thus face an enormous practical challenge: they often can't treat one disorder without affecting another one. "It's like a balloon where you push on one side and the other side pops out," says Janet Wozniak, the Massachusetts General Hospital psychiatrist who helped define childhood bipolar disorder. With kids like Max, she adds, parents often have to settle for "just having one part of the symptoms reduced."
Max's life has improved in some ways since his early childhood. The Manville School, part of the Judge Baker Children's Center in Boston, has given him a social life. Last year he won a "Welcome Wagon" award after teachers noticed he was always the first to show new students around. When his classmates have outbursts of their own, he talks them down. "He'll say that maybe they need to take some space, take a deep breath, leave the classroom," says his teacher, Julie Higgins.
He has not, however, figured out how to talk himself down, and for all he has progressed as a classmate, he struggles as a student. Technically, Max is in fourth grade -- Manville does not separate grade levels -- but he is behind in some subjects. He loves science and art, but he has a hard time reading, and although he is creative, he can't put his ideas in a coherent order. Even holding a pencil for more than a few minutes can be a challenge. "Sometimes you can look at him and you know his disorder has captured him," says the school's director, Jim Prince. "But we can't abandon him. We have to be able to hold on to him, sometimes literally, but also emotionally, to help him come out on the other side."
(Read cover story at http://www.Newsweek.com.)
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