Meet Max.
He’s a 10 year old who’s gone through a lifetime of trials and tribulations already.
And he was profiled in this story in Newsweek about children with bipolar disorder.
Max had an unusual childhood, according to the article:
Max never slept through the night, and neither did she. He cried for hours at a time. He banged his head against his crib and screamed until his face burned red. Nursing, cuddling, pacifiers — none of them helped. At 2 a.m., at 3, at 4 and 5 and 6, Amy cradled her son, trying to believe this was typical infant irritability, the kind her friends with kids had warned her about. It must be colic or gas, she thought, as Max howled another day into being. Exhausted, mystified, she made jokes — he was born on Halloween, she ate too many spicy chicken wings before delivery — trying to explain how a baby too young to hold up his head could raise such hell.
After a year, the jokes gave way to worry. Max was reaching and surpassing his milestones, walking by 10 months and talking in sentences by age 1, but he wasn’t like the babies in parenting books. Richie carried his son to the backyard and tried to put him down, but Max shrank back in his father’s arms; he hated the feel of the grass beneath his small bare feet. Amy gave Max a bath and turned on the exhaust fan; he put his hands over his ears and screamed. At 13 months, he lined up dozens of Hot Wheels in the same direction, and when Amy nudged one out of order, he shrieked “like you’d just cut his arm off.” At day care, he terrorized his teachers and playmates. He wasn’t the biggest kid in the class, but he attacked without provocation or warning, biting hard enough to leave teeth marks. Every day, he hit and kicked and spat. Worries became guilt. Amy had been overweight and dehydrated in pregnancy. Was Max so explosive because she had done something wrong?
At two, the chief of child psychiatry at Tufts-New England Medical Center, Joseph Kankowski, diagnosed Max with bipolar disorder. Yes, you read the right — age 2. (I’m not sure how you differentiate an “irritable mood” in an infant at age 2, as opposed to a normal infant’s irritable mood.)
You’re then led on a journey through the next 8 years of Max’s life (along with the frustrating journey of his mom and dad, dealing with a medical profession that clearly has no idea what’s going on with Max).
As CL Psych notes, 38 medications later, Max has found a set of treatments that seem to be working for him. (CL Psych has some good commentary about the article in general, worth your time.)
This is a part of a bipolar article package for Newsweek and includes advice for parents of bipolar children and what leading experts in bipolar disorder say about the biology of bipolar disorder. As usual, other factors that play an important role in the development of bipolar disorder — the psychological and social factors — are given short shrift and bipolar disorder is mis-labeled throughout the article as a medical “disease” (it is a mental disorder, not a disease — these terms have specific meanings for a purpose).
We’re always happy to see a human interest story such as Max’s in a mainstream magazine, but we do wish the reporter worked harder to present a more balanced picture of this issue (and the controversy surrounding the diagnosis of this adult disorder in children).
22 comments
From the excerpt you posted, I wonder if this child originally had a mental disorder at all, or if he suffered from Sensory Processing Dysfunction (aka Sensory Integration Disorder), for which there is no pharmaceutical treatment. Instead, intensive occupational therapy is called for in SPD. My older son has this disorder and it is very disruptive to everyday life, and can mimic problems from ADHD to autism (it is also frequently comorbid with these).
I wondered the same thing, among other disorders he could’ve had…
The key for me being that his symptoms were non-specific to the point that I imagine a lot of professionals would’ve felt very, very uncomfortable choosing just one at 2 years of age.
I thought biploar disorder peaked after adolescence and up to around 20 years old. Is it common that psyhologists diagnose these types of disorders in children so young?
38 different kinds of medication for such a young child seems harsh, it is good to hear that there is a treatment that is working for him though.
I am a child and adolescent psychiatrists in Australia. I’ve read the article in Newsweek and watched the online video of Max and his parents.
Here in Australia he probably would have got an O.T. assessment and some sensory integration issues identified, ADHD may well have been diagnosed. It’d be interesting to see some psychometric testing.
What he almost certainly wouldn’t have got is 38 meds and a diagnosis of Bipolar Disorder.
Although his parents clearly love him dearly, there does appear to be some family dynamic issues. Mother admits to “bribing” him for years with toys to behave well – his bedroom does indeed look like a “Toys R Us” shop as she says. Dad is on the outer a bit and complains about this.
He is getting better now – but much may relate to late latency stage reasoning ability (though adolescence approaches as the article notes) coupled with self-efficacy and self-esteem gained through karate and horse-riding and his liking for science and art – that’s certainly what came through in the video.
There is an excellent parenting program that helps parents with children with difficult temperaments and oppositional behaviour like Max, called the “Incredible Years” program that was developed by a Prof Carolyn Webster-Stratton in Seattle. It is becoming widely used in the UK and we’ve introduced it here in Australia with some good results. It’s surprising it’s not more widespread in the USA – but your health system may be a factor.
We have a survey of child psychiatrists in Australia and New Zealand that shows the great majority are very sceptical of Paediatric Bipolar Disorder as constructed in parts of the USA. Results should be published later this year.
Re-reading what I just posted – I should add the point that Max’s (and his parents’) narrative of his life and meaning attached to his moods and behaviours have been medicalised since before he can remember. This could well be a perpetuating factor for the same, as it reduces his belief in his own self-efficacy and control of his emotions and behaviour.
My son was also diagnosed bi-polar at a very young age, 4 yrs. old. When he was diagnosed I was elated because I then found an answer as to why he behaved in such a way. Medication was a welcome in our life. While I do not believe in medicating a child, and think that 38 different medications is a little much, I can certainly understand how medicine is needed in the case of our special needs children.
My son, who is now 15, as been diagnosed as adhd as well, and personally I don’t understand why the doctors don’t understand that adhd, ocd, odd, ect. eventally turn into bi-polar disorder. All of my research, tells me this. Autism, aspergers, are also linked. Let’s face it Doctors, you can try to “blame” the parents, say that we have some how “reduced” our childrens “own self-efficacy and control of emotions and behavior” simply because our children were diagnosed at early ages, when in fact, early diagnosis of bi-polar is fairly new in itself. The brain is awesome, and will never be fully understood, no matter what nor how many degrees or years psychologist may have under the belt, so to target the parents of children who have exhibited behaviors of mental concerns especially from birth, could possibly be a sign that more research on the mental health professional side is needed. Try reading “The Bipolar Child” by Demitri Papolos, M.D., and Janice Papolos-The Difinitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder. Copyright is 1999. Who knows what more is to know now?
I am a licenced family counselor who worked with children so extreme as described their parents gave them to child services for foster care. These children were severly disrupting the lives of all family members. My treatment of these overwhelming children was earplugs and whatever seemed to work that was not cruel. Many children grew out of most disruplive behavior as group socialization and words set in. But families who tried to parent these children the first 2 – 3 years on their own put themselves and all their children at risk and took away those special years of childhood from the family.
Peter, you make some excellent points, especially about the “medicalization” of these childhood behaviors. Kevin’s note that these are often behavioral issues that can be dealt with, well, behaviorally, is important too. Not to blame parents, but many (especially first-time) parents simply have little parenting skills and believe all children should just “behave” naturally or instinctually.
I also came across this response from Peter Breggin to the Newsweek piece on the Huffington Post, which I thought makes for an interesting read:
http://www.huffingtonpost.com/dr-peter-breggin/psychiatry-makes-war-on-b_b_103337.html
Wow, great article!!! Would you mind checking out mine and leave a comment telling me what you think? It’s here: http://brainblogger.com/2008/05/27/the-bipolar-trend/
Thanks!!!
I haven’t heard of doctors blaming parents, but being a child of a particular parent I agree that parents can perpetuate and cause certain behaviors of children. Unfortunately, not all parents have the best interest in mind for their children and make choices that do not benefit the child. I know this as fact as I have experienced this with one of my parents (who likes to medicalize/ diagnose/ label–basically find the bad and the negative of someone). Yes, it is easy to blame parents or others, but since I am a person with LD & ADD I have seen actions and decsions made with the parents’ interests in mind…not the childs. So, I agree, most definately, family dynamics is a large factor (it is easy to blame the child and see the child as “the problem” because they aren’t quote, end-quote, normal).
Amen Austraila. Let’s let children BE, just BE, instead of labeling. For some reason society likes labels. As I am currently writing a book, I offer my experiences of a child/adult with LD & ADD that might alter perspectives and ideally alleviate the need to label.
I am not sure where self-efficacy fits in to Max’s story, but from my experience I see opportunites as challenges to face instead of avoid. I don’t quit when things are hard. I am resilient, persist and eventually learn. Does this mean I have high-efficacy?
In my professional career, when it comes to certain things I don’t believe I can perform well, specifically when responsibilites/tasks are new or I am unsure of “the big picture”. This is low self-esteem, derived from an inaccurate self-perception. This is seperate from self-efficacy, right?
Hey Doc,
Until you have actually lives with a child with BP….please, do not judge his family! We suffer just as the child does!
My husband wasn’t diagnosed with Bipolar I until his late 20s, but by talking with him and his parents, he’s probably had Bipolar symptoms since birth. He certainly had depression virtually his entire childhood with a break (stable mood) for a couple years in college before the manic-depressive cycles began. We met during his stable period, but it became clear within a few years, that he had a mood disorder and was finally diagnosed correctly just recently.
I agree, diagnosing Bipolar during childhood is such a new area in psychology that we really can’t jump to any conclusions. Did my husband have bipolar as a young child, and just hadn’t had a manic episode yet, or was it truly only unipolar depression? If it was unipolar depression, did that predispose him to bipolar or was it coincidence? We really need many more studies on these types of situations.
I think that some children are definlety more extreme than others, but I also think some could just be lack of boredom or the children not being dispicined. ITs important to find out what the child needs before jumping to conclusions of bipolar and so forth.. If you tried everything and nothing works well maybe.. I had a very hyper active girl who was instanly bored of everything very young.. She learned very quickly and rarley ever played with toys and threw temper trantums like you wouldn’t belive. ONe time she threw she threw everything all over the place in her room even her matress upside down because she was angry at just two years old. She could go from 8 in the morning to 12 at night and still be hyper. She never took naps. What I found works with these types of children is activies outside the home I got her in dancing sports and always took her places , walks, park etc.. Its alot of work to keep these children happy and it can be exhausting but if you find what works with them, things that they enjoy it really does work.. SHe is older now, 5 much more behaved She still has trouble getting to bed early and is frequenlty late for school but she loves reading and is doing great in school and is a very happy child. SHe still needs extra activites outside of school to get her happy and tired out and she still tires me out. lol : )
Argh, John. You’re quoting Peter Breggin????
“first-time parents,” John?
How about parents who share the brain disorders they have passed down to their children? Behavior isn’t everything. Beneath behavior often lies a …… brain! Fancy that! 😉
Gina, mental disorders are not 100% genetic. Even those we believe to most strongly genetically influenced, like schizophrenia, don’t show 100%. And if you need to understand what that percentage risk actually means, I recommend reading this entry over at Mind Hacks:
http://www.mindhacks.com/blog/2009/07/80_genetic_20_pol.html
“What it means is that 80% of the variance in the measured illness was explained by genetic factors in the specific group that was studied.”
And you misread — I did not quote Peter Breggin. I suggested readers read an article he wrote. Why? Because you need to be well read to even begin to comprehend the complexities of mental disorders. These are not black and white issues and are not conducive to black and white thinking about them.
Seriously, diagnosing children at age 2 with any kind of mental illness (outside of some very specific childhood disorders, like autism) is just plain ridiculous. I don’t care who’s doing it.
Agreed, Dr. Grohol. Peter Breggin was an excellent introductory source about ADHD.
I usually don’t agree with Gina Pera on anything but she is right to rant about Peter Breggin. That man is as dangerous as Gina!
He does have some wacko ideas. However, the central theme for me is questioning the prescription of stimulants to children.
That is a story about an autistic child. Omg…the lining up cars, the sensory issues with the grass….textbook…wow…where are these people from! They obviously dont have a clue. (I have a son with autism, by the way.)