“By the first grade
her teacher started telling me Tori was very, very angry,” Heidi
Littlefield remembers. Her daughter was inconsolable- a clue that
she had bipolar disorder.

On the one hand rages, frantic, and excited- kind of mania. “They
just don’t need as much sleep and they’re not tired,
and they’re go, go, go, go, go,” explains Dr. Yvonne
Pennington, Tori’s cognitive therapist, “They get in
this big expansive thing, like they’ve got better powers
than everybody else, and they can do more.”

There are also morbid nightmares. “Even in the waking state
they are still talking about these morbid things they have dreamed,
but they’re still sort of seeing them,” says Dr. Pennington.

And on the other end of the spectrum, a depression that can last
for weeks. “There was no amount of tears, no amount of kicking,
screaming, anything, that would possibly communicate my pain, but
carving into my leg, ‘kill me’,” Tori recalls.

Experts say even with proper treatment, recovery is a life-long
battle. “About 1/3 of patients get completely well in terms
of their symptoms, about another half get moderate benefit in terms
of their symptoms, and about a quarter don’t get much benefit
in terms of their symptoms in the long run. And about 10% commit
suicide,” explains Dr. Nassir Ghaemi, director of the Bipolar
Disorder Research Program at Emory University.

Tori is now on medication and in therapy, but she still lives
in fear of her next depressive or manic episode. “It scares
me of how I might feel when it does happen. It scares me about
what it might do to my future.”

According to a recent mental health report from the U.S. Surgeon
General’s Office, about 11 percent of youths aged 9 to 17 (approximately
4 million people) have “a major mental illness that results in
significant impairments at home, at school and with peers.” Consider
these additional mental health statistics cited by the World Health
Organization’s Global Burden of Disease study:

• Four of the 10 leading causes of disability for persons age 5
  and older are mental disorders.
• Among developed nations, including the United States, major depression
  is the leading cause of disability.
• Manic-depressive illness (bipolar disorder), schizophrenia and
  obsessive-compulsive disorder also appear among the top of these
  rankings.
• Mental disorders are tragic contributors to mortality, with suicide
  perennially representing one of the leading preventable causes of
  death in the United States and worldwide.

Those who suffer bipolar disorder, one of the most frequently diagnosed
youth mental health diseases, experience a combination of extremely
high (manic) and low (depressed) moods. Bipolar youth may have more
normal moods between these episodes, while the periods of depression
or mania can last for days, weeks or even months. What many parents
don’t know is that these symptoms often mimic those attributed
to attention-deficit hyperactivity disorder (ADHD). According to the
Child & Adolescent Bipolar Foundation (CABF), 15 percent of U.S.
children diagnosed with ADHD may actually be suffering early-onset
bipolar disorder instead.

Who is at risk of developing bipolar disorder? CABF says the illness
usually begins in late adolescence – often appearing as depression
during teen years – although it can start in early childhood
or later in life. It is not exactly known how many children are affected
by the disorder because studies are lacking, but is estimated to affect
1 to 2 percent of adults worldwide. Consider the following statistics
and risk factors associated with bipolar disorder, cited by CABF:

• An equal number of men and women develop the illness (men tend
  to begin with a manic episode, women with a depressive episode).
• It is found among all ages, races, ethnic groups and social classes.
• The illness tends to run in families and appears to have a genetic
  link.
• Like depression and other serious illnesses, bipolar disorder
  can also negatively affect spouses, partners, family members, friends
  and coworkers.

• According to the American Academy of Child & Adolescent Psychiatry
  (AACAP), up to one-third of the 3.4 million children and adolescents
  with depression in the United States may actually be experiencing
  the early onset of bipolar disorder.

• Bipolar disorder is more likely to affect the children of parents
  who have the disorder. When one parent has bipolar disorder, the
  risk to each child is estimated to be between 15 and 30 percent.
  When both parents have bipolar disorder, the risk increases to 50
  to 75 percent.  
• Family history of drug or alcohol abuse may be associated with
  bipolar disorder in teens.

How can you determine if your child is suffering
from bipolar disorder? The AACAP says that youth who have the disorder
may begin to show either manic or depressive symptoms:

Manic Symptoms :

• Severe changes in mood compared to others of the same age and
  background – For example, either unusually happy or silly,
  or very irritable, angry, agitated, or aggressive
• Unrealistic highs in self-esteem – Your child feels all-powerful
  or like a superhero with special powers
• Significant increase in energy – The ability to go with
  little or no sleep for days without feeling tired
• Increase in talking – Your child talks too much or too
  fast, changes topics too quickly, and cannot be interrupted
• Distractibility – Your child’s attention moves constantly
  from one subject to the next
• Repeated high risk-taking behavior – For example, abusing
  alcohol and drugs, reckless driving, or sexual promiscuity

Depressive Symptoms :

• Irritability, depressed mood, persistent sadness or frequent
  crying
• Thoughts of death or suicide
• Loss of enjoyment in favorite activities
• Frequent complaints of physical illnesses, such as headaches
  or stomachaches
• Low energy level, fatigue, poor concentration, complaints of
  boredom, etc.
• Major change in eating or sleeping patterns, such as oversleeping
  or overeating

Some of these signs are similar to those that occur in teens with
other problems, such as drug abuse, delinquency, attention-deficit
hyperactivity disorder or even schizophrenia. A child and adolescent
psychiatrist can only make the diagnosis with careful observation
over an extended period of time.

If you suspect that your child has bipolar disorder (or any psychiatric
illness), CABF suggests you take daily notes of your child’s
mood, behavior, sleep patterns, unusual events and statements made
by your child that cause you concern. Share these notes with the
child and adolescent psychiatrist you choose to evaluate your child.
Because children with bipolar disorder can be charming and charismatic
during an appointment, they initially may appear to a professional
to be functioning well. Therefore, you should keep the following
characteristics in mind when choosing a doctor for your child:

• Knowledgeable about mood disorders, has a strong background
  in psychopharmacology, and stays up-to-date on the latest research
  in the field

• Knows he/she does not have all of the answers and welcomes information
  you may discover about your child
• Explains medical matters clearly, listens well and returns phone
  calls promptly
• Offers to work closely with you and values your input
• Has a good rapport with your child
• Understands how traumatic a hospitalization is for both you
  and your child, and keeps in touch with your family during this
  period
• Advocates for your child with managed-care companies when necessary
• Advocates for your child with the school to make sure he/she
  receives services appropriate to his/her educational needs

Adolescents diagnosed with bipolar disorder can be effectively
treated. The Surgeon General’s Office says many children are
treated with mood stabilizing drugs like lithium and valproic acid,
which helps reduce the number and severity of manic episodes as well
as prevent depression. However, the use of lithium can cause toxicity
and impairment of renal and thyroid functioning, so it is not recommended
for families unable to keep regular appointments that would ensure
monitoring of serum lithium levels and of adverse events. The AACAP
says that psychotherapy is also used to help a bipolar adolescent
understand himself/herself, adapt to stresses, rebuild self-esteem,
and improve relationships.

The CABF says many parents of children with bipolar disorder have
discovered numerous techniques referred to as therapeutic parenting.
The following techniques can help calm your child when he/she is
symptomatic and can help prevent and contain relapses:

• Practicing and teaching your child relaxation techniques
• Using firm restraint holds to contain rages
• Prioritizing battles and letting go of less important matters
• Reducing stress in the home, including learning and using good
  listening and communication skills
• Using music and sound, lighting, water, and massage to assist
  your child with waking, falling asleep, and relaxation
• Becoming an advocate for stress reduction and other accommodations
  at school
• Helping your child anticipate, avoid or prepare for stressful
  situations by developing coping strategies beforehand
• Engaging your child’s creativity through activities that
  express and channel his/her gifts and strengths
• Providing routine structure and a great deal of freedom within
  limits
• Removing objects from the home (or locking them in a safe place)
  that could be used to harm himself/herself or others during a rage

The National Depressive and Manic-Depressive Association suggests
these additional ways in which you can help your bipolar child:

• Read about bipolar disorder and share what you learn with your
  family. Your doctor can suggest resources to help you learn more.
• Encourage your child to join a local support group. You can
  accompany your child and share information and experiences with
  the support group.

• Offer a great deal of emotional support. This step involves
  understanding, patience, affection and encouragement. Do not put
  down feelings expressed, but point out realities and offer hope.
• Never ignore remarks about suicide. Report them immediately
  to your child’s therapist.

Even before Andy’s first birthday… there were signs.

“He did not point to things. He would not wave. We’ve been trying to get him to wave since 6 months and he will not do it to this day. Didn’t clap his hands until he was over 18 months,” says his mom, Wendy Faber.

At his 18-month check-up, Andy still wasn’t speaking… that’s when his pediatrician mentioned autism.

“As soon as he said it was a possibility, it was ‘what do we need to do?” says Wendy.

“Go in, get an evaluation,” says Michael Morrier, M.A., and Early Childhood Coordinator with the Walden Early Childhood Center in Atlanta, “They may not be able to specifically say autism… but they would al least be able to say there’s enough symptoms here that we should start treatment. We should start doing something.”

The American Academy of Pediatrics, government agencies, and private autism groups have started a campaign to teach parents of the early signs of autism…

So that treatment can begin earlier.

“The brain, especially with young kids, has a lot of neuro-plasticity. If something happens it’s still sort of young enough that you can make a new pathway to do what the old one couldn’t do,” says Morrier.

Ideally, he says… treatment should begin by 18 months of age.

But too often, doctors miss the diagnosis.

“I think that’s one of the most frustrating things with the early intervention is that the parents know at around 12 months, 18 months… and they’re saying there’s something wrong with my child. And the professionals are saying ‘he’s a boy, he’ll talk late, don’t worry about it’.”

“If the pediatrician tells you there’s nothing wrong or they’ll grow out of it… go to someone else. I think your gut feeling, you know,” adds Mrs. Faber.

Thanks to early intervention… Wendy intends to keep the dreams she had when her son was born.

“I plan on him going to college. I plan on him doing everything I ever dreamed for him. I mean I realize there may be things he struggles with, but I realize he can overcome them. With help.”

The causes of autism remain unknown, but the effects are very evident. Many families throughout the world have autistic children. Consider the following statistics:

• Autism spectrum disorders occur in one of every 166 children.
• Autism occurs in one out of every 250 children.
• Four-out-of-five autistic individuals are male.
• Some individuals with autism may also be intellectually impaired.
• One-third of those with autism suffer from epilepsy.
• Diagnosis for autism increased 556 percent during the 1990s.

Raising a child with autism can be very trying, but it can also be very rewarding. Temple Grandin, Ph.D., is an assistant professor at Colorado State University, and perhaps the most well-known sufferer of autism in the world. Grandin has developed abattoirs for humane cattle-slaughtering, using her experiences with autism to help devise ways to keep the cattle from panicking. Grandin credits a strong network of parents and teachers with his ability to succeed in life. Consider the following list Grandin has created to help others whose children or students have autism. Think of ways to apply some of the classroom techniques below at your house. You may want to share this list with your child’s teachers.

• Many people with autism are visual thinkers. I think in pictures. I do not think in language. All my thoughts are like videotapes running in my imagination. Pictures are my first language, and words are my second language. Nouns were the easiest words to learn because I could make a picture in my mind of the word. To learn words like “up” or “down,” the teacher should demonstrate them to the child. For example, take a toy airplane and say “up” as you make the airplane takeoff from a desk. Some children will learn better if cards with the words “up” and “down” are attached to the toy airplane. The “up” card is attached when the plane takes off. The “down” card is attached when it lands.
• Avoid long strings of verbal instructions. People with autism have problems with remembering the sequence. If the child can read, write the instructions down on a piece of paper. I am unable to remember sequences. If I ask for directions at a gas station, I can only remember three steps. Directions with more than three steps have to be written down. I also have difficulty remembering phone numbers because I cannot make a picture in my mind.
• Many children with autism are good at drawing, art and computer programming. These talent areas should be encouraged. I think there needs to be much more emphasis on developing the child’s talents. Talents can be turned into skills that can be used for future employment.
• Many autistic children get fixated on one subject such as trains or maps. The best way to deal with fixations is to use them to motivate schoolwork. If the child likes trains, then use trains to teach reading and math. Read a book about a train and do math problems with trains. For example, calculate how long it takes for a train to go between New York and Washington.
• Use concrete visual methods to teach number concepts. My parents gave me a math toy that helped me to learn numbers. It consisted of a set of blocks that had a different length and a different color for the numbers one through 10. With this I learned how to add and subtract. To learn fractions my teacher had a wooden apple that was cut up into four pieces and a wooden pear that was cut in half. From this I learned the concept of quarters and halves.
• I had the worst handwriting in my class. Many autistic children have problems with motor control in their hands. Neat handwriting is sometimes very hard. This can totally frustrate the child. To reduce frustration and help the child to enjoy writing, let him type on the computer. Typing is often much easier.
• Some autistic children will learn reading more easily with phonics, and others will learn best by memorizing whole words. I learned with phonics. My mother taught me the phonics rules and then had me sound out my words. Children with lots of echolalia will often learn best if flash cards and picture books are used so that the whole words are associated with pictures. It is important to have the picture and the printed word on the same side of the card. When teaching nouns the child must hear you speak the word and view the picture and printed word simultaneously. An example of teaching a verb would be to hold a card that says “jump,” and you would jump up and down while saying “jump.”
• When I was a child, loud sounds like the school bell hurt my ears like a dentist drill hitting a nerve. Children with autism need to be protected from sounds that hurt their ears. The sounds that will cause the most problems are school bells, PA systems, buzzers on the scoreboard in the gym, and the sound of chairs scraping on the floor. Try and reduce the amount of loud and alarming sounds in and around your house. In many cases the child will be able to tolerate the bell or buzzer if it is muffled slightly by stuffing it with tissues or duct tape. Scraping chairs can be silenced by placing slit tennis balls on the ends of the legs or installing carpet. A child may fear a certain room because he is afraid he may be suddenly subjected to squealing microphone feedback from the PA system. The fear of a dreaded sound can cause bad behavior. If a child covers his ears, it is an indicator that a certain sound hurts his ears. Sometimes sound sensitivity to a particular sound, such as the fire alarm, can be desensitized by recording the sound on a tape recorder. This will allow the child to initiate the sound and gradually increase its volume. The child must have control of playback of the sound.
• Some autistic people are bothered by visual distractions and fluorescent lights. They can see the flicker of the 60-cycle electricity. To avoid this problem, place the child’s desk near the window or try to avoid using fluorescent lights. If the lights cannot be avoided, use the newest bulbs you can get. New bulbs flicker less. The flickering of fluorescent lights can also be reduced by putting a lamp with an old-fashioned incandescent light bulb next to the child’s desk.
• Some hyperactive autistic children who fidget all the time will often be calmer if they are given a padded weighted vest to wear. Pressure from the garment helps to calm the nervous system. I was greatly calmed by pressure. For best results, the vest should be worn for twenty minutes and then taken off for a few minutes. This prevents the nervous system from adapting to it.
• Some individuals with autism will respond better and have improved eye contact and speech if the teacher interacts with them while they are swinging on a swing or rolled up in a mat. Sensory input from swinging or pressure from the mat sometimes helps to improve speech. Swinging should always be done as a fun game. It must NEVER be forced.
• Some children and adults can sing better than they can speak. They may respond better if words and sentences are sung to them. Some children with extreme sound sensitivity will respond better if the teacher talks to them in a low whisper.
• Some nonverbal children and adults cannot process visual and auditory input at the same time. They are mono-channel. They cannot see and hear at the same time. They should not be asked to look and listen at the same time. They should be given either a visual task or an auditory task. Their immature nervous system is not able to process simultaneous visual and auditory input.
• In older nonverbal children and adults, touch is often their most reliable sense. It is often easier for them to feel. Letters can be taught by letting them feel plastic letters. They can learn their daily schedule by feeling objects a few minutes before a scheduled activity. For example, fifteen minutes before lunch give the person a spoon to hold. Let them hold a toy car a few minutes before going in the car.
• Some children and adults with autism will learn more easily if the computer keyboard is placed close to the screen. This enables the individual to simultaneously see the keyboard and screen. Some individuals have difficulty remembering if they have to look up after they have hit a key on the keyboard.
• Nonverbal children and adults will find it easier to associate words with pictures if they see the printed word and a picture on a flashcard. Some individuals do not understand line drawings, so it is recommended to work with real objects and photos first. The picture and the word must be on the same side of the card.
• Some autistic individuals do not know that speech is used for communication. Language learning can be facilitated if language exercises promote communication. If the child asks for a cup, then give him a cup. If the child asks for a plate, when he wants a cup, give him a plate. The individual needs to learn that when he says words, concrete things happen. It is easier for an individual with autism to learn that their words are wrong if the incorrect word resulted in the incorrect object.
• Many individuals with autism have difficulty using a computer mouse. Try a roller ball (or tracking ball) pointing device that has a separate button for clicking. Autistic children with motor control problems in their hands find it very difficult to hold the mouse still during clicking.
• Children who have difficulty understanding speech have a hard time differentiating between hard consonant sounds such as ‘d’ in dog and ‘l’ in log. My speech teacher helped me to learn to hear these sounds by stretching out and enunciating hard consonant sounds. Even though the child may have passed a pure tone hearing test he may still have difficulty hearing hard consonants. Children who talk in vowel sounds are not hearing consonants.
• Several parents have informed me that using the closed captions on the television helped their child to learn to read. The child was able to read the captions and match the printed works with spoken speech. Recording a favorite program with captions on a tape would be helpful because the tape can be played over and over again and stopped.
• Some autistic individuals do not understand that a computer mouse moves the arrow on the screen. They may learn more easily if a paper arrow that looks EXACTLY like the arrow on the screen is taped to the mouse.
• Children and adults with visual processing problems can see flicker on TV-type computer monitors. They can sometimes see better on laptops and flat panel displays that have less flicker.
• Children and adults who fear escalators often have visual processing problems. They fear the escalator because they cannot determine when to get on or off. These individuals may also not be able to tolerate fluorescent lights. Irlen Institute colored glasses may be helpful for them.
• Individuals with visual processing problems often find it easier to read if black print is printed on colored paper to reduce contrast. Try light tan, light blue, gray or light green paper. Experiment with different colors. Avoid bright yellow – it may hurt the individual’s eyes. Irlen colored glasses may also make reading easier.
• Teaching generalization is often a problem for children with autism. To teach a child to generalize the principle of not running across the street, it must be taught in many different locations. If he or she is taught in only one location, the child will think that the rule only applies to one specific place.
• A common problem is that a child may be able to use the toilet correctly at home but refuses to use it at school. This may be due to a failure to recognize the toilet. Hilde de Clerq, an international specialist from the Centre for Training in Autism and Asperger Syndrome in Antwerp, Belgium, discovered that an autistic child may use a small non-relevant detail to recognize an object such as a toilet. It takes detective work to find that detail. In one case a boy would only use the toilet at home that had a black seat. His parents and teacher were able to get him to use the toilet at school by covering its white seat with black tape. The tape was then gradually removed and toilets with white seats were now recognized as toilets.
• Sequencing is very difficult for individuals with severe autism. Sometimes they do not understand when a task is presented as a series of steps. An occupational therapist successfully taught a nonverbal autistic child to use a playground slide by walking his body through climbing the ladder and going down the slide. It must be taught by touch and motor rather than showing him visually. Putting on shoes can be taught in a similar manner. The teacher should put her hands on top of the child’s hands and move the child’s hands over his foot so he feels and understands the shape of his foot. The next step is feeling the inside and the outside of a slip-on shoe. To put the shoe on, the teacher guides the child’s hands to the shoe and, using the hand-over-hand method, slides the shoe onto the child’s foot. This enables the child to feel the entire task of putting on his shoe.
• Fussy eating is a common problem. In some cases the child may be fixated on a detail that identifies a certain food. de Clerq found that one child only ate Chiquita bananas because he fixated on the labels. Other fruit such as apples and oranges were readily accepted when Chiquita labels were put on them. Try putting different but similar foods in the cereal box or another package of a favorite food. Another mother had success by putting a homemade hamburger with a wheat free bun in a McDonald’s package.

Autism Society of America
Emory Autism Center
Center for the Study of Autism
Marcus Institute
Child and Youth Health