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.