"Within days, Heather Norris, then 2, became the youngest child in Tarrant County with a diagnosis of bipolar disorder [5]."
The following is an extract from: International Journal of Risk & Safety in Medicine 19 (2007) 209-221 209. (emphasis added)
"Pediatric bipolar disorder: An object of study in the creation of an illness
David Healy ! and Joanna Le Noury
North Wales Department of Psychological Medicine, Cardiff University, Bangor LL57 2PW, Wales, UK
"...3.Bipolar Disorder in Children
The emergence of bipolar disorder in children needs to be reviewed against the background outlined above. Until very recently manic-depressive illness was not thought to start before the teenage years and even an adolescent onset was atypically early. The clearest indicator of change came with the publication
of The Bipolar Child by Papolos and Papolos [35]. This sold 70,000 hardback copies in half a year.
Published in January 2000, by May it was in a 10th printing. Other books followed, claiming that we were facing an epidemic of bipolar disorders in children [24] and that children needed to be treated aggressively with drugs from a young age if they were to have any hope of a normal life [12]. Newspapers throughout the United States reported increasingly on cases of bipolar children, as outlined below.
A series of books aimed at children with pastel colored scenes in fairy tale style also appeared. In My Bipolar Roller Coaster Feelings Book [23], a young boy called Robert tells us he has bipolar disorder.
As Robert defines it doctors say you are bipolar if your feelings go to the top and bottom of the world, in roller coaster fashion. When Robert is happy he apparently hugs everybody, he starts giggling and feels like doing backflips. His parents call it bouncing off the walls. His doctor, Doctor Janet, calls it silly, giddy and goofy.
Aside from giddiness, Robert has three other features that seem to make the diagnosis of pediatric bipolar disorder. One is temper tantrums. He is shown going into the grocery store with his Mum and asking for candy. When she refuses, he gets mad and throws the bag of candy at her. His mum calls this rage and he is described as feeling bad afterwards.
Second, when he goes to bed at night Robert has nightmares. His brain goes like a movie in fast forward and he seemingly can't stop it.
And third, he can be cranky. Everything irritates him - from the seams in his socks, to his sister's voice, and the smell of food cooking. This can go on to depression when he is sad and lonely, and he just wants to curl up in his bed and pull the blanket over his head.
He feels as though it's the end of the world and no one cares about him. His doctor has told him that at times like this he needs to tell his parents or his doctor and he needs to get help.
Dr. Janet gives Robert medication. His view on this is that while he doesn't like having bipolar disorder, he can't change that. He also doesn't like having to take all those pills but, the bad nightmares have gone away and they help him have more good days. His father says a lot of kids have something wrong with their bodies, like asthma and diabetes and they have to take medicine and be careful, and so from this point of view he's just like many other children.
His parents have told him that his bipolar disorder is just a part of who he is, not all of who he is. That they love him and always will. Finally his doctor indicates that it's only been a little while since doctors knew that children could have bipolar disorder, and that they are working hard to help these children feel better.
In another book, Brandon and the Bipolar Bear, we are introduced to Brandon, who has features in common with Robert that the unwary might fail to realize indicate bipolar disorder [1]. When we are introduced to Brandon , he has just woken up from a nightmare. Second, when requested to do things that he doesn't want to do he flies into a rage. And third, he can be silly and giddy.
His mother takes both Brandon and his bear to Dr. Samuel for help, where Brandon is told that he has bipolar disorder. Dr. Samuel explains that the way we feel is controlled by chemicals in our brain. In people with bipolar disorder these chemicals can't do their job right so their feelings get jumbled inside.
You might feel wonderfully happy, horribly angry, very excited, terribly bad or extremely irritated, all in the same day. This can be scary and confusing - so confusing that it can make living seem too hard.
When Brandon responds that he thinks he got bipolar disorder because he is bad, Dr. Samuel responds that many children have bipolar disorder, and they come to the doctor for help. Neither they nor Brandon are bad - it's a case of having an illness that makes you feel bad. Brandon moves on to asking how he got bipolar disorder if he didn't get it from being bad, to which Dr. Samuel responds by asking him how he got his green eyes and brown hair. Brandon and his mother respond that these came from his parents.
And Dr. Samuel tells them it's the same with bipolar disorder. That it can be inherited. That someone else in the family may have it also. The final exchange involves Brandon asking whether he will ever feel better.
Dr. Samuel response is upbeat - there are now good medicines to help people with bipolar disorder, and that Brandon can start by taking one right away. Brandon is asked to promise that he will take his medicine when told by his mother. Brandon and the Bipolar Bear comes with an associated coloring book, in which Brandon's Dad makes it clear that a lot of kids have things wrong with their bodies, like
asthma and diabetes, and they have to take medicine and be careful too.
Janice Papolos, co-author of The Bipolar Child, in a review on the back cover of Brandon and the Bipolar Bear says: 'children will follow (and relate to) Brandon's experience with rapid mood swings, irritability, his sense of always being uncomfortable and his sadness that he can't control himself and no one can fix him. The comforting explanation that Dr. Samuel gives him makes Brandon feel not alone, not bad, but hopeful that the medicine will make him feel better. We were so moved by the power of this little book and we feel better that we can now highly recommend a book for children aged 4 through 11'.
The book The Bipolar Child arrived at Sheri Lee Norris' home in Hurst , Texas , in February 2000. When it did Karen Brooks, a reporter in the Dallas Star-Telegram describes Norris as tearing open the package with a familiar mix of emotions. Hope, skepticism, fear, guilt, shame, love. But as she reads in the book about violent rages, animal abuse, inability to feel pain, self-abuse and erratic sleeping patterns, Norris is reported as feeling relief for the first time in over a year. Now she finally knew what was wrong with her daughter. . . Within days, Heather Norris, then 2, became the youngest child in Tarrant County with a diagnosis of bipolar disorder [5].
Brooks goes on to note that families with mentally ill children are plagued with insurance woes, a lack of treatment options and weak support systems but that parents of the very young face additional challenges. It is particularly hard to get the proper diagnosis and treatment because there has been scant research into childhood mental illness and drug treatments to combat them.
Routine childcare is difficult to find, because day-care centers, worried about the effect on other children, won't accept mentally ill children or will remove them when they are aggressive. Few baby sitters have the expertise or the desire to handle difficult children, leaving parents with little choice but to quit work or work from home.
Having outlined these difficulties, Brooks also notes that the lack of public awareness of childhood mental illness means that parents are judged when their children behave badly. They are accused of being poor parents, of failing to discipline their children properly, or even of sexual or physical abuse or neglect. The sense of hopelessness is aggravated when they hear about mentally ill adults; this leaves them wondering whether the battles they and their children are fighting will go on forever.
In a few short paragraphs here Brooks outlines the once and future dynamics of disease from ancient to modern times - the reflection on parents or family, the concerns for the future, the hope for an intervention.
But she also covers a set of modern and specifically American dynamics.
Heather Norris's problems began with temper tantrums at 18 months old. Sheri-Lee Norris had a visit from the Child Protective Services. Someone had turned her in because Heather behaved abnormally. Sheri-Lee was furious and felt betrayed. She brought Heather to pediatricians, play therapists and psychiatrists, where Heather was diagnosed with ADHD and given Ritalin. This made everything worse. Faced with all this, a psychiatrist did not make the diagnosis of bipolar disorder because the family had no history of it. But Sheri-Lee began asking relatives and discovered that mental illness was, indeed, in her family's history. She presented that information along with a copy of The Bipolar Child to her psychiatrist, and Heather got a diagnosis of bipolar disorder immediately.
Heather Norris' story is not unusual. The mania for diagnosing bipolar disorders in children hit the front cover of Time in August 2002, which featured 9-year-old Ian Palmer and a cover title Young and Bipolar [26], with a trapline, why are so many kids being diagnosed with the disorder, once known as manic-depression? The Time article and other articles report surveys that show 20% of adolescents nationwide have some form of diagnosable mental disorder. Ian Palmer, we are told, just like Heather Norris, had begun treatment early - at the age of 3 - but failed to respond to either Prozac or stimulants, and was now on anticonvulsants.
While Heather Norris was in 2000 the youngest child in Tarrant County to be diagnosed as bipolar, Papolos and Papolos in The Bipolar Child indicate that many of the mothers they interviewed for their book remembered their baby's excessive activity in utero, and the authors seem happy to draw continuities between this and later bipolar disorder. The excessive activity amounts to hard kicking, rolling and tumbling and then later keeping the ward awake with screaming when born.
Or in some instances being told by the sonographer and obstetrician that it was difficult to get a picture of the baby's face or to sample the amniotic fluid because of constant, unpredictable activity [35]. It is not unusual to meet clinicians who take such reports seriously.
Anyone searching the Internet for information on bipolar disorder in children are now likely to land at BPChildren.com, run by Tracy Anglada and other co-authors of the books mentioned above. Or at the Juvenile Bipolar Research Foundation (JBRF), linked to the Papoloses and The Bipolar Child. Or at a third site, bpkids.org, linked to a Child and Adolescent Bipolar Foundation, which is supported by unrestricted educational grants from major pharmaceutical companies.
In common with the mood-watching questionnaires in the adult field, all three sites offer moodwatching questionnaires for children. The Juvenile Bipolar Research Foundation has a 65-item Child Bipolar Questionnaire, which also featured in the Time magazine piece above; on this scale most normal children would score at least modestly.10
The growing newsworthiness of childhood bipolar disorder also hit the editorial columns of the American Journal of Psychiatry in 2002 [40]. But where one might have expected academia to act as a brake on this new enthusiasm, its role has been in fact quite the opposite..."
End of Extract
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