Signs & Symptoms of Early Onset Bipolar Disorder

I wanted to include some expert perspective on signs and symptoms of Early Onset Bipolar Disorder.  Mani Pavuluri is a Psychiatrist; she also is on the advisory counsel of a website that hosts the support group I co-moderate.  She has gone to great lengths to research and provide information to parents of children with bipolar disorder. If you or someone you know has a child with bipolar disorder, I urge you to check out her book.  Also, find a support group.  There are few people out there who understand, yet thanks to the internet I found a wonderful support group of parents all over, going through something similar.

I assembled this page with an outline.  The first bullet explains symptoms, as outline by Mani Pavuluri, MD, PhD (2008), the indented bullet explains what experiences we have had with that particular symptom.  These are some of the early signs or symptoms of bipolar disorder:

·         Elated mood- acting really silly, overly excited, having a sense of being invincible, laughing more than is appropriate, or doing a behavior compulsively (being so overwhelmed with the feeling they must keep doing it!) 

o   My experience here- Tre would be walking on the side walk and I would ask him to hold my hand, he would say “It’s okay Mom, if a car gets too close I’ll push it out of the way” or “If someone tries to take me, I’ll kill them” (at 4!).  He would do things repetitively, like flip a light switch on and off and somehow me mentioning he needed to stop or that it was enough compelled him to keep doing it. This is where it gets hard, it feels like there is disrespect, like your child is supposed to be listening, but in reality it’s not something easy for them to control.  Sometimes he would laugh as I would tell him what he had done had hurt me. I chalk this partly up to not understanding his emotions, and not being sure what the appropriate emotional response was (but sometimes it was really disturbing, to be honest). 

·         Irritable mood- aggressive, raging, slamming doors, not easily able to switch from on activity to another. Kids explain after the swing that they tried to stop themselves, yet they could not. Parents describe it like being in a war zone.

o   For us- War zone is an appropriate title.  I know when Tre becomes very irritable things slam, he yells, and he throws things.  It to me is like a seizure and his doctor said it very much is. He will knock things off counters, knock furniture over, throw things; it can be very stressful to deal with.  Yet there is not much you can do about it. The words you speak fall on deaf ears.  His mind has no capacity to process what I say when he is in that mode. So it’s like riding out the storm.  The more stable he is, the shorter the storm lasts.  Sometimes we go weeks or months without a major episode, in harder times he will cycle better elated and irritable, nonstop.  It is almost like he is at mercy to his body.  He regrets what he does, even says he hates himself for it, yet he cannot stop himself.  I have watched him try with all of his might.

·         Inflated self-esteem or grandiosity- The child will claim to be the best at whatever he/she is doing.  This can include the child talking or acting like he/she knows everything.  This tends to be a mask for the true lack of self-esteem and/or self control the child actually has.

o   Personally- I have seen Tre do this, however he tends to be very good at the things he puts his mind to.  However, while most of us have experienced a child that knows everything, my son has taken it to a whole new level.  I swear sometimes he would argue that the sky was not blue!

·         Decreased need for sleep- maybe they are up super early or refuse to go to bed at night. Maybe you put them to bed, to check on them at midnight and find them wide awake, playing in their room… Yet they can wake up in the morning bright and chipper.

o   In our house- He did not need the extra sleep it seemed. However, for our sanity we tried establishing a bedtime routine.  I literally would have to sit and read to him until he would fall asleep at night, to get him to fall asleep in his bed. Actually, not much has changed.  He is nine now and has no issue staying up until midnight. Yet, if I relax on the couch at eight, he curls up next to me and usually falls asleep.

·         Pressure to keep talking and flights of ideas- Talking, rambling, none stop

o   For us- This is for me a rough one, because I was a chatter box of a child.  So, I see sometimes it becomes excessive but I manage it okay. There are times he just keeps pushing ‘But I have one more thing to say!’

·         Constant goal-directed activity- fiddling, making a mess at home, if you say that it needs cleaned, the child gets defensive. Perhaps they say it’s not their mess…  Other behavior includes switching from one activity to the next, driven to keep doing more and more

o   Our perspective- We get a lot of meltdowns from standing between what he thinks he needs to do, and what he is doing.  Maybe it can be something as dangerous as riding his bike down the middle of the street, no matter how hard we try explaining why he cannot, he can’t let it go.  We call it mission mode here.  He determines something needs to be done and he goes on a mission to complete it.  This is one of the biggest causes of meltdowns in our house. 

·         Excessive pleasurable activities (hypersexual), poor judgment, and risk taking- Maybe the child starts dressing inappropriately, finding inappropriate pictures, or doing things more physical in nature.  Poor judgment means these children take extreme physical risks, being sometimes dangerously impulsive.  Acts like attempting to jump out of a moving car, destroying furniture, trying to jump off the roof, etc.

o   Our experience- Fortunately we have not dealt with hyper sexuality. Risk taking is something that is not always going on, it sometimes happens in the peak of a mood swing. It’s like their thought process isn’t clear. I see Tre go into a kind of fight or flight mode, and if he chooses flight, it can be dangerous to him.  The situation he is trying to escape may be something as simple as “When we get home, you need to brush your teeth”. Somehow his mind takes that as him being under attack. It ties into the previous symptom; goal orientated behavior.

·         Features of depression- children feel differently than adults; crabby, cry for no reason, excessively whiney, look unhappy, cycling from irritable to crying, hurting themselves.  Children often are extremely sensitive to rejection, because of the bad responses they have had from others over time.

o   For us- We have seen depression and while it is quieter and more controlled than the other erratic behavior can be, it is also the most terrifying for me.  I watch him very closely when he is in a depressed mode. 

·         Threats of suicide- often even the youngest child with bipolar disorder show suicidal behaviors.  Suicide behavior is reported in as many as 25%  in children with bipolar disorder.  Sometimes this behavior is mistaken for high risk behavior; jumping in front of a car, or out a window.

o   For me- This is a terrifying statistic and sadly one we have experienced.  He at one point tried putting his head through the window, and told me it was because he wanted to die.  He didn’t want to live in this world anymore.  I felt like I was in a nightmare I couldn’t wake up from, because he was hurting so badly and there was nothing I could do to help him.

·         Psychosis- hallucination, delusions, present in 17-60% of patients.

o   Fortunately this is something we have not had to deal with.

Reference

Pavuluri, M., M.D., Ph.D., (2008) what works for bipolar kids help and hope for parents. New York: The Guilford Press.