...or as best as one can know. I get asked this a lot, especially with his young age. Granted, it is a serious diagnosis with serious implications. It's also a very complex illness that has only begun getting unraveled. But now more than ever bipolar disorder is getting the attention it deserves. More research is going into it and professionals are looking for answers. And that's a good thing. Mental illness isn't like it used to be when doctors told parents to lock the children up, send them to institutions, or force them to endure electric shock treatment. We force them to endure med trials and frequent blood tests instead. Okay, all joking aside, people with mental illness have a far greater chance of living a normal life than ever before.
Back to the subject. Many people ask me how I can discern the difference between normal three year old behavior, a "spirited" or strong-willed child's behavior, and a more serious problem like mental illness. I have always known Taz was different, more difficult than most kids his age, and sensitive. The first couple years I blamed it on the terrible two's. They started early and he was just a more intense kid, at least that's what other people told me. When he turned three and things got even worse, I started to wonder about ADHD. Actually, I was pretty sure he would get diagnosed with that once he went to school. That's as far as my concerns went.
But then I happened to catch a show on HBO called "Boy Interrupted", which was a documentary about a family whose son had bipolar disorder, and at 15, committed suicide. When I heard the mother describing what he was like at a young age, the stories sounded eerily familiar. So I went to the internet and googled "bipolar disorder in children".
I had no problem believing bipolar existed but I had no idea it existed in children, let alone children as young as preschool. Come to find out, bipolar disorder looks very different in children than in adults, and it's still in the process of being more clearly defined. Anyway, I read through a checklist of symptoms and decided this needed further investigation. I must have spent 2 hours (I think I was supposed to be working) scrolling through every story and every bit of research I could find about bipolar disorder in children. When I realized it all fit, I was numb. I couldn't think, I couldn't make dinner, I couldn't even form the words to tell someone.
A couple weeks later I was still only beginning to believe Taz could have something this serious and had planned on putting it on the back burner until he was older. But, then he stopped sleeping. Literally, he went from sleeping just fine all the way through the night to suddenly only sleeping 3 or 4 hours per night for days on end. But it wasn't like he couldn't fall asleep or couldn't stay asleep, it was truly as if he didn't need sleep. He wouldn't even seem tired until 11pm some nights. Then be up at 3AM rearing to go for the day. He would say "I up!" like it was a beautiful cheery morning, sun shining, birds chirping.
So I called our pediatrician. He said to give him Melatonin, a natural hormone already produced in our bodies but given artificially to gently help ease you into the sleep cycle. It worked for a week or so, then it stopped. We upped the dose over and over until we were right at the edge of the healthy limit. Still didn't work. So our pediatrician recommended trying a psychiatrist.
It was around this time I started hanging around the online forums for parents of children with bipolar disorder. CABF (the Child and Adolescent Bipolar Foundation) is a great resource. I started to learn about all the intricacies these kids have in common. I also heard from other parents with very young children with bipolar symptoms starting medication and getting therapy.
As Taz's symptoms began increasing, I started to seriously consider getting a professional evaluation for bipolar disorder. We also did some blood tests to rule out any medical causes as well. So, I'm sure you are wondering what the symptoms of bipolar are and how a three year old displays them.
Periods of irritability: I don't mean just a little bit cranky because he's hungry or tired. I mean periods where you couldn't touch him, talk to him, or even look at him without him lashing out. Grumpy is an understatement.
Severe tantrums or rages: Not your typical kicking and screaming on the floor toddler tantrum. Taz would get completely out of control, hitting, kicking, scratching, sometimes biting, with all his strength. He was like a little wild animal fighting for survival. He would throw anything that happened to be in his path. When we put him in his room to calm down, he would destroy anything he could get his hands on. He's put holes in the walls, thrown trucks and step stools at us, and you can't even reach him because he's so far gone. These can last anywhere between 30 minutes to 2 hours to an entire afternoon.
Defiance: Ever hear of ODD (oppositional defiance disorder)? A lot of bipolar kids qualify for this diagnosis as well but I like to think of it as part of the bipolar instead of slapping a bunch of letters under his name. Most three year olds like to please adults. They like to be helpful and feel important. Not Taz. You could ask him to do the simplest task and you would receive a resounding "NO!" Even if I made it the most fun game in the world and offered lots of praise and encouragement, it was still "NO!"
Depression: There would be periods of hours where Taz would mope around the house, not interested in playing or doing anything. Nothing made him happy. I couldn't talk to him. He would be very quiet and tired. He had low energy and slept more during these cycles too.
Night terrors: These can be normal for some kids but they are also a symptom of bipolar disorder, along with other problems with sleep. I think I mentioned above that there were times when Taz just didn't seem to need sleep. He also experienced night terrors where he would wake up screaming, thrashing around, pointing at things on the walls and ceilings, and attacking us like we were some kind of creature from a horror film. It would take him sometimes an hour to calm down and go back to sleep. This would happen over and over each night.
Fascination with gore/violence: Taz hasn't had much exposure to these things. For older kids with bipolar this can be a very big issue. Fortunately it isn't for us yet. There was one occasion recently where we drove by a tree cutter on the side of the road and Taz said, "that cuts Chica's head off." Then he stated that he was going to kick Chica's head off. That may be normal feelings of jealousy but expressed in a much more violent way than most three year olds. I can't leave Taz alone with his sister because I can't trust him to be safe.
Anxiety: Taz has some anxiety pretty constantly. But there are random points during the day or week where he has severe separation anxiety that can result in an emotional meltdown. There was one time when all of us were shopping at Target and DH stepped away for one minute to look down an aisle. Taz about had a heart attack that daddy left. He rammed the cart into a shelf and started attacking me. Taz is also very sensitive to changes in routine and environment. His anxiety gets set off very easily and it effects his sleep majorly and he gets clingy during the day.
Hyperactivity: Again, most bipolar kids qualify for more than one diagnosis, ADHD being one of them. I prefer not to state that he does have this although he probably would qualify.
Mania: This can look a little different in each child. Some get very goal oriented. Some spend or want to spend a lot of money. Some engage in risky behavior. For Taz, I can tell when he's manic because he gets this crazy look in his eye, and it's hard to explain, but I feel like something has taken over his body and he's lost all control. Hyper would be an understatement. But he will jump off high surfaces. He gets very silly and giddy beyond control. He laughs at inappropriate things. He can't calm down. He goes from laughing to screaming to crying in a matter of 30 seconds. One time he kept running at me trying to bit me while laughing hysterically.
Hypersexual: This is part of mania. When Taz is manic he will try to grab butts and boobs. He also rubs himself on things and gets obsessed with talking about and touching private parts. More than just curiosity, it gets out of control. Again, this is without exposure to sexual content.
Racing thoughts/Talking incessantly: It was 11pm one night and we were trying to get Taz to bed. DH went into his room and Taz was talking a mile a minute about one thing, then switching rapidly to another, and couldn't stay organized or focused but just had to talk. There was another time when we were in the grocery store and he was walking ahead of us literally naming and talking about every single item we walked by over and over. It was like an engine was running inside him that he just couldn't stop.
Grandiosity/Inflated Self-esteem: Taz will dispute me to the very end of a discussion about what he thinks is right. He constantly tells me how to drive. He'll ask why we're going this way, I tell him that's the way to go home. And he emphatically says "no". And I tell him to trust me that I know where we're going. He will argue up and down that I'm not going the right way. This is just one example.
Taz fits most of the main symptoms, but also down to the more subtle symptoms. Craving carbs, getting hot easily, being more hyper in the evening, poor working memory, sleep reversal, issues reading facial features and social cues, the ability to hold it together in front of other people then lashing out at home, and probably more that I can't think of now.
So...that's a lot of information. Any questions?
Next post I will write about our journey to therapy and medication. What's working now and what's not. Then we'll go from there.