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Children arrive with a distinct personality and way of reacting to this world. Some babies, from the moment they exit the womb, arrive yelling, screaming and kicking their legs. They don't sleep. They have colic. They are fussy. Other babies arrive in a more laid-back fashion. They eat, sleep, and snuggle just as the Baby Books describe. What I'd like to discuss in this section, is the babies, who are more unique or different in the way they respond. As these unique babies grow, their personalities and behaviors change also. They may be moody, aggressive, reactive, or oppositional in some way. Their moods may change quickly, even during the period of 24 hours. They may have weak social skills, or inability to keep friends. These kids may have a poor self-image and be critical of themselves for areas of their life that they recognize are different or more difficult than their siblings and friends. As life becomes more difficult, the depression often gets worse, and the cycle repeats itself. Add the hormonal changes of puberty to this already complex set of issues, and coping with this type of life, can almost seem impossible. This challenge affects not only the child, but the whole family. As the mood disorder continues, coping mechanism are stressed and new ways of coping are needed. This is another job in itself, besides parenting the child. Terms such as depression, manic-depression, Bipolar, or Mood Disorder, may be used to define these kids. As the parents seek help in raising them, professional assistance is often needed, because the "normal" way of parenting, just does not work. What may have worked for two other kids in the same family, does not work for this one. It can be very frustrating and exhausting to parent a child with a mood disorder, is a gross understatement. What is a mood disorder? The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), divides mood disorders into two categories: depressive disorders and bipolar disorders and then gives a detailed list of criteria for each group. Family history of depression or mood disorders is one of several risk factors. Papolos & Papolos, The Bipolar Child, provide detailed explanations of the many types of mood disorders and how they present throughout the life-span. They also elaborate on the difficulty making a correct diagnosis, medications used for treatment, and coping with Bipolar Disorders. Often child psychiatrists will delay giving a more specific diagnosis than "mood disorder' until the child reaches the age of 18. Such caution arises from a desire to avoid falsely labeling a child and the need for observation over time to develop a more precise diagnosis. Sometimes the term, "mood disorder NOS" will be used. This means a mood disorder "not otherwise specified." This term is another way of not pining down one label or diagnosis to explain the child, when they may fall into several possible diagnoses. These various ways of describing similar symptoms can be confusing to parents, as they struggle to understand their child or teenager. Also, parents may seek a second opinion, and receive a different diagnosis for their child. "Now what?" may be the next question a parent thinks. To complicate the picture even more, co-morbid conditions often exist along with a mood disorder. Co-morbid means a secondary or additional diagnosis exists which affects their health. For example, the child might also have a heart condition, diabetes, thyroid disease, or a learning disability. These illnesses or conditions would be co-morbidities which may impact the mood disorder, and therefore the total health of the person has to be considered when confirming a diagnosis. It is virtually impossible to discuss mood disorders, or any type of mental illness, without also discussing medications. There are many resources that discuss medications, dosing, side effects, and adverse reactions. Some of these books are listed at the bottom of this page. Most medications have to be tried for several weeks, before you can evaluate the effectiveness of the drug. These weeks can seem like years, if your child is struggling and unhappy. When a second medication is added, then you have to observe for any potential interactions of the meds. A combination of medications is often required, for a child with a mood disorder to be stabilized. It is not uncommon for the child to go thru multiple medications and combinations of medications, before the right medications are found. It is not unusual for this search to take several years. In the meantime, the child and the family are suffering. In order to not falsely blame a drug for not "working", one must also look at many other factors besides just the medication. Some of these other factors are various changes occurring at the same time, in a kid's life: changes in their environment, family or living arrangement changes, school changes, and so forth. Since no one exists in a vacuum, many other factors are always impacting upon a person's mood and behavior. All of these factors combine to make evaluation of a drug's effectiveness more difficult. Was the improvement or worsening of mood, due to the medication, or these other factors? Some will argue the label is not what is really important. It is getting the correct treatment and help that is most important. But my view is, without the correct diagnosis (label), how can you be sure you are receiving the best?, the correct medications, for example. Also, different diagnosis have different prognosis. I want to know as a parent, what the future may bring, so I can prepare myself, my family, and my child. I don't want to be surprised. I want to read, study and learn as much as possible, so I can take the best care of my child. Unfortunately, many psychiatrists are reluctant to give a specific diagnosis for a child or teen. This compounds the parents' frustration. While you are waiting to find the "right" psychiatrist, "right" diagnosis, the right medication, what is happening in the meantime? Your child is growing up, and missing out on having a life. This can be one of the toughest things about mood disorders. Parents want the best for their child. They want them to have fun, friends, and joy in their life. They don't want them to miss out on a having a childhood or being a teenager that participates in school, after school activities and so on. This desire fuels the need for prompt help. There is a sense of urgency because the days are slipping by and your child is not well. Joining a group through the Child and Adolescent Bipolar Foundation is one way to get support and additional information. There are email groups who "chat" on line and offer daily suggestions or just a place to vent. Realizing you are not alone in the struggle is one of the biggest things these resources offer. Resources: Papolos, D. & Papolos, J. (1999). The Bipolar Child. New York: Broadway Books. Schoen-Johnson, Barbara (1997). Adaptation and Growth: Psychiatric-Mental Health Nursing. Philadelphia: Lippincott. Fourth edition. Wilens, T. (2001). Straight Talk about Psychiatric Medications for Kids. New York: Guilford Press. Child and Adolescent Bipolar Foundation: www.bpkids.com National Institute of Mental Health: www.nimh.nih.gov National Mental Health Association: www.nmha.org
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"The world breaks everyone and afterward many are strong at the broken places."
"A man is infinitely more complicated than his
thoughts."
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