[Deana]

We may be taking 2 foster children, girls ages 3 and 4. The 3 year old has behavior problems:tantrums, occassional self harming, hyper, defiance, etc. The foster mom thinks she is bi-polar. The psychiatrist disagrees and things some of the problems are coming from the home she is in (they have 3 bio kids and 6 foster kids in the home, the girls go to preschool and daycare so not home much and not much attention at home, foster parents want boys) Well this just doesn't sound like bi-polar to me because the foster mom says they were having problems for a while but no problems right now. If she was bi-polar she wouldn't just get better would she?? The bio dad is bi-polar, bio mom has drug issues. So anyway those of you who have bi-polar kids what do you think?

[Peggy]

I am not an expert, but those behaviors can also be for trauma, and from sexual abuse, or abuse in general.

[aMarylandfamily]

Onset childhood Bi-Polar can begin as early as this and yes it cycles in and out ... so one day (or week or month) can be wonderful and watch-out for the manic cycle (even can be gentle manic) when it hits. Bpkids.com is a wonderful site to review for symptoms and information.

The self-harm behavior is a definite red flag for bi-polar along with the tantrums and other behaviors described. Professionals, especially psychiatrists, are very reluctant to use this diagnosis as it literally makes a child awaiting adoption placement "unplaceable" due to the extreme needs of the child which are re-occurring all through their life. Another clue - find out what meds if any the child is on. ADHD (hyper) behaviors also mask bi-polar.

Update as you know more and I'll try and fill in more info and answer more questions. Re-read past posts (Mom of Many/Pam) has posted many times regarding bi-polar and its effects.

[clara]

Dear Deana,

I would strongly recommend a book by depression specialist
J.Raymond DePauloJr., M.D Professor of Psychiatry and current Director of the Affective (Mood) Disorders Clinic at the Johns Hopkins University School of Medicine. He is a research expert and clinician on depression and bi-polar disorder. The book is called: Understanding Depression; What we know and what we can do about it. He is internationally regarded as one of the world's foremost authorities on the subject. His book is detailed, comprehensive and easy to follow. In it he discusses the symptoms and causes of biploar disorder. The clinic itself also offers an opportunity for a one time consultation and diagnosis.
It is published by John Wiley & Sons Inc. It is an indispensible source of accurate, medical information.

Best of luck

Renée

[Dianna]

Deana, these behaviors sound like our daughter who came to us at age 3 years 11 months. She turned out to have mood disorder and emerging bipolar disorder. She had many other issues as well and needed a tremendous amount of individual attention. There could be many reasons for behaviors and no pure cause or diagnosis in the complex foster world they come from. Like our daughter's psychiatrist says, "Hope for the best and be prepared for the worst." There is a lot of good support here. Good Luck.

[Mom_Of_Many]

My 9 year old adopted son is bipolar and doing very well on his medication (Lithibod and Seroquel). When we first got him, at two, he banged his head against the wall, never stopped moving, clawed at his face, raged, bit, stayed up all night. Bipolar can be evident from Day One and many adopted kids ARE bipolar because many of the birthmothers who are forced to give up their kids couldn't parent them simply because they were ill. Bipolar also causes substance abuse in an attempt for the person to self-medicate. We figure Lukie's birthmom prolly had bipolar and that is why she used drugs. Lucas is defiinitely better on meds. And ADHD meds made him worse (which is common with bipolar kids). You may want to read the Early Onset Bipolar Bible called "The Bipolar Child" by Dimitri and Janice Papalos and the site www.bpkids.org is awesome. I go there all the time. However....with adopted kids there are many possible reasons for this behavior. Often there is more than one reason for this behavior. It can be Fetal Alcohol Syndrome/Effects. It can be RAD (but I think bipolar is often mistaken for RAD in adopted kids and they aer also often comorbid). Could be various forms of autism. Could be a combination of all those things or other things. We still haven't figured out the entire puzzle of what is wrong with Lucas. We have the bipolar, but that doesn't explain why he has trouble learning in school....FAS? FAE? Genetic problem? We don't know. Yes, Bipolar kids can go into remission. Lucas got markedly better without meds at age five, and we continued to think it was ADHD, but the meds made him worse. They put him on Prozac and he got psychotic, which is also normal for bipolar (antidepressants are terrible for kids who get manic). Finally, at age 8, a GOOD child psychiatrist (we had been thru four) asked him if he ever heard vocies and I just kind of laughed to myrself because Lucas never acted like he heard voices. He said "Yes." Later he was able to talk about a "devil" and "angel" voice that he heard (and this child has NO imaginatioin at all). On good meds, the voices have gone away, but some kids have psychotic symptoms with bipolar too. Childhood bipolar does not present like adult bipolar....it is rapid cycling. My son presented as a super hyperactive kid who was oppositional (he is much better now). Bipolar is VERY hereditary. If it is in the family history, and you know it, that is a red flag. So is a history of parental depression, substance abuse or suicide in the birth family. I can't tell you what is wrong with your toddler, but I have done a lot of homework on bipolar, since two of my adopted kids do have it. A couple things to look for: children who simply do not sleep or wake up in the middle of the night and don't go back to sleep, kids who are overly active and/or talkative, kids who rage or get violent and oppositional way beyond the norm and terrible times with transitions. Another thing: many of the kids maintain in school/daycare, but it is so hard for them to do so that they totally fall apart at home. Good luck trying to solve the puzzle. We're still going at it

[Mom_Of_Many]

I re-read your post. I guess I just scanned it at first. I would say that, with her familyhistory and behavior, this is bipolar most likely. It is usually called ADHD in the adoption profiles, but the history is there, and that matters a lot. I do not feel that bipolar is the worst thing a child can have, although my two bipolar kids do not get violent (many do) and Lucas may as he gets older. So far (knock on wood) he is stable as is my 18 year old daughter. But they will be on meds forever. It is a challenge, and again may be comorbid with other things, since we're talking about kids who had poor prenatal histories. Don't rule out FAS/FAE if the mother substance abused. If she didn't say "no" to drugs, she didn't say "no" to alcohol. And it could be a bipolar/FAE diagnosis (we are probably looking at that with Lucas). Lucas is VERY challenging and I have tof ight every year for his education...and he is losing more and more ground in school every year (that would be the FAE). I could not parent two of Lucas (although some people can and do). Do your homework and go to the site I gave you and chat with some of the parents. Also read the bipolar book (it is all about childhoodl bipolar only). A psychiatrist nixing the bipolar dx. at first is common. That doesn't mean the child doesn't have it. Ok, enough of my wordy posts for now. Good luck

[lucyjoy]

I would suggest you look at RAD and attachment issues as well as bi-polar. If it is attachment, a change in environment and parenting stategies may be all that is needed(Actual RAD will require attachment based therapy).

[Dr. Art]

One cannot make a diagnosis from behaviors alone. The behaviors indicative of Bipolar Disorder substantially overlap with those of ADHD, ODD, RAD, and several other conditions. Generally, one needs a good early social history and a thorough assessment by a well experienced mental health professional with substantial training and background assessing and treatment adopted and foster children, many of whom have trauma-attachment issues.

An excellent book to read is, The Bipolar Child. It is written for both parents and professionals and I think you'll find it most helpful.

That being said, there are a few red-flags your story raises that might lead one to consider bipolar disorder: Tantrums that last for an extended period of time (more than 30 min) and that the child cannot stop, a history of biological family members having Bipolar Disorder (there is a strong genetic component to this condition).

Finally, if the psychiatrist you've been to is a Board Certified Child Psychiatrist and has substantial experience with pediatric cases of Bipolar disorder, then I'd accept the doctor's assessment. If the doctor has not worked with any or many such children, you might want to travel to get a second opinion from a child psychiatrist who is more expert in this area.

Regards

[lucyjoy]

I had a psycologist tell me he could not ***** my child for bipolor because with his severe RAD he was a compulsive liar and the doctor felt he would not seriously allow the testing.

This same child, when assessed a few years later forpsychotic behaviors by a well know RAD therapists, took over 30 min to answer one question. She said that had never occured before i all her years of testing. A few days later, he completed the entire test in 30 min.

He use to through tantrums for hours at a time but they were more staged then real and he was most definately enjoying himself. (He no longer does this).

With a RAD kid, how could anyone ever know if they were really bipolor?

[Mom_Of_Many]

I have adopted two RAD kids and two bipolar kids withiout RAD. It isn't that hard to tell. First of all, the right meds bring bipolar into line. SEcondly, bipolar kids do make eye contact and are very remorseful after they have acted out or had a rage. Both of my RADs hated being touched. My bipolars are highly affectionate and used to seek out my comfort when they had been out of control. My RAD kids were deliberately in control, staging acting out for their own purposes and never meeting my eyes or acting sorry for their behaviors. The destruction that the RADs did was more serious than my bipolar kids (although some bipolar kids can get violent, especially on antidepressants or stimulants---not good for bipolar k dis). The history is mandatory. The biological component is overwhelming. If your child is on a good mood stabilizer or two plus an antipsychotic (the two meds most commonly helpful together for bipolar disorder) and the child imporves a lot, you are likely treating bipolar disorder. I would NOT ask a therapist, psycologist or social worker to diagnose this. They have no medical training and tend to say everything is behaviorally based. But if the child has a bipolar parent, and a history of substance abuse in the family (another big red flag), it is a good idea to try bipolar meds on the child. RAD therapy will not do a thing for bipolar disorder. He could be written off as a RAD kid who just won't heal. Bipolar kids with RAD is another story......I wouldn't want to have to deal with that and try to sort out what is what. I do not seem the same lack of compassion or lack of caring in my bipolar kids that I saw in my RAD kids. My bipolar son, who we got at two, may have had a bit of RAD when we first got him (looking back), but he was so young and got so much hugging and affection that now we are very close; very bonded. I think the age you get the child is a factor too, but that's just my opinion. I think it's important to figure out what is what (from a child psychiatrist). I can see RAD therapy scaring a bipolar child to death and not really helping, but making the bipolar worse. A lot of bipolar kids are scared to death of everything and many have hallucinations. I hope this helped. This is my experience only.

[lucyjoy]

Actually, I did consult two psychiatrists. One of the things that prompted me to think bi-polar was my son's reaction to antidepressants. They made him angrier. He, however, was tried on several anti-psych meds that were inaffective.

Your explanation fo the differences in your children is very helpful, though. Thanks.

[Dr. Art]

Some very good points are made here.

The reaction to usual (SSRI) anti-depressant medications is a common reaction of children with Bipolar Disorder and does suggest that illness rather than depression.

Not all children with Bipolar disorder respond to the atypical antipsychotics. A typical regimen is to begin with a mood stabilizer, such as Depakote, Lithium, and there are many others. The atypical antipsychotics are usually used if a child's violence does not abate. However, some children do not respond to the typical medications and need lots of tinkering. This is a complex illness. Frequently the meds that worked for a latency age child need significant adjustment and additions when a child hits puberty and again when the teen hits young adulthood. Again, an excellent book to read is The Bipolar Child.

A competant and well trained mental health professional can differentially diagnos Bipolar Disorder from ADHD, ODD, Conduct Disorder, RAD, and assess any other comorbid conditions. The person, obviously, should have significant experience and training with such children...not just mental health training or just attachment training. Generally it is not through "testing" that the diagnois is made, but through a review of past history, onset of symptoms, bio family, and current behaviors.

There are some usual red flags:
1. Tantrums that last for more than 30 minutes and are not within the childs control while ongoing. some children will even say they cannot stop or plead with the parent to help them stop...others are just uncontrolleably viiolent and go on and on.
2. History of bio parents (but this is not a 1 to 1 correspondence, the risk rises from about 1 to 5 % in the general population to maybe 10 to 15% if both parents are bipolar).
3. Grandiosity
4. Pervasive unsatisfiability or irritability or dysthmia

and others...

Regards.