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Rosalie Greenberg, M.D.


                                    PEDIATRIC AND ADOLESCENT PSYCHIATRIST

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Welcome to the information section of my website. This is the section where I will answer general questions frequently asked by parents of bipolar youngsters. I have received several important questions from visitors to my website. Although I cannot respond to them individually, I will attempt to answer those that many families face, in one way or another, when living with a bipolar child. I regret that I am unable to offer individual advice and cannot respond to any question, nor can I comment, about a particular child or situation.  This website is for educational purposes only. Any questions specifically about your child should be addressed with his or her treating mental health professional. 

 

If you’d like to suggest topics for this website, please email me at:medicalartspsychotherapy@verizon.net.  If you need a referral to a psychiatrist for your child or adolescent, or want other information for parents about pediatric bipolar disorder, see the following website:  www.cabf.org.

 

Questions List

1) When and how does a parent explain to their child that they have bipolar disorder?

2) What exactly is bipolar disorder?

 

When and how does a parent explain to their child that they have bipolar disorder?

 

This will vary with the child’s age, level of mental understanding and maturity, and how the family views the illness.

 

To a young child the word “bipolar” itself means nothing. But contrary to what grownups often think, many young children are able to acknowledge how they feel, especially if given a choice of different feelings. Typically I ask them if they feel “happy,” “sad” or “mad” (angry). If the meaning of the question and the choices are unclear, then I try to use examples or other words to help the child understand what he is being asked. Parents should listen carefully, and as much as possible use the child’s words in discussing the problem. For example if Steven has said, I’m a bad boy. I sad.” Explaining to the Steven that he is not a bad boy but he knows what he did was wrong or unacceptable behavior.

 

A parent might say “Sometimes I know that you feel very angry and break things or say mean things. But then later you feel very sad (or angry at yourself) - that’s because I know that you are really a good boy and know right from wrong. Sometimes it just can be hard for kids to control their feelings. Having mixed up feelings can feel very uncomfortable. Mom and dad are trying to help you feel better and happier and not get into trouble because you are a good boy, but we all need some help.”

 

Then a parent may go on to explain how some kids and grownups are much more sensitive than other people they know. It’s helpful to acknowledge that this can be true whether they have bipolar disorder or not. An explanation may be as follows: “Like you, a lot of people have problems controlling their feelings and they need to learn other ways to deal with them. Everyone has something that they have to work on. Some kids have trouble with reading; others have trouble with running, or singing. Learning different ways to do these hard things, and putting in a lot of work, can help make them less of a problem.”

 

If a youngster is cognitively older, or more mature, and emotionally ready, he or she may accept being told that he has a mood disorder, and that’s why he can feel like an emotional ping pong ball. Explain that you realize that sometimes, he feels intensely happy or sad or angry, or all of these feelings at the same time - yet you know that he knows that his reaction is out of proportion to what happened. Like with the younger child explaining how everyone has problems in one way or another helps normalize his problem to some degree, so that he doesn’t feel like a pariah. An important message to accompany this explanation is that although he is not to blame for having the problem, he is responsible for how he deals with it. Hurting someone else, no matter what problem one has, is wrong. The point is that having bipolar disorder is not an excuse for bad behavior.

 

Labeling the problem with its proper name - bipolar disorder - will again depend upon the individual’s age, maturity, receptivity and understanding of the disorder. For some youth, hearing that they have an illness, like bipolar disorder, reinforces their sense of being different from other kids, and they feel like they are damaged for the rest of their life. This is why education about the disorder is so important for both the family and child. It is not a life sentence, but for most, it may well be a lifelong issue.

 

It is important to convey that the disorder does not define the child. Bipolar disorder is something the child has, but it is not who he is. Again, giving him the message that he is in charge of and responsible for his life and his actions no matter what problem he has.

 

Individual responsibility for one’s behavior is one of the most important lessons we as parents need to teach our children whether they have bipolar disorder or not. Explaining that the choice is up to the child, either he will control the illness, or the illness will control him, is a crucial message we need to get across, to help foster growth into a positive and productive member of society.

 

 

What exactly is bipolar disorder?
     This disorder may be more familiar to you by its past name “manic-depression.”The term “bipolar” refers to the two predominant mood states—mania and depression—that are the hallmarks of the condition.  In general, mania refers to an elevated, expansive or irritable mood and depression is characterized by a sad or irritable mood and/or the loss of pleasure in nearly all activities. By definition, either of these mood states must be accompanied by changes in energy level, thinking, and behavior. Some individuals experience what’s called a mixed mood state, when symptoms of both mania and depression are present at the same time.

 

    The different mood states are associated with a variety of symptoms, among them: sleep and appetite disturbances, concentration difficulties, major unexplained changes in energy levels, distractibility, and exaggerated feelings about one’s worth. However, it’s seldom that I see a youngster with all of the possible characteristics of pediatric bipolar disorder.

 

    One child, for instance may be predominantly irritable, while another may be very silly with rapid speech and in an “up” mood most of the time. A child might have significant sadness and low energy while another youngster may be highly energetic and bossy. Still others may exhibit a “grab bag” of bipolar symptoms.

 

    Although adults may think that the child is unaware of his mood problem, my young patients never cease to amaze me with the creative analogies they come up with for describing their swings between mania and depression. Some say they feel like a ping-pong ball bouncing back and forth between the different mood states. Others describe it as having an angel on one shoulder and a devil on the other. Their vivid language reflects their often daily struggles with the abrupt and unanticipated changes they experience when shifting between their highs and lows.

 

    To confuse matters further, bipolar kids’ moods tend to shift much more rapidly than those of grownups with the disorder. While adults most commonly experience weeks or months in a single mood state—either mania or depression—youngsters often have ups and downs in the course of one or just a few days.  (This pattern of daily mood shifts can be seen in adults but is much less common). Bipolar children in a manic state are much more likely to be very irritable, as opposed to the extra happy, expansive and silly moods seen in the majority of adults.  Adults typically have clear cut episodes of the illness and periods of time when they feel well and exhibit good functioning.  In many kids the disorder is ongoing, without long periods of being well.

 

    Like many conditions, bipolar disorder exhibits itself in different ways—and in varying degrees— from child to child. Even though one youngster may be incapacitated by the illness and unable to attend school or participate in extracurricular activities, another may function perfectly fine outside the home but struggle significantly with family life.  Although a child may not be one of the extreme cases featured in the media or seen on television, he may still benefit significantly from treatment.

 

    The truth is that diagnosing a bipolar child is more like making a movie than taking a snapshot. Sometimes the diagnosis is clear fairly quickly, but in other cases it’s necessary for a psychiatrist, after gathering information from the parents and other pertinent individuals, to observe a child’s behaviors and moods over weeks or even months, before making the diagnosis. As in anything else in life, once you have a clear sense of the problem, the approach to working on it and overcoming it, has a much better chance of being successful. 

 

This information is not intended to replace the advice of a treating doctor.

Dr. Greenberg disclaims any liability for the decisions you make based on this information.

 

 Links

National Organizations Focused Specifically On Bipolar Disorder

 

Child & Adolescent Bipolar Foundation - CABF


Depression & Bipolar Support Alliance - DBSA


National Organizations Focused On Mental Health

 

American Academy Of Child and Adolescent Psychiatry (AACAP)


Federation of Families for Children's Mental Health


NAMI Child & Adolescent Action Center


National Alliance on Mental Illness - NAMI


National Institute of Mental Health - NIMH