Bipolar disorder (also known as manic-depression) is a serious but treatable medical illness. It is a disorder of the brain marked by extreme changes in mood, energy, and behavior. Symptoms may be present since infancy or early childhood, or may suddenly emerge in adolescence or adulthood. Until recently, a diagnosis of the disorder was rarely made in childhood. Doctors can now recognize and treat bipolar disorder in young children.

Early intervention and treatment offer the best chance for children with emerging bipolar disorder to achieve stability, gain the best possible level of wellness, and grow up to enjoy their gifts and build upon their strengths. Proper treatment can minimize the adverse effects of the illness on their lives and the lives of those who love them.Families of affected children and adolescents are almost always baffled by early-onset bipolar disorder and are desperate for information and support.

How common is bipolar disorder in children?

It is not known, because studies are lacking. However, bipolar disorder affects an estimated 1-2 percent of adults worldwide. The more we learn about this disorder, the more prevalent it appears to be among children.

It is suspected that a significant number of children diagnosed in the United States with attention-deficit disorder with hyperactivity (ADHD) have early-onset bipolar disorder instead of, or along with, ADHD.

According to the American Academy of Child and Adolescent Psychiatry, up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder.

What are the symptoms of bipolar disorder in children?

Bipolar disorder involves marked changes in mood and energy. In most adults with the illness, persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.

However, the illness looks different in children than it does in adults. Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.

Symptoms may include:

• an expansive or irritable mood
• depression
• rapidly changing moods lasting a few hours to a few days
• explosive, lengthy, and often destructive rages
• separation anxiety
• defiance of authority
• hyperactivity, agitation, and distractibility
• sleeping little or, alternatively, sleeping too much
• bed wetting and night terrors
• strong and frequent cravings, often for carbohydrates and sweets
• excessive involvement in multiple projects and activities
• impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
• dare-devil behaviors
• inappropriate or precocious sexual behavior
• delusions and hallucinations
• grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

Symptoms of bipolar disorder can emerge as early as infancy. Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word "no" often triggered these rages.

Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children.

What are the symptoms of bipolar disorder in adolescents?

In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness.

• Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.
• Bipolar II. In this form of the disorder, the adolescent experiences episodes of hypomania between recurrent periods of depression. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity.
• Cyclothymia. Adolescents with this form of the disorder experience periods of less severe, but definite, mood swings.
• Bipolar Disorder NOS (Not Otherwise Specified). Doctors make this diagnosis when it is not clear which type of bipolar disorder is emerging.

For some adolescents, a loss or other traumatic event may trigger a first episode of depression or mania. Later episodes may occur independently of any obvious stresses, or may worsen with stress. Puberty is a time of risk. In girls, the onset of menses may trigger the illness, and symptoms often vary in severity with the monthly cycle.

Treatment

Although there is no cure for bipolar disorder, in most cases treatment can stabilize mood and allow for management and control of symptoms.

A good treatment plan includes medication, close monitoring of symptoms, education about the illness, counseling or psychotherapy for the individual and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support.
The good news is that with appropriate treatment and support at home and at school, many children with bipolar disorder achieve a marked reduction in the severity, frequency and duration of episodes of illness. With education about their illness (as is provided to children with epilepsy, diabetes, and other chronic conditions) they learn how to manage and monitor their symptoms as they grow older.

This information was excerpted from an article by the Child and Adolescent Bipolar Foundation (http://www.bpkids.org/). You can find the entire text of this article at their site (http://www.bpkids.org/learning/about.htm), as well as valuable links to other resources.

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Answers to Children's Questions About Adoption

written by Debra Smith, A.C.S.W., National Adoption Information Clearinghouse in 1989. Revised June 1994.

We all know there are different kinds of families in the world. Some families have a lot of children; some have only one or two. Some families have one parent; some have two. In some, a grandmother or grandfather lives in the same house, and in others there are no grandparents nearby.

The questions above are questions that different children might ask about certain kinds of families called "adoptive families." Children who are adopted might ask their parents these questions. Children who are friends, schoolmates, or neighbors of a child they hear is adopted might be thinking the same questions. So let's answer them.

What is Adoption?

Adoption is a process that our society developed so that children can grow in loving surroundings. All children have the right to grow up in a loving family, whether they find it in the one they're born in, or in one that adopts them.

Adoption is a legal procedure that makes a child who is the biological or birth child of one man and woman into the legal child of another adult or adults. What does that mean? It's kind of complicated, but here goes.

First, we ought to review how babies get born. You probably know that it takes a man and woman to make a baby. The baby grows inside the woman until it is time to be born. On that day the baby comes out into the world. That's the day that gives all of us our birthdays!
That child is called the biological or birth child of that man and woman.

Why Do Some Children Need or Want to be Adopted?

Sometimes, even though the baby that is born is precious and beautiful and wonderfully lovable, the birth parents cannot take care of the baby. A baby needs a lot of care. Someone has to feed the baby, change the baby's diaper when it's wet or dirty, bathe him or her, hug, tickle, read stories, make sure he or she takes naps and goes to the doctor for check-ups, everything! When the child is older, parents make sure he or she goes to school, does homework, dresses warmly in winter, and everything else kids do. Sometimes being a parent is hard work.

There are many reasons why a child might need or want to be adopted. Maybe the birth parents are very young themselves when they have the baby, and still have a lot of growing up to do. Or maybe there is poverty or sickness or war in their country and they feel their child would be happier in a place where those things aren't going on. Maybe the man and woman don't get along very well with each other and just can't help a child grow up because of these problems. Perhaps they try at first, but it just doesn't work out.

Another very sad reason a child might need new parents is if the birth parents have died.

If birth parents make a plan for adoption, it's a very difficult decision for them to make. They usually love their child very much, and only make an adoption plan because deep down they think it's best for the child. They often feel sad about saying good-bye to their child, but happy at the same time, because they think he or she will have a better life. Often, other adults who know about children and what is needed to take care of them, help the parents make the decision.

If it's a baby who is going to be adopted, he or she can't talk, and therefore is not involved in making the decision. However, an older child might have a lot to say about whether or not he or she wants to be adopted, and by whom. Usually older children without families want to be adopted. They want to belong to a family.

OK, if the birth parents do decide on an adoption plan, or if some other adults help them decide, what happens next?

Why Does Someone Adopt?

During the time before the baby is born, and probably even way before that, adults who want a new child in their family talk to other adults who work at places called adoption agencies. These are offices where people go and say, "We'd like to have a new child in our family. We'd like to adopt a child." These are also places where the birth parents or other adults can go and say, "We'd like you to find a new family for this child."

Who Adopts?

Who adopts children? Often it's married couples who go to adoption agencies. They might be unable to make a baby together (it happens sometimes), and they want very much to love a child and help him grow up to be a happy and healthy person. Sometimes it's a single man or single woman who goes to the agency. They might not have a partner to help them make a baby, but they still think they could be a good father or mother and would love a child very much.

Sometimes a relative of a child adopts him or her, like a grandmother or aunt and uncle. Sometimes the new husband or wife of the birth parent adopts the wife's or husband's child by a former marriage. That's a step-parent adoption. You probably know someone who lives in a step-family already. These adoptions are a little different than non-relative adoptions, because the adoptive parents and child already know each other. But they still count as adoptions.

Sometimes people are able to make babies themselves, and may already have birth children, but still want to adopt another child, just because they love children so much.

People who want to adopt often have different ideas about the kind of child they'd like to join their family. Some might ask for a baby, some might ask for an older child, or even more than one, like two sisters or two brothers, or a brother and a sister.

The people at an adoption agency are trained to understand things about families and children. They usually ask the people who want to adopt lots of questions to make sure they understand what being parents is all about. Our fifty states even have special laws that adoptive parents have to follow. When the laws have all been followed, and the people at the adoption agency feel sure the adoptive parents are ready, they will give the child that they got from the birth parents to the new adoptive parents.

Where has the child (or children) been in the meantime? The child might be in the hospital where he or she was just born. Or the child might have been living with a foster family. That's a family that cares for a child for a short time until he or she can go home or until a permanent home is ready. He or she might have been living in an orphanage or children's home. If the child is coming from another country, the parents might even go to the airport to meet their new child!

After the child has been living with his or her new family, the people from the adoption agency usually come to visit the child and family a few times to make sure everything is going OK, and to see that the child is being well taken care of. Then, after a certain amount of time, the family sends some legal papers to a court, and may even go to a court themselves, to appear before a judge with the adoption agency person. This procedure is called an adoption hearing.

The adoption hearing does not usually take place in the big, open courtroom, where anybody can come in and listen. More likely, it would take place in the judge's private office, called his or her chambers. The parents, and perhaps the older children in the family, if there are any, tell the judge how much they love the adopted child. The adoption agency person tells the judge the family is a nice family. If the child is old enough to talk, he or she can say something too. If the child is a baby, he or she just looks cute and giggles, and everybody else laughs and cries, the way people do when they get emotional. People take pictures, and there might even be a party because it's such a happy occasion!

At this time the child's name is put on a birth certificate with the adoptive parents' names, and the adoption is one hundred percent official. Legally that child belongs to those parents, and those parents belong to that child. From then on, they just go about the business of being a family, living, learning, playing, and loving together.

There's another way adoptions are arranged, and that is directly between the birth parents and the,adoptive parents. They might meet together, or another person who knows them both might help make the arrangements. Mostly the same things happen as we mentioned before, it's just that an agency is not involved.

What are Adopted Children Like?

Just like everybody else. They're not better or worse. They like to run and jump and play. They go to school. They get sick sometimes, just like all children do. They like stories and hugs, and are told to eat their vegetables, just like everyone else.

However, adopted children may have things on their minds that other children don't. Other people need to be sensitive about these things. For instance, even though adoption is a happy way for families to be made, adopted children might think it's bad or wrong that they don't live with their birth parents. But after some time goes by, they usually realize their adoptive family is a good place to be. It wouldn't be too nice to tease somebody about being adopted in a mean way while he or she was figuring that out.

Adopted children might wonder what their birth parents are like, if they never had the chance to know them. They might wonder if they have birth sisters or brothers, or aunts, uncles, and cousins that they don't know about. They might wonder what country their birth relatives came from many years ago, or what religion they are, or if they have any health problems. They might think they would like to meet their birth parents when they grow up to ask them some of the questions they have been wondering about. That may or may not be possible. They'll probably talk about it with their adoptive parents before they decide what to do.

Adopted children sometimes get in trouble, and their parents yell at them, just like all parents do once in a while. They might worry that they will have to go away from their adoptive family, but they soon learn that they have found a permanent home.

How Many Children Are Adopted Every Year in the United States?

Now, the question about how many children are adopted in the United States. The number is slightly different for each year. In 1992, about 127,000 children of all races, ages, and nationalities were adopted.

To help you visualize how much 127,000 is, if you took 127,000 pennies and lined them up end to end in a straight line, that line would be more than 2 miles long! If you keep adding that number to itself over a few years, you can see that starts to be quite a lot of children growing up in adoptive families.

If you have any concerns or questions about adoption, talk about them with your parents, your minister, priest, or rabbi, your school counselor or teacher, your doctor, or any other adult you know and trust. If they don't know the answers, they can find someone who does. There's also a list below of some books that explain adoption to children. You could probably get some of them at a library or book store near you. They might be helpful too.

Some Books That Explain Adoption to Children

Adopted Like Me, by Jeffrey R. LaCure.
Being Adopted, by Stephanie Herbert.
The Day We Met You, by Phoebe Koehler.
Families Are Different, by Nina Pellegrini.
A Family for Jamie: An Adoption Story, by Suzanne Bloom.
A Forever Family, by Roslyn Banish Roslyn and Jennifer Jordan-Wong.
Horace, by Holly Keller.
I Miss My Foster Parents, by Stefon Herbert.
Lucy's Feet, by Stephanie Stein.
A Mother for Choco, by Keiko Kasza.
Oliver: A Story About Adoption, by Lois Wickstrom.
Steven's Baseball Mitt, by Kathy Stinson.
Tell Me a Real Adoption Story, by Betty Jean Lifton.
Through Moon and Stars and Night Skies, by Ann Warren Turner.
Together Forever: An Adoption Story Coloring Book, by Sara L.F. Barris and Doryce Penn Seltzer.
Two Loves for Selena, by Laurie G. Tanner.
The Visit, by S. Latisha Herbert.
William is My Brother, by Jane T. Schnitter.
Zachary's New Home: A Story for Foster and Adopted Children, by Geraldine M. Blomquist and Paul B. Blomquist.