Going to extremes: There is hope regarding mental health issues in children and adolescents
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When Pat Sumner’s son, Eric, was in elementary school, she chalked up his moodiness to anxiety issues. After two decades of frustration and confusion, the diagnosis of bipolar disorder was tough.
Sumner knows all too well the toll that bipolar disorder takes on a family. After seeing many troubling behavioral changes in Eric when he was a young boy, she took him to counseling. “When he was 14 and started cutting himself, I realized the seriousness of his condition,” she says. Eric saw a psychiatrist at 16 and started taking the medication Prozac.
“I know first-hand how certain behaviors can be confusing,” she adds. “How do you determine what is wrong? Where do you go for help?”
She describes bipolar disorder as a family illness. “Whether it is a child with the disorder, or a spouse or sibling, the family travels this journey together. My experience is typical of families living with a young child or an adolescent battling these issues,” Sumner says.
Eric’s diagnosis didn’t come until he was 27. “When we went to our first meeting of the Depression and Bipolar Support Alliance, I remember Eric listening to a young woman speak,” she recalls. “He told me, ‘She is describing my thoughts and feelings.’ Before that moment, he believed he was the only one who felt like that.”
What is bipolar disorder?
According to the National Alliance on Mental Illness (NAMI), statistics show one in five U.S. children ages 13-18 have, or will have, a serious mental illness. Mental health issues affect a child or teen at home, at school or in the community.
Bipolar disorder is a mental illness highlighted by extreme mood swings ranging from high (mania) to low (depression) and low to high.
While symptoms may occur in young children, they tend to occur during the late teens or early adult years.
Without treatment, a child or adolescent often seeks relief in other ways, whether it is addiction or, in Eric’s case, cutting.
Warning signs
Bipolar disorder may be hard to diagnose but there are warning signs.
Signs of mania:
- Feeling overly happy or “high” for long periods of time,
- Multiple mood shifts (angel/devil),
- A decreased need for sleep,
- Feeling energetic and experiencing racing thoughts,
- Feeling extremely restless or impulsive,
- Becoming easily distracted,
- Being abnormally overconfident, and
- Risky behavior (impulsive sex, spending sprees).
Signs of depression:
- Feeling mad, sad or irritable for long periods of time,
- Withdrawing from friends/family,
- Losing interest in previously enjoyed activities,
- Anxiety,
- Hypersensitivity,
- Lethargy and apathy,
- Problems with memory, concentration, decision-making,
- Thinking about or attempting suicide, or
- A preoccupation with death.
“Early symptoms of bipolar disorder can be anxiety or depression. In some situations, it may begin when a child has trouble finishing school assignments, starts to get poor grades or has difficulty socializing with friends,” says Sudhakar Selvaraj, M.B.B.S., Ph.D., director of the Depression Research Lab and assistant professor of psychiatry and behavioral sciences at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). “Any sudden behavioral or emotional changes, such as sudden crying spells, should be noted.”
Diagnosis
To pinpoint a diagnosis, there are initial steps a doctor may take:
- A physical exam to rule out any other medical conditions that may cause the symptoms,
- A mental health exam (including a questionnaire and interviews with family), and/or
- A diary that tracks sleep and mood swings.
“If there is no medical reason for the symptoms, the next step is to obtain a good assessment.
Pediatric bipolar disorder is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood,” says Iram Kazimi, M.D., assistant professor of psychiatry and behavioral sciences at McGovern Medical School at UTHealth. “Early diagnosis and intervention are important just as they are in other medical conditions such as heart or kidney disease.”
Kazimi, a psychiatrist who specializes in child and adolescent mood disorders and bipolar disorder and is affiliated with Memorial Hermann-Texas Medical Center, says identifying bipolar disorder in youth is challenging because youth can have more frequent shifts in mood and energy.
“A thorough evaluation that takes into account daily functioning in several things is required to rule out anxiety, depression or problems with learning,” she adds. “It is encouraging that treatments have improved over the past five years “and you must find a professional team you trust. This is not a sprint, it is a marathon.”
ADHD and bipolar disorder share similar symptoms, such as mood instability, bursts of energy, restlessness, talkativeness and impulsivity. It is possible for an individual to often have both. “With bipolar disorder, an individual moves through different episodes of mania and those with ADHD have chronic symptoms.”
Whenever a child or adolescent is diagnosed, the individual and the family needs to become aware of stressors that can bring on an episode, such as alcohol, drugs or little sleep.
Treatment works
While there is no cure for bipolar disorder, professional treatment can help control symptoms. After a diagnosis, the doctor will begin a treatment program tailored for that individual that may include:
- Medication (mood-stabilizing drugs or anti-depressant/anti-psychotic drugs), and
- Targeted therapies (combination of neuropsychological, psychiatric and psychological).
For the best outcome, treatment must be ongoing. “With the proper treatment, bipolar disorder can be controlled and a person can lead a healthy and productive life that can include college and an enjoyable family life,” Kazimi adds.
What can a parent do?
After a parent makes sure their child or teen receives the proper diagnosis and treatment, there are simple things to do that make a difference:
- Be patient,
- Listen and encourage conversation,
- Don’t do things that trigger an episode,
- Be understanding about mood episodes,
- Have fun, and
- Remember that treatment will make life better.
Pediatric Bipolar Research Registry
The Pediatric Bipolar Research Registry at UTHealth’s Center of Excellence on Mood Disorders is unique, says Jair C. Soares, M.D., Ph.D., the center’s director, professor and the Pat R. Rutherford Jr., Endowed Chair in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School. “We think it is a game-changer that can be transformational,” he adds. “The registry collects data, performs brain scans and does neurological assessments. We want to understand subtle changes early on.”
The Department of Psychiatry and Behavioral Science’s Developmental Neuropsychology Clinic is part of the McGovern Medical School. Its mission is to enhance the lives of children, adolescents and adults with developmental, emotional, behavioral and/or academic concerns through comprehensive evaluation and early detection.
Another resource is the UTHealth Harris County Psychiatric Center, the largest provider of inpatient psychiatric care in Houston. “We provide comprehensive, patient-centered care to adults, adolescents (13-17) and children (4–12),” Soares adds. “We offer a supportive environment focusing on assessment and stabilization of those in all levels of crisis. Most treatment is done on an outpatient basis but we do have inpatient treatment as well.”
A network of UT Physicians’ clinics offer clinical psychiatric treatment services “and we see the results of partnering with school systems to disseminate information,” Soares explains.
New research results
Researchers at UTHealth recently announced the results of a promising new study: genetic alterations that can be modulated by stress have been identified in children at high risk for bipolar disorder.
“We’ve known that children of patients with bipolar disorder have a higher risk of developing the illness but the biological mechanisms are largely unknown,” says Gabriel R. Fries, Ph.D., first author and a postdoctoral research fellow in the Department of Psychiatry and Behavioral Sciences at McGovern Medical School.
By analyzing the blood of children of controls and comparing it to children of bipolar patients, adds Soares, senior author of the study, “we identified several genes or markers that can explain the increased risk.”
Remain optimistic
Pat Sumner, president of NAMI Fort Bend, now works tirelessly to make sure families affected with mental health issues know about resources, such as referrals, support groups and classes that provide information and strength during a family’s journey.
“There is hope and recovery is possible,” Soares says. “By focusing on children at risk, providing intervention and proper ongoing treatment, individuals can realize their full potential, learn to cope with life’s stresses, work productively and make meaningful contributions.
Suicide Prevention
National Alliance on Mental Illness (NAMI) statistics show suicide is the second leading cause of death in youth ages 10 to 24, and 90 percent of those who died by suicide had an underlying mental illness.
If you think a family member or someone you know is at immediate risk of harming himself or herself, or hurting another person, act immediately:
- Call 9-1-1,
- Don’t leave the person alone and stay until help arrives, and
- Call a health care professional.
Written by: Wendy Cederberg