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For Lynne Broman, 37, of Los Angeles, just taming the disorder would be more than enough. A single mom, she is raising three children, two of whom--Kyle, 5, and Mary Emily, 2--are bipolar. At the moment it's Kyle who is causing the most trouble. He has been expelled from six preschools and two day-care centers in his short academic career and has made a shambles of their once tidy home. Kyle was hospitalized for violent outbursts at age 4 and still has periods when he goes almost completely feral. He once threw a butcher knife at his mother, nearly striking her before she ducked out of the way. "That day started out fine," Broman says, "but he turned on me like a rabid dog."
Until quite recently, a child who behaved like this would have been presumed to have either attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder. Bipolar would not even have been considered. And with good reason: the classic bipolar profile, at least as it appears in adults, is almost never seen in kids.
Most bipolar adults move back and forth between depressions and highs in cycles that can stretch over months. During the depressive phase, they experience hopelessness, loss of interest in work and family, and loss of libido--the same symptoms as in major (or unipolar) depression, with which bipolar is often confused. The depressive curtain can descend with no apparent cause or can be triggered by a traumatic event such as an accident, illness or the loss of a job.
But in bipolar disorder, there is also a manic phase. It usually begins with a sort of caffeinated, can-do buzz. "Sometimes the patients find the highs pleasant," says Dr. Joseph Calabrese, director of the mood-disorders program at Case Western University in Cleveland. As the emotional engine revs higher, however, that energy can become too much. Bipolars quickly grow aggressive and impulsive. They become grandiose, picking fights, driving too fast, engaging in indiscriminate sex, spending money wildly. They may ultimately become delusionally mad.
With kids, things aren't nearly so clear. Most children with the condition are ultra-rapid cyclers, flitting back and forth among mood states several times a day. Papolos, who co-wrote The Bipolar Child, studied 300 bipolar kids ages 4 through 18, and he believes he has spotted a characteristic pattern. In the morning, bipolar children are more difficult to rouse than the average child. They resist getting up, getting dressed, heading to school. They are either irritable, with a tendency to snap and gripe, or sullen and withdrawn.
By midday, the darkness lifts, and bipolar children enjoy a few clear hours, enabling them to focus and take part in school. But by 3 or 4 p.m., Papolos warns, "the rocket thrusters go off," and the kids become wild, wired, euphoric in a giddy and strained way. They laugh too loudly when they find something funny and go on long after the joke is over. Their play has a flailing, aggressive quality to it. They may make up stories or insist they have superhuman abilities. They resist all efforts to settle them and throw tantrums if their needs are denied. Such wildness often continues deep into the night--which accounts in part for the difficulty they have waking up in the morning. "They're like Dr. Jekyll and Mr. Hyde," says Papolos, "which is how their parents describe them."