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Expert Q&A

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Who can helpmy bipolar 6-year-old?

Asked by Christine, California,

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Editor's note: This answer was published originally on May 11, 2010, and prompted considerable response. Today we offer more on the topic from Raison and Dr. Ken Duckworth of the National Alliance on Mental Illness.



Who can help me with my 6-year-old son who is bipolar, and we have no tools in helping him learn self-control?

We are now starting to experience a little bit of violence, and we are really concerned about the turn of this behavior.

He is perfect in school. It's at home where we have so many problems. Now it's affecting his homework focus and his getting up in the morning to be ready for school.

Our insurance doesn't offer much support other than medicine. No one really can provide specific therapy or tools for us.

Expert Bio Picture

Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Christine,

One of a doctor's primary clinical challenges is to make accurate diagnoses. Without the right diagnosis, it is often impossible to implement appropriate treatment.

This is as true in psychiatry as anywhere else in medicine. In your case, I worry that a diagnostic label may be keeping you from seeing a deeper truth that even a little bit of clinical detective work would make obvious.

Here is the issue: Your son may or may not have bipolar disorder.

Recent studies suggest that while many adults with bipolar disorder had troubled childhoods, only a fraction of troubled children will go on to manifest classic adult bipolarity. Troubled childhoods lead down many roads, a few of them good (i.e. return to normal behavior with age), many of them bad (e.g. adult substance abuse, criminal behavior, anxiety and/or depression, and bipolar disorder). But the case you describe has an interesting twist that makes it less likely to involve a clear-cut diagnosis.

I'm immediately struck by your statement that your son is "perfect in school" and acting up only at home. Such selective bad behavior argues strongly against the problem being simply a bipolar condition. Most children with a clear mental condition (e.g. bipolar disorder, attention deficit hyperactivity disorder) display behavioral troubles across a range of environments, which makes sense because the bad behavior results primarily from an internal malfunction rather than external conditions. Usually, school is where such children have the most problems.

The fact that your son is having troubles only at home strongly suggests that he may be a "canary in the coal mine" for a larger problem occurring in the family. I say "canary in the coal mine" because in the old days, miners would bring a canary underground with them. If they encountered poisonous gases, the canary would lose consciousness first and fall over. This would serve as a warning of the danger.

Children are often canaries in the coal mine of family conflict. Children who are sensitive or easy to anger are often at greatest risk to serve this role. I can't tell you the number of times I've seen a child saddled with a psychiatric diagnosis when the real problem lay with the mother and father, or some other component of the larger family system. The proof of this claim has been in the fact that when the family environment improved, the child's behavioral problems either resolved or improved so significantly that only the component directly tied to a mental condition remained.

Sometimes when I've done family therapy in such circumstances, I end up with a strong conviction that the identified patient is in fact the sanest member of the family system, which is why he or she is having so much trouble coping. I am not saying that this is your situation, but given your description of the problem, you would do well to consider this possibility.

It is a tragedy that we as a people haven't built a society with adequate resources available to its members to get help for situations like yours. I hear your concern about not having insurance support, but let me encourage you as strongly as possible to budget your finances in a way that will allow you to get help for your son. If problems like this go untreated, they can often lead to a lifetime of difficulty.

Based on the description of your situation, family therapy is the initial treatment I would recommend. If my sense of your problem is correct, a competent family therapist may be able to improve your son's behavior rapidly, saving you the burden of long-term treatment. But be ready -- if you are serious about helping your son, he is likely not to be the only person who will have to change his behavior. And he is very likely not to be the only person who will feel considerably better!

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