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The Hard Decisions You Have to Make When Your Child Has Pediatric Bipolar Disorder

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Editor's Note

This story has been published with permission from the author’s daughter and names have been changed.

I was scared for myself the day my 7-year-old tried to stab me. But not half as scared as I was for her. When the knife pierced the cover of the book I’d raised to protect my face, Sadie (not her real name) snapped out of her trance. Terror replaced her glazed stare. She collapsed in my arms, sobbing. I held her tight, breathing in the scent of her strawberry shampoo and stroking her heaving back.

• What is Bipolar disorder?

Sadie was diagnosed with pediatric bipolar disorder the year before. By then, I’d stopped deluding myself that her long history of troubling behavior was something she’d outgrow. Even in a kindergarten class full of fidgety kids, her antics stood out. Her classmates dubbed her the weird girl. The naughty girl. The girl who never listened. She veered from being a gregarious charmer one minute, a pint-sized troublemaker the next. And then there were her debilitating bouts of anxiety and phobias, which included a fear of being poisoned. After a boy at school casually mentioned that Gorilla Glue was toxic, Sadie refused to set foot in any store that sold it.

When her teacher suggested she undergo a psychiatric evaluation, I readily agreed. A week before her sixth birthday, I sat in the office of the child psychiatrist who’d worked with Sadie and interviewed me and my husband Jim. Braced for bad news, I still couldn’t quite believe it when he said Sadie was among the one percent of children he diagnosed with pediatric bipolar disorder.

The adult version of the illness runs in both my family and Jim’s. But I didn’t know much about bipolar disorder in children, although I agreed with the doctor that many of Sadie’s symptoms fit the profile for the mental illness — rapid shifts in mood and energy, talking too much and too fast, threatening to harm herself or others. But neither Jim nor I could fathom putting our young child on a powerful psychotropic drug.

That evening, I checked out a website for families of bipolar children where parents discussed the various meds their kids took and the side effects they’d experienced. I felt woozy reading about a 9-year-old who packed on lots of weight in three months; a once precocious kindergartner transformed into a zombie; a teen whose body twitched from assorted tics. The way the parents signed their posts was almost as hard to stomach: their user names followed by a list of the meds their children took. Many included three, four or more drugs.

I wasn’t about to join their club.

I turned to therapy for Sadie instead. She adored her psychologist, whose cozy office had cupboards and drawers crammed with toys. They met twice a week to play and talk about Sadie’s feelings. To my relief, she started first grade on a more even keel. But it wasn’t long before I started getting concerned emails from her teacher. Sadie was disrupting the class with bizarre comments, she wrote, like saying she needed to roll her eyes back into her head. She burst into fits of laughter for no reason and couldn’t sit still. She complained to the school counselor that she didn’t have any friends because she was “stupid” and “bad.”

Things were unraveling at home, too. One afternoon, I turned from the refrigerator where I’d been getting her a glass of water. She stood behind me, lips quivering, eyes brimming with tears. Alarmed, I asked her what was wrong. When she told me she wanted to cut off her nipples or ears, I almost dropped the glass. “I just want to hurt myself,” she whispered. “Sometimes I want to hurt you and Dada, too.”

Then came the knife incident. I called Sadie’s therapist for an emergency meeting. Like Jim and I, she wasn’t a fan of medicating little kids. But she admitted that some needed meds to become stable enough to even benefit from therapy. And that Sadie was spiraling into a dark place. Since we wanted a second opinion before moving ahead with medication, the therapist put us in touch with a second psychiatrist who’d helped a boy with problems similar to Sadie’s.

“Sounds like we’ve got a child who’s really hurting,” he said softly when I called him.

I felt like I’d been holding my breath for weeks and could finally let it out. We met the following day. I gave him a detailed inventory of Sadie’s symptoms and our family’s history of mental illness. That afternoon, I sat with Sadie at the kitchen table while she ate a snack. I showed her a self-assessment for depression designed for children the doctor wanted her to complete. I worried that she’d resist answering the questions or that they’d upset her. But she couldn’t wait to get started. As she haltingly read each question aloud, a look of recognition spread across her face. It was like she’d finally landed on a planet where people spoke her language. A few minutes later, she handed me the finished questionnaire. I blinked back tears as I read the answers she’d marked with a crooked X: I am sad many times, I am bad all the time, I am sure that terrible things will happen to me…

The psychiatrist said her score indicated she was seriously depressed. That night, Jim and I discussed the pros and cons of putting her on the drug the doctor recommended. It had fewer side effects than the one her first psychiatrist wanted to prescribe. But like all medications, it had the potential to cause serious problems, such as diabetes. It was scary to think about jeopardizing Sadie’s physical health. It was even scarier to imagine her continuing to struggle. Or risk losing her forever.

When I told Sadie about the medication, she hopped up and down as if I’d just announced we were going to Disneyland. “Will it fix my brain and stop me from being bad?” she asked.

I hugged her and told her the truth: I didn’t know, for sure. The only way to find out was to give it a try. Driving to the pharmacy the next day, my mind drifted to the parents on the bipolar forum. I remembered how quick I’d been to judge them and felt a pang of shame. Now I knew what it was like to be in their shoes. To be desperate to ease my child’s pain and have only imperfect options to choose from.

A few weeks after Sadie started medication, her teacher commented on how much happier and calmer she seemed. On her eighth birthday, the girl whose rollercoaster moods had pushed kids away beamed as she blew out the candles on her Hannah Montana cake, surrounded by friends.

Sadie’s 18 now, a good student with a passion for theater and a busy social life. Like most families in our situation, we’ve had to experiment with different drugs over the years. But I’ve never regretted my decision to try medication. It let Sadie reclaim her childhood. And it gave me back my daughter.

Getty image via Maria Golenishcheva

Originally published: February 17, 2021
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