"I became psychotic and thought I was a cat, thought the CIA was after me, all kinds of horrible things," Simon says.

Reflecting on her childhood, she says the signs of her illness always existed.

"When I was depressed as a child, it could look like I was moody or antisocial, and when I was manic, it could look like I was incredibly active and productive," she says.

Shifts between mania and depression are classic bipolar symptoms. But the illness can also mimic attention-deficit hyperactivity disorder (ADHD), characterized by "short attention span and distractibility, impulsivity and hyperactivity," says Dr. Steven Jaffe, a child psychiatrist.

Those similarities can lead to misdiagnosis. According to the Child and Adolescent Bipolar Foundation, 15% of children diagnosed with ADHD may actually be bipolar.

"So there is this overlap between the two," Dr. Jaffe says. "They are very similar, and it's very important for treatment to be able to separate out."

Bipolar children are at risk for failing grades, drug abuse and suicide. Also, the wrong medication can trigger bipolar episodes and make the condition even worse, therefore making it critical to make the correct diagnosis early.

"They need good, solid psychiatric care," Dr. Jaffe says. "Child psychiatrists that see these kids know what to do, know the medicines and are keeping up with the new medicines we deal with every day."

Lizzie Simon, who was first diagnosed as simply depressed, is now able to maintain control over her disorder with the help of both counseling and medication.

"I think that being on medicine has improved my life tremendously. I can wake up every day and know that I'm going to be OK," she says. "I don't have a constant persistent fear that things are going to get way out of control in my own brain. And to be able to count on that is huge."

By Kim Ogletree
CWK Network, Inc.

According to a 2000 mental health report from the U.S. Surgeon General's Office, about 11% of youths aged 9 to 17 (approximately 4 million people) have "a major mental illness that results in significant impairments at home, at school and with peers." Consider these additional mental health statistics cited by the World Health Organization's "Global Burden of Disease" study:

• Four of the 10 leading causes of disability for persons age 5 and older are mental disorders.
• Among developed nations, including the United States, major depression is the leading cause of disability.
• Manic-depressive illness (bipolar disorder), schizophrenia and obsessive-compulsive disorder also appear among the top of these rankings.
• Mental disorders are tragic contributors to mortality, with suicide perennially representing one of the leading preventable causes of death in the United States and worldwide.

Those who suffer bipolar disorder, one of the most frequently diagnosed youth mental health diseases, experience a combination of extremely high (manic) and low (depressed) moods. Bipolar youth may have more normal moods between these episodes, while the periods of depression or mania can last for days, weeks or even months. What many parents don't know is that these symptoms often mimic those attributed to attention-deficit hyperactivity disorder (ADHD). According to the Child & Adolescent Bipolar Foundation (CABF), 15% of U.S. children diagnosed with ADHD may actually be suffering early-onset bipolar disorder instead.

Who is at risk of developing bipolar disorder? CABF says that the illness usually begins in late adolescence - often appearing as depression during teen years - although it can start in early childhood or later in life. It is not exactly known how many children are affected by the disorder because studies are lacking, but is an estimated to affect 1-2% of adults worldwide. Consider the following statistics and risk factors associated with bipolar disorder, cited by CABF:

• An equal number of men and women develop the illness (men tend to begin with a manic episode, women with a depressive episode).
• It is found among all ages, races, ethnic groups and social classes.
• The illness tends to run in families and appears to have a genetic link.
• Like depression and other serious illnesses, bipolar disorder can also negatively affect spouses, partners, family members, friends and coworkers.
• According to the American Academy of Child & Adolescent Psychiatry (AACAP), 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.
• Bipolar disorder is more likely to affect the children of parents who have the disorder. When one parent has bipolar disorder, the risk to each child is estimated to be l5-30%. When both parents have bipolar disorder, the risk increases to 50-75%.
• Family history of drug or alcohol abuse may be associated with bipolar disorder in teens.

How can you determine if your child is suffering from bipolar disorder? The AACAP says that youth who have the disorder may begin to show either manic or depressive symptoms:

Manic Symptoms:

• Severe changes in mood compared to others of the same age and background - either unusually happy or silly, or very irritable, angry, agitated or aggressive
• Unrealistic highs in self-esteem - your child feels all powerful or like a superhero with special powersSignificant increase in energy and the ability to go with little or no sleep for days without feeling tired
• Increase in talking - your child talks too much, too fast, changes topics too quickly and cannot be interrupted
• Distractibility - your child's attention moves constantly from one subject to the next
• Repeated high risk-taking behavior, such as abusing alcohol and drugs, reckless driving or sexual promiscuity

Depressive Symptoms:

• Irritability, depressed mood, persistent sadness or frequent crying
• Thoughts of death or suicide
• Loss of enjoyment in favorite activities
• Frequent complaints of physical illnesses, such as headaches or stomach aches
• Low energy level, fatigue, poor concentration, complaints of boredom, etc.
• Major change in eating or sleeping patterns, such as oversleeping or overeating

Some of these signs are similar to those that occur in teens with other problems, such as drug abuse, delinquency, attention-deficit hyperactivity disorder or even schizophrenia. A child and adolescent psychiatrist can only make the diagnosis with careful observation over an extended period of time.

If you suspect that your child has bipolar disorder (or any psychiatric illness), CABF suggests you take daily notes of your child's mood, behavior, sleep patterns, unusual events and statements made by your child that cause you concern. Share these notes with the child and adolescent psychiatrist who you choose to evaluate your child. Because children with bipolar disorder can be charming and charismatic during an appointment, they initially may appear to a professional to be functioning well. Therefore, you should keep the following characteristics in mind when choosing a doctor for your child:

• Knowledgeable about mood disorders, has a strong background in psychopharmacology and stays up-to-date on the latest research in the field
• Knows he or she does not have all of the answers and welcomes information you may discover about your child
• Explains medical matters clearly, listens well and returns phone calls promptly
• Offers to work closely with you and values your input
• Has a good rapport with your child
• Understands how traumatic a hospitalization is for both you and your child, and keeps in touch with your family during this period
• Advocates for your child with managed-care companies when necessary
• Advocates for your child with the school to make sure he or she receives services appropriate to his or her educational needs

Adolescents diagnosed with bipolar disorder can be effectively treated. The Surgeon General's Office says that many children are treated with mood stabilizing drugs like lithium and valproic acid, which helps reduce the number and severity of manic episodes as well as prevent depression. However, the use of lithium can cause toxicity and impairment of renal and thyroid functioning, so it is not recommended for families unable to keep regular appointments that would ensure monitoring of serum lithium levels and of adverse events. The AACAP says that psychotherapy is also used to help a bipolar adolescent understand himself or herself, adapt to stresses, rebuild self-esteem and improve relationships.

The CABF says that many parents of children with bipolar disorder have discovered numerous techniques referred to as therapeutic parenting. The following techniques can help calm your child when he or she is symptomatic and can help prevent and contain relapses:

• Practicing and teaching your child relaxation techniques
• Using firm restraint holds to contain rages
• Prioritizing battles and letting go of less important matters
• Reducing stress in the home, including learning and using good listening and communication skills
• Using music and sound, lighting, water and massage to assist your child with waking, falling asleep and relaxation
• Becoming an advocate for stress reduction and other accommodations at school
• Helping your child anticipate, avoid or prepare for stressful situations by developing coping strategies beforehand
• Engaging your child's creativity through activities that express and channel his or her gifts and strengths
• Providing routine structure and a great deal of freedom within limits
• Removing objects from the home (or locking them in a safe place) that could be used to harm himself, herself or others during a rage

The National Depressive and Manic-Depressive Association suggests these additional ways in which you can help your bipolar child:

• Read about bipolar disorder, and share what you learn with your family. Your doctor can suggest resources to help you learn more.
• Encourage your child to join a local support group. You can accompany your child and share information and experiences with the support group.
• Offer a great deal of emotional support. This step involves understanding, patience, affection and encouragement. Do not put down feelings expressed, but point out realities and offer hope.
• Never ignore remarks about suicide. Report them immediately to your child's therapist.

American Academy of Child & Adolescent Psychiatry
Child & Adolescent Bipolar Foundation
Lizzie Simon
National Depressive and Manic-Depressive Association
"The Global Burden of Disease"
U.S. Surgeon General's Office