Expert: Joyce A. Anthony - 3/27/2011

Question
ok here it goes i have a 6 year old son and i have known for awhile that something is wrong with him i just dont know quite what that might be i dont know if it is for attention or if it is bipolar. his father has severe bipolar and i have been diagnosed with pmdd for a mood disorder and well i am having a very difficult time with my son now. he has always had some seperation issues from when he turned 4 but before that he was fine i could go out and he was great with it but he turned 4 and it all changed i cant go anywhere unless i get someone that he acually likes to watch him because they do what he likes to do and they have there girlfriend there too.which the only person he will stay with is his uncle who likes the video games and movies he likes which are always scary with morbid parts in them.well why i am asking for answers now is because he is great in school but he likes all his teachers and they are all women but also he was just put in speech class because he speaks to fast at times and leaves words or sounds out well he will get home from school and he is fine until the kids wont do what he says or wont play what he wants to. also he gets very upset when the girl next door who is 14 wont pay attention to him he will get very angry and try to hurt one of the kids or he just starts crying and it is hard to calm him down. well about a week has gone by now and he woke up one night about 4:30 in the morning screaming about bugs getting in his ears and going to eat his brains and it too me an hour to get him back to sleep then he went on the next day when he got home and seen the bug again i had to clean his ears and show him nothing was in there. well today an ant got on him and he started freaking out saying it got inside his body and i had to calm him down again.then i went to the store and i got a phone call from his dad i had to rush home because he seen some bugs in the grass he was playing in and started freaking out saying they were getting in his body and he just started itching him self and i had to calm him down and get him to stop.he is very good in school and gives them no problems at all unless i go up there its just at home but i think that it might be cause of there scedule because he doesnt like change at all.and he seems to like school very much and his teacher because he wont let you joke about or even talk about her around him.it is very hard to get him to go to sleep and when he does it is hard to wake him up unless you tell him he is going to be late for school i know it is not adhd because his older brother has adhd/add very bad and i know the difference in between them i just dont know what to do anymore it is putting a strain on me and my husband also because he likes to play us against each other to he likes to get us fighting and then wants me to love on him by holding him and rocking him. he has very bad behavoir outside of school we cant go out to dinner anymore because we are afraid of what might happen if he has an episode so please help any infomation will help thanks kristina

Answer
Kristina:

Your son is definitely showing symptoms consistent with early onset bipolar disorder.  Most likely, however, a doctor will just list it as a mood disorder because of his age.  Children with bipolar disorder have a horrible time waking up and falling asleep because it represents a transition.  You also mention he doesn't like change.  Often, these kids will behave away from parents and then act out with the parent around.  In spite of how it looks, it is because they know the parent will love them no matter what and they feel safer allowing their guard to drop.  There does have to be rules about any violence during  these times, however.  I do think part of his behavior is learned.  Bipolar children are expert manipulators.  What starts out as a true breakdown (such as the babysitting episode# can eventually turn into the child throwing a tantrum #as opposed to a meltdown) to get his way.  That may be happening with the babysitting.  As for the bugs--this shows a sign of nightmares that have transferred into his waking moments--a very strong sign of bipolar disorder because the dreams of these children are very vivid.  I would suggest that he not be allowed to watch gory movies at this point as they can make the issue worse.

That said, I would have your son evaluated by a psychologist who has experience with mood disorder in children.  It is important to ask about such experience, because many doctors will just say it is ADHD--and medication for ADHD will cause the bipolar disorder to worsen.  Have him evaluated as soon as you can and started on some type of program to help him learn to manage moods, find alternative ways of expressing his discomfort and fear and possibly some medication.  

In the meantime, try to keep his time at home as structured as possible.  If you need to take him someplace, tell him in advance where you are going and what behavior you expect from him.  Before going inside, have him review the expected behavior with you.  This often helps avoid meltdowns.  Also, try to keep a record of meltdowns--where he is, what time of day it is, who he is with, what set it off...that will help when the doctor evaluates him.
                          Joyce A. Anthony