Advice for Parents of Bipolar Children

For all the new research into genes, brains, and symptoms, the parents of bipolar children still face a startling lack of knowledge in one arena: what they should do from a practical standpoint. Raising a bipolar child will never be easy. NEWSWEEK's Mary Carmichael asked researchers for their advice. Find out how parents of bipolar children can get help, here. And find a list of resources and additional researcher here.

How do people usually react when their child is given a diagnosis of bipolar disorder?
Janet Wozniak, assistant professor of psychiatry, Harvard Medical School, Boston:
"I think people cling to the idea that children's brains are somehow protected and that serious mental problems only afflict people who are older, or that if they do affect children, it's because of trauma. I've been thinking a lot about why people have such a hard time understanding that children could have a serious mental illness. I think it's because their hearts and lungs usually work well. Most kids' checkups are well checkups. But the brain is the most complex part of our body. It only stands to reason that it could have problems. ... There's no parent anywhere who could stand up to the scrutiny that these parents will have to endure. Everything they do is scrutinized. I routinely talk to parents who are blamed for being too lenient, too strict, over-involved, under-involved. I usually start out by telling them, 'you know that as a parent of a child with this problem, you'll feel like you can do nothing right.' They hear from teachers and neighbors and relatives. Everybody's full of curbside advice."

David Miklowitz, professor of psychology and psychiatry, the University of Colorado, Boulder: "There can be a public humiliation that goes with it. It's implied that parents aren't doing something right, something they often hear from extended family members. I think a lot of parents are relieved when they get this diagnosis, because it at least explains things. But there are still societal stigmas. Some people think it's a nonsense diagnosis, like 'the disease of the decade.' There's a long history in psychiatry of blaming families—old-fashioned Freudian stuff—and I think that happens a lot with pediatric bipolar disorder. I really wish we could do away with parent blaming, especially when we know these disorders have strong genetic and biological bases, but it's alive and well in our culture."

Kiki Chang, associate professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, Stanford, Calif.: "A lot of the time, the mom always seems to be more concerned and the dad thinks the problem is just behavioral. Sometimes that's actually a good balance. When we do family-focused therapy, we'll often spend the first four sessions out of 16 just talking about what bipolar disorder is, what does it mean, how do you get it, why are medications necessary. I think that part really helps decrease the parents' anxiety. Most of the time we can get everyone on board with the therapy, rather than rushing into a medication treatment. But that's not always an option for all parents. Family-focused therapy is not something a lot of people have expertise on, or something that's typically done. You have to go to the places where they're doing research on it to get this kind of treatment. ... These parents care so much about their kids. It doesn't mean that they're able to do everything. Sometimes it's very difficult. But I can see that behind the difficulties there's love and connection and a desire to help, and that's why we're doing this kind of research, because we see what pain these families are in."

Jim Prince, director, the Manville School, Judge Baker Children's Center, Boston: "All of these kids have great disabilities, and that means pain for their parents. There's a stigma that's often attached to kids who aren't behaving well. The parents feel under pressure. They have to do a lot of direct advocacy to make sure their kids get the proper help. And then the diagnosis also comes with controversy. Some people think no child should get this diagnosis. But I see the controversy around the science as just an indication of how much further we have to go in helping these kids."

What should parents of bipolar kids focus on?
Stuart Ablon, associate director of the Collaborative Problem Solving Institute, department of psychiatry, Massachusetts General Hospital, Boston (one of the doctors treating NEWSWEEK's cover subject, Max Blake): "Max is one of the few kids who certainly warrants the diagnosis, but even when it's accurate, it doesn't give the adults a role. It doesn't tell them what to do. Our philosophy is, forget the diagnosis: what are the factors that are causing these problem behaviors? We ask parents to focus more on teaching skills and less on motivating behavior. They have three options for how they can respond to problems. They can try to impose their will-but they're not going to pull it off, the kid will go nuts, and the problem won't be addressed. They can drop some of their expectations, which parents often view as giving in. Or they can try Collaborative Problem Solving. We're trying to get Max's concerns on the table, then Amy and Richie's, and then invite Max to solve the problem with us. In the process of doing that, we can teach him problem-solving skills. The tough thing about it, though, is that sometimes Max's impulsivity can blow right through whatever plans we make."

What generally happens when bipolar kids hit puberty?
David Miklowitz: "As you go up the age ladder, the symptoms tend to resemble those in adults more and more. When the kid becomes a teenager, the episodes are characterized by mixed symptoms, rapid cycling, psychosis, and severe irritability. ... The big issue in adolescence is that all kids strive for independence. They try to define themselves separately from their parents. If they have a psychiatric illness, that tends to derail them socially—they fall behind their peers. Other kids shun them or make up rumors, and they get isolated. Some of them aren't really ready for the developmental tasks of adolescence. By age 18 many kids feel ready to take on the world, but a lot of these kids don't. The other big worry is that adolescence is often the first time that kids go off their medications. They get to be 12 or 13 and say, 'I don't really have to do this." It can become a weapon against their parents. I worked with a kid who started leaving lithium tablets all over the house—on the table, behind the toilet, under his mother's pillow. This was his way of saying, 'look what I can do.'"
How can parents cope if they are struggling with some of the same behavioral issues that affect their kids?

David Miklowitz: "That comes up all the time. It's a very multifaceted problem. If the parent is unstable, the kid's going to be unstable. One of the issues is whether we can get the parents into the proper treatment if they also have a disorder. They may not have even been diagnosed. We also tell them they have to be better communicators with their kids than their neighbors. They have to learn skills that go beyond the normal. We try to get them to be a role model for the kid."

John Weisz, president and CEO, Judge Baker Children's Center, Boston: "We're not the parents. We're secondary. We do know specific parenting skills that can help, but if there are particular skills parents don't want to use, we respect that. Still, parent training is very helpful to so many of the families we serve. When children have significant behavioral or emotional problems, their parents need general parenting skills, but pushed to a much higher level than the norm. Sometimes a parent may feel 'if the therapist wants to see me, uh oh, that must mean I'm the problem.' That's not our view at all; we just want to support the parents in building special skills for the special challenges their kids face."