Bipolar in Kids: Knowing When It’s More Than “Acting Out”

What is considered “normal” behavior and when should I seek professional help?

By Susan Resko

In psychiatry, we do not yet have objective biological tests, like blood work or brain scans, that can validate the presence of disease—doctors must still rely on observations of symptoms and on their own medical opinions to make a diagnosis. But that doesn’t make mental illnesses any less “real” than broken bones.

So, when it comes to observing symptoms, how do you know if your child’s troublesome behavior is merely “acting out”—or something more? Should we listen to Great-Granny, who chides that there’s nothing wrong with Junior that a good spanking wouldn’t fix? Try dietary restrictions, vitamin therapy, or homeopathic remedies? Blame the school? Or worse, blame yourself for being a bad parent?

Trust your instincts. If you are worried about your child’s persistent behavior and you feel like something just isn’t right, don’t ignore that nagging inner voice. Any number of behaviors that are part of a disorder can be observed in perfectly well adjusted children. The difference is that in a diagnosable (but treatable!) disorder, the behavior is impairing, persistent, and developmentally inappropriate. For example, if a 3-year-old has an occasional nightmare that sends him running to his parents’ bedroom, that’s developmentally appropriate; however, if a 12-year-old sleeps on the floor of her parents’ bedroom more often than not, that’s something that warrants a closer look.

Many behaviors fall in a gray area. If you turn to the Internet to learn whether a child’s behavior is “normal” before deciding whether or not to see a doctor, BEWARE: Know your sources, and don’t believe everything you read! You can trust information from the National Institute of Mental Health, the American Academy of Child and Adolescent Psychiatry, The Balanced Mind Foundation, and other reputable mental health advocacy groups. When researching books online, look for opinions and references from reputable sources—and remember: Anyone can claim to be an expert and self-publish a book with impressive looking endorsements on the back cover.

Documentation is a critically important step in determining how worrisome a child’s behavior is. Keep a notebook in your kitchen or another central, convenient place and jot down the date, time, and a quick note anytime your child does something that strikes you as outside the range of normal (you can go back and fill in details later). Documentation will help you reflect and assess whether you might be over-reacting, or if you are seeing a trend. And if the time comes, a doctor will be better able to assess the situation if you have careful records.

Make a note of your family history. Psychiatric illness is highly genetic. While it’s not your fault that you or your spouse may have passed along a genetic predisposition, it’s important for doctors to know. In previous generations, psychiatric illness was often hidden—think about those family members who may have been the “black sheep” of the family; self-medicated with drugs or alcohol; were estranged; had troubles with the law or holding down a job; were unable to maintain long-term relationships; had quirky habits; or died young for a mysterious, hush-hush reason.

Talk with your child’s teacher, school nurse, or guidance counselor. Are they seeing the same behaviors at school? If not, it doesn’t mean that what you’re seeing at home isn’t real. Like adults who might put on a “game face” at work or social gatherings, children fight to mask troubling thoughts while under the social microscope of school. Many children will let it all hang out at home where they feel safe. To get a full picture, your doctor will want reports from multiple sources that have interaction with your child.

Other well-meaning parents may say, “Oh, relax; my child did that.” But if you are still concerned, trust your gut and consult a child psychiatrist about scheduling an evaluation. Ask your child’s school social worker or guidance counselor for a list of qualified professionals, or look in the referrals section of reputable mental health websites. (You may want to check with your insurance company, too.)

Contrary to many reports in the media and in the blogosphere, psychiatrists are not out to medicate every child into submission. A good psychiatrist will rule out other medical reasons and try school, family, and/ or other therapeutic interventions first. And despite what your beloved Great- Granny might say, spanking most certainly won’t help.