Sorting out mental illnesses in kids can be a challenge

Question: My 13-year-old son was just diagnosed with bipolar disorder. Apparently, it is becoming increasingly common and is often mistaken for ADHD (Attention Deficit Disorder) or, like in my son's case, ODD (Oppositional Defiant Disorder). This is so because the symptoms manifest differently in kids than adults.

Knowing this years earlier and being able to treat it would have spared my son and our family a lot of agony. There is lots of great information at www.bpkids.org. I implore you to inform your readers about this mental illness. --No Name, Portland, Maine

Answer: A number of mental illnesses can strike early in life. Often, as you say, they look different in children than they do in adults. As a result, and because for years it was thought that children were immune, these illnesses often go undetected and untreated. Depression and bipolar disorder are two examples of mental illnesses that have only recently been recognized as occurring in children. Unfortunately, the word still hasn't gotten around to many doctors and parents.

Often children with depression seem more irritable and angry than sad. This behavior can make teachers and family members angry with them. And this, in turn, may make them even less likely to be properly diagnosed.

Bipolar disorder, too, can look different in children. Rapid mood swings and long, violent temper tantrums sometimes take the place of some of the manic behaviors seen in adults with the disorder.

Oppositional Defiant Disorder, though, is primarily diagnosed in children. Sometimes youngsters given this diagnosis are actually depressed or have Attention Deficit Hyperactivity Disorder. Or they may simply have a strong but still "normal" dose of in-your-face behavior. Sorting these out can be a challenge.

When a mental illness is diagnosed, parents will want to be sure that all other possibilities have been considered. Any diagnosis should be clearly explained and backed up with careful observation by a child psychiatrist or psychologist.

The diagnosis of a mental illness can, as you say, provide the clarity a family needs to know what to do to help a child. But it can also have devastating effects on a child's self-esteem and on parents' dreams.

Don't let a label -- no matter how accurate -- interfere with the recognition of a child's strengths! And don't assume the worst. A child with bipolar disorder, for example, will not necessarily have the adult version of that illness later in life. The biggest challenge for you may be to balance facing reality with maintaining hope.

We applaud your efforts to share your experiences and help parents and children find the support and treatment they deserve. Here are two Web sites that can provide more information: www.nimh.nih.gov (The National Institute of Mental Health), www.aacap.org (American Academy of Child and Adolescent Psychology.

Question: I am a stay-at-home mom with a 22-month-old son. When I have to tell him "no," he will sometimes hit or bite me. He will not do this to anyone else, which is good, but I am not sure how to stop this.

When he does it, I tell him, "No, we don't hit or bite." I also tell him it hurts, and I walk away. Sometimes I will lay him in his bed and leave him alone to calm down.

If you have any other suggestions, I would greatly appreciate it. --M.T., Clayton, Calif.

Answer: It sounds as if you are already following the suggestions we would have made: Don't get too upset, tell him you don't like it, and walk away.

Maybe you need to say "Don't bite" more forcefully -- no matter how sweet and remorseful your little boy looks at the time.

Nearly all toddlers go through a phase of biting. Their parents are usually the victims. One of our colleagues says, "A bite is just a step beyond a kiss."

Children tend to bite when they are upset or about to fall apart. They must learn that it hurts and isn't acceptable.

Taking biting too seriously, though, may reinforce it. If you get too upset by it, you will add to your son's overreaction. Then, the biting is more likely to become a habit.

Calmly walking away (if you can leave the child in a safe place) is much more likely to give him the message that biting is not acceptable. Eventually, he'll learn to stop.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, NY 10168. Questions may also be sent by e-mail to: nytsyn- families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider.

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