Professor Mother Blog

Whereas the shift to include Aspergers under Autism is one that has progressed naturally, based on two decades of practice and research, medical professionals are breaking out the category of bipolar disorder for children.  The new DSM is proposing a new term, distinct from bipolar disorder, called Temper Dysregulation Disorder (TDD).

Temper Dysregulation Disorder is intended to find help for the child who is consistently irritable, who throws temper tantrums several times a week and has explosive temper issues with little provocation.  In other words, that child that you walk on eggshells around, waiting for the inevitable screaming and throwing.  The one that gets kicked out of preschools; the one that pushes parents’ buttons; the one where you know that something is wrong, but what?

Prior to the 1990s, bipolar disorder was only diagnosed in adults, and it was understood that full-fledged bipolar behavior started around adolescence.  Parents and teachers, of course, could describe erratic behaviors much younger, but the medical professional field did not recognize this childhood behavioral issues as anything other than something that behavior management could control.  Parents were, understandably, upset at the implication that their child’s behavior was caused by poor parenting.

Since the mid90′s, the diagnosis rates of bipolar disorder for children has skyrocketed over 4000%.  Given that it was practically 0% before, this is not unusual for it to shoot up (new label means more diagnosis which means increased rate), but it is still an alarming rate for an “experimental” label.  Along with the label of bipolar comes an inference that it is a biological issue, rather than poor parenting- and biology often implies medication.  The medications approved for adult use are not lightweight medications- these are no aspirins.  Certainly, the use of serious medications on a child’s developing nervous system and physical growth has to be accounted for. Doctors and parents have carefully monitored medications and struggled with trying to determine what is working, what is an appropriate dosage and what other alternatives might work.

The other challenge is that not all people who were identified as having bipolar disorder as a child developed the full range of mania/depression that characterizes adult bipolar disorder.  Many of the children “lost” their label as they aged, whereas some children who had not been identified DID develop bipolar as adolescents.  Clearly, there is no well-established line of determination.

And so now we have TDD- an attempt to bridge the chasm between nature and nurture, between child and adult, between poor parenting and biology, between medication and behavior management.  It’s a “new” label that the American Psychiatric Association hopes will provide options for treatment, for causality… for hope.

It’s a label I’ll be teaching my teachers and one that I hope that brings strategies and ideas.  Good luck TDD…

I got a very unusual phone call today.  A local man is writing a novel and wanted information on the best home environment for a child with bi-polar disorder and ADHD.  Turns out he has a 30-year old son with these issues whom he no longer has contact with and he’s trying to process his grief through writing.  He found me through the university’s contact source and wanted an “expert’s opinion”.

I had to tell him that while a strong, loving secure home can HELP these conditions, it can’t fix them.  Environment PLUS medication can help a lot, and make some issues go away, but the biology doesn’t change the fact that these conditions are there.  I referred him to a counselor and the fantastic book “Beautiful Boy: A Father’s Journey through his Son’s Meth Addiction“  by David Sheff.  While there are differences (Nic Sheff has drug addictions, his son is NOT taking his medications), there are similarities- broken marriage, striving to make an environment where the child can be successful, addiction to the “high” of drugs for one, the mania of the other, loss of communication with the adult child who can’t handle their own life, but really wants to.  Really, over the course of 25 minutes, I learned quite a bit about this man’s life.

As a professional, I can sit in my little office and discuss how sometimes, the person who needs to focus on recovery is the parent.  How the hardest part is providing options, choices, support and love, but ultimately, the child is the one who has to want to change themselves.  How a child can struggle with issues and how we want to FIX things, but we can’t- only they can.  How so much of this is biology and genetics, and you cannot cause these things, and you cannot fix them- you can only deal with them.  I can say that as a professional.

But as a person- as a daughter- as a mother… where is that line where you “allow them freedom” and why does that feel so much like losing them?  At what point does “love” become “tough love”?  At what point does “tough love” become “abandonment”?

As a daughter, I am deeply grateful that my mother did not give up on me and continued to be there when I needed her.  That she listened to our latest crisis and did not declare that it was more than she could handle.  That she continued to provide options.

And as a mother, to what degree do I allow my child to fail before I help him or her?  Do I keep helping?  When do I step back and let them find their own strength?  And how on earth can I ever say “No”?   I can say “no” to little things- “no dessert without vegetables at dinner; no tv without finishing homework; no, you can’t go outside until your room is clean”.  But this man’s son is living on the streets, and he has to say “no” when his son asks for money because he knows it will go for drugs, and he’s afraid his son will kill himself.  And he doesn’t know what to do.

There are no easy answers- I know that.  Parenting is a job that you figure out as you go along.  There are no recipes, no formulas and no guarantees.  I know this with my professional part.  But my mother part will go home, hold my son and daughter, be grateful that I can still kiss away the booboos, and I will pray.

And I will be grateful that all I have to say “no” to tonight is the enforcement of homework on a Monday night and dessert after dinner.  My heart’s with you, sir.