This book is intended to be a practical manual for parents of children with Bipolar Disorder (BD). The author is a psychotherapist who has worked with adults and children with BD. The book is divided into five sections. Section One, which has six chapters, focuses specifically on BD. Sections Two and Three focus on children with BD comorbid with Asperger’s Syndrome (AS) and Tourette Syndrome (TS), respectively and are not as pertinent as the fourth section that addresses how Attention Deficit with Hyperactivity Disorder (ADHD) and BD differ. The last section discusses how to deal with schools, professionals, psychiatric hospitals and the police. The Conclusion looks at six keys to personal wellness for families of children with BD.
Chapter One provides an overview of BD. The author describes the youth with BD as having a Warrior Archetype and he provides a case history of an adolescent with BD. He describes the presentation of bipolar disorder in adults, including the concepts of hypomania, mania and depression, which are useful. He indicates that BD in children mixes the manic and depressive states together to form aggressive depression, rather than the more accurate term mixed state. From his clinical observations and research he outlines sixteen characteristics of BD in youth. Some of the characteristics are well described. Other characteristics do not seem as accurate eg. children with BD have a “seemingly malevolent enjoyment of knives, fire and dangerous behavior.” Such a comment could be frightening to parents. He organizes the 16 characteristics into a checklist that he considers a self-awareness checklist rather than a diagnostic instrument.
Chapter 2 focuses on medications used to treat BD and related conditions. He discusses the role of mood stabilizers, antipsychotics, antidepressants, benzodiazepines and other drugs such as propranolol. A number of drug names are misspelled including citalopram and methylphenidate.
The third chapter begins with a case history to describe how to understand and manage rage in children with BD. Nine useful survival strategies for managing rage are described. The American perspective is evident as the author states “If you have to call the police, let them know your child’s diagnosis right away and tell her that if she is holding a knife when the police come in she is in danger of being shot.” The author describes eight ways to distinguish the melt down of a youth with AS from rage related to BD which is not as helpful to most parents who have a child with BD as the most common comorbid condition is ADHD and not AS.
Chapter 4 focuses on helping an adolescent with BD, by using a model borrowed from Dr. Kurt Lewin. He describes five survival strategies; some of which appear useful eg a Mood Feedback Scale. Unfortunately some of his terminology is derogatory. For example, he makes the following statement: “Opening communication relieves parents of the terror that they are raising a deranged child.”
Chapter Five is extremely confusing. The chapter centers on the empathy factor in children with BD. Lynn coins a term “anempathy” to mean the inability to experience empathy. Anempathy is described as a result of any of five factors: frontal-lobe dysfunction; “Alexithymia”; psychosis; Post Traumatic Stress; or AS. The author goes on to describe each factor and then provides survival strategies for managing anempathy in children and teens with impulsive, destructive and dangerous behavior.
Chapter 6 describes non-pharmacological treatment approaches for BD, ADHD, and Depression. The author states that research on the efficacy of naturopathic remedies is not well established but he has seen that they can reduce symptoms. He cautions that parents should check with their physician before using any over-the-counter supplement. He also has a fairly extensive section on electro-convulsive therapy that is rarely used in youth.
Parts Two and Three are centered on AS and TS respectively. The author devotes one chapter to each diagnosis on it’s own and a second chapter on each diagnosis comorbid with BD. Since the focus of the book is on BD, these chapters are not as relevant.
Part Four centers on the relationship of ADHD and BD. The overlap between ADHD and BD is appropriately described. Seven criteria for differentiating ADHD from BD are outlined, most of which are accurate. One differentiating criteria which does not appear as useful is the lack of understanding of the feelings of others. He summarizes the chapter with a discussion about the importance of diagnosing BD early so appropriate treatment can be provided.
Part Five describes interactions with schools, professionals, psychiatric hospitals, and police. Parents are provided with some good ideas about choosing a physician, a psychotherapist, and educational plans. He makes an excellent point that hospitalization should never be considered as punishment, but rather facilitate medical evaluation or limit dangerous behavior. His comments about the downside of psychiatric hospitalization could be disconcerting to parents. The last chapter describes six principles for surviving the enormous stress of parenting these youth.
Despite some good descriptions of children with BD and some useful strategies for parents, I would not recommend this book to parents. I thought there was too much emphasis placed on AS and TS. I felt some comments made by the author were derogatory and inaccurate.