Transcript

Deborah Amos: From American Public Media, this is "A Mind of Their Own," an American RadioWorks documentary. I'm Deborah Amos.

Amos: What does it feel like when you're a child with a mind you can't control?

Eric: I think millions of things all at once, I can't concentrate.

Erin: It's like seeing the world through red sun glasses; red-lensed sunglasses. That's like the angry side of it, like, you see like everything like angry.

Athena: Well, a lot of times, you're hyper and you kind of act stupid. And a lot of people are like, 'Oh my god, what's the matter with you? Is it a disease? Can you die from it?'

Amos: In the coming hour, "A Mind of Their Own," a documentary about children with bipolar disorder from American RadioWorks. First, this news update.

Segment A

Athena: My Dad walks in the door and he's got me this huge present for Valentine's Day. So, I'm all happy, all happy, all happy - all of a sudden, I'm ****ed off. I have no clue why, and then like an hour or two later, not even, I'll be sad. I'll be like sobbing.

Amos: Most children can be volatile at some point in their development, with no particular cause for worry. But at what point do irritability, mood swings and tantrums constitute a serious mental illness?

Athena: A lot of people don't understand that it's not just my attitude. It's something physical that I can't control.

Amos: A growing number of children are being diagnosed with bipolar disorder, a condition historically associated with adults. It's named bipolar illness, or manic depression, because those who have it swing between emotional poles: extreme highs to intense lows. Euphoria, creativity and grandiosity to lethargy, darkness, even suicidal thoughts. About two and a half million Americans have the diagnosis, but until about ten years ago, no one thought children could suffer from it.

Today, it's estimated that up to half a million children have bipolar illness, but the diagnosis remains controversial. A relatively small number of psychologists and psychiatrists treat the condition in young people. So how do parents, teachers, physicians recognize the brain disorder in a child, and then seek help?

During the next hour, through the lives of three Massachusetts children and their families, producer Karen Brown takes us through the early signs, attempts at treatment and the ups and downs of coping with a bipolar child.

Athena: M-A-R-L-B-O-R-O. Our team is like this. Boom, chick, boom boom, chick. [cheer fades]

Karen Brown: Eleven-year-old Athena Rinoldo beams as she does this practice cheer. [cheering] As she jumps, her thin body practically ricochets off the walls of the mobile home she shares with her mother in Marlboro, Massachusetts. Her favorite teen idol is Hilary Duff, and she dreams of becoming a real cheerleader.

Athena: We'll be doing round offs and cartwheels, we'll be screaming our lungs out, and everybody's like so happy they have me on their team because, like, I have so much energy.

"Let's go!" [cheer ends]

[Erin playing guitar in background]

Brown: Erin Reddick is a 17-year-old rocker who lives in a Boston suburb.

Erin: With my music, people tell me that I should write happy stuff, but that just doesn't work for me. The stuff that comes out of my mind is just like, you know, all sorts of negativity.

Brown: Fittingly, Erin's favorite color is black. She wears thick, dark eye-liner, tight jeans, and clunky silver pentacles around her neck. She's perfected a sarcastic stare, and when she wants to get away from her family, she writes songs in her basement studio.

Erin: This one already has a name. It's called "Go to Hell." [song begins]

Eric: This is Mr. Stick, he's like a stick figure. In this one you see his building is burning, and then he runs by one person needing help, and then he runs by another person needing help.

Brown: Eric Rancke is a 16-year-old who likes to crack up his friends with his South Park-style cartoons.

Eric: Until he gets to his room, and there's a beer sitting on a table, and he's like, "Alright, it's still cold."

Brown: Eric usually wears baggy clothes and a backwards baseball cap as he lounges around his western Massachusetts home. He has visions of becoming a late night comedian, like his hero Conan O'Brien.


Eric: Well, basically, one thing you should know: I have no problem making a complete *** of myself.

Brown: You could easily picture these three kids at a comedy club, rock concert, or half-time show. But for Eric, Erin, and Athena, growing up has not gone according to plan. Athena was kicked out of her after-school cheerleading program for getting into fights. Erin has threatened her mother with a knife and was arrested for public drunkenness. Eric cursed out his middle-school principal and still holds the record for detentions. All three have been diagnosed with bipolar disorder.

Dr. Kay Jamison: I think bipolar illness is hard for anyone at any age, but particularly if your brain hasn't developed, and hasn't been able to develop the kinds of friendships and relationships you need for support.

Brown: Dr. Kay Jamison is a professor of psychiatry at John's Hopkins University. In her book The Unquiet Mind, she writes about her own experiences with manic depression, which took hold when she was a teenager.

Dr. Jamison: You're at a time of life when everyone around you seems to be healthy, and all of a sudden, you have an illness that affects your thinking, your energy, your ability to walk, talk, do all of the things that make you a human being. And so it's just a level of pain and suffering that I think is unimaginable unless you've actually been there.

[music by Nirvana]

Erin: Just, there'd be times that I'd feel dead, or there'd be times when I'd feel on top of the world, but I wondered why I was so different from the other kids? Why I couldn't make friends, why I was the unpopular one, why I had decided to make myself dress different, listen to different music, why all this stuff was the way it was?

Brown: But when does being different qualify as being mentally ill?

Dr. David Miklowitz: We look for evidence that their moods have a negative impact on their ability to function in life. And that's very different, I think, than being a moody teenager.

Brown: Dr. David Miklowitz is a professor of psychiatry at the University of Colorado and author of The Bipolar Survival Guide.

Dr. Miklowitz: For instance, it's not unusual for young kids to pretend to be superheros when they play together. At what point does that become a grandiose delusion? When the kid gets up on the roof and tries to jump off because they think they can fly.

Brown: But it's not always so clear cut. And in the cases of Eric, Athena, and Erin, the early signs only became clear in hindsight.

Athena: When I was younger, I would hurt people. Like, I might like, jump on them, pull their hair, slap them or something.

Eric: There was this one time when I was sitting next to my friend, and for no reason the principal of our school was like, "No, you two move." And I was in a really depressed time, I was like angry about something. So I just said, "I f-ing hate you."

Erin: I remember bits and pieces, just like, me being like suicidal at ages that no other kids were. I remember listening to stuff like Nirvana when I was a little kid, when all the other kids were listening to like pop music and stuff. I don't like that music, never have, never will.

Sherry Reddick: She was 7 pounds 9 ounces. She was born the day before her due date and that was the nicest thing she's ever done for me.

Brown: Erin's mom, Sherry Reddick, remembers the trouble beginning about the time Erin's younger brother was born. Erin was three.

Sherry: She just did not want a sibling. And along with the kicking and hitting and screaming, because this new sibling was brought into the house, during his bris, she tried jumping out a window. But her rages would last for hours. She looked like a crazy - a wild person. And then as soon as she was finished, she was as calm as could be, like nothing happened.

Mary Rinaldo: I had the day care center, that we were in at the time, ask me to remove her because of her behavior. Other parents were starting to show concern about the safety of their children. She would go into a tantrum, and she would run out of the room and attempt to get out of the building.

Brown: Athena's mom, Mary Rinaldo, has been dealing with Athena's unpredictable outbursts from the terrible twos until today. Even during my brief visit to their home, one moment she was doing handstands on the floor; the next, she was crumpled in a corner and asking sternly when I planned to leave.

[Athena muttering]

Brown: You know, if you don't feel like chatting, you can go off.

Athena: It's just, I'm just getting a little bit mad because my mom is doing all the talking and she won't shut her mouth!

Mary: True.

Athena: I'm gonna smack you if you don't shut your mouth!

Conni Rancke: I can remember stopping in the middle of the supermarket with a full cart of food, and Eric was beyond control, screaming his head off. I picked him up out of the cart, left the food right in the middle of the market and drove home. There was nothing I could do to stop him from crying.

Brown: Conni Rancke adopted Eric days after his birth. The tantrums began a few years later, and got progressively worse. Today, they're much less common, but they still happen. Just last week, they argued over whether Eric could drive in a snowstorm.

Conni: There was some door slamming, wasn't there?

Eric: I did throw a trash can.

Conni: Oh, the plastic one you broke, you mean?

Eric: I didn't break it. When it hit the wall, the wall broke it.

Conni: [laughing] Oh, the wall broke it!

Brown: Conni now attributes that sort of behavior mostly to Eric's bipolar disorder, but it took years before she, or the other moms, realized the tantrums, the hitting, the running away were clinical red flags.

Conni: One of the most insidious things about having a child with bipolar disorder, is that their symptoms don't look like illness. You get a kid who's acting out in class, or who's fighting, or is always getting in accidents. That doesn't look like illness to anybody. It didn't look like illness to us.

[music]

Athena: My friend today, I told her I had bipolar, and she kind of backed off away and said, "Oh my god, is it contagious?" and I was like, "No!"

Erin: I've had friends who've been diagnosed and have refused to believe it. And then there's parents who say, "Oh yeah, it doesn't really exist. It's just them acting out. You know, they need to learn to control their temper."

Eric: Kids with bipolar gotta know that they're not that different. They have bigger mood swings than other people. There's probably kids that don't have bipolar that are a lot weirder than they are.

Brown: An estimated one in five children has a diagnosable mental illness, but many go untreated. That's not surprising if you consider the roots of child psychiatry. Freud and his followers believed children were born with a clean mental slate and that only damage during childhood could lead to psychological problems later in life. In the 1970s, doctors began to diagnose children with depression. But until the early 90s, calling children "bipolar" was only for the true renegades of psychiatry. Even today, childhood bipolar disorder isn't mentioned in the standard manual of psychiatry.

Martha Hellander: I regard it as a public health crisis. It's an epidemic, if you will.

Brown: Martha Hellander is research director for the Child and Adolescent Bipolar Foundation.

Hellander: If this many kids had some other strange illness that was causing them to not be able to go to school, and want to kill themselves, and so on, you know there would be attention focused on it.

Brown: Hellander's group advocates for better research, treatment, and awareness about the disorder.

Hellander: What we hear is a long story of going from one doctor to another begging for help, describing horrendous symptoms that the child has at home, and being told that "It's your fault. You're not disciplining enough. You're too strict. You're too lenient." And the last place the doctors have wanted to go is to say, "Is there something going on in this child's brain from within that's causing this behavior that we see?"

Brown: That's a critical distinction, says Dr. David Miklowitz. For one, the causes are believed to be genetic, and researchers think the bipolar brain works differently.

Miklowitz: I would say there are certain chemical imbalances in the brain, and certain structures in the brain that may be either overactive or underactive. And the point is that because of the biology of this condition, not all the behavior in this condition is controllable by the person.

Brown: In adults, bipolar disorder has distinct periods of highs and lows. Each extreme can last days, weeks, or months. In children, moods can flip-flop several times a day or even hour, and in some cases, Miklowitz says, they're simultaneous.

Miklowitz: These kids have what we call "mixed disorders," which means you're manic and depressive at the same time. If you can imagine having your thoughts race, feeling a sped up feeling like you can't sleep and don't want to sleep, but at the same time feeling suicidal, feeling hopeless about the future.

Brown: But if the symptoms in children are distinct from adults, is it truly bipolar disorder?

Dr. Rachel Klein: Bipolar disorder is the flavor of the month in the diagnosis of children.

Brown: Dr. Rachel Klein is a professor of psychiatry at New York University.

Dr. Klein: The children who are described as bipolar are reported to have chronic mania. They're always irritable, impulsive, difficult, etc.. And as a result, people say, "It's different in children. It's chronic." Then by definition, we're not talking about the same disorder.

Dr. Miklowitz: The problem is, across the country, different criteria are being used.

Brown: Dr. David Miklowitz says the symptoms of bipolar illness often look like attention deficit hyperactivity disorder.

Dr. Miklowitz: What's one person's ADHD kid is another person's bipolar kid. And as a result, there's a lot of confusion and disagreement.

Amos: I'm Deborah Amos. You're listening to "A Mind of Their Own," from American RadioWorks.

Just ahead, as the professionals debate the prevalence of bipolar disorder in children, anguished parents are still wondering, "What is going on?"

Conni: There have been times when he has been almost catatonic with depression. Where we'll sit by his bedside and stroke his back, because he won't face you, and just tell him over and over again, that it's going to be alright and that we're going to fix it somehow. It's excruciating.

Amos: Our program continues in just a moment, from American Public Media.

TO BE CONTINUED IN NEXT THREAD...

http://americanradioworks.publicradio.org/features/bipolarkids/transcript.html

Segment B:

Amos: This is "A Mind of Their Own," an American RadioWorks documentary from American Public Media. I'm Deborah Amos.

Bipolar disorder is a relatively new diagnosis in children, and the professionals still can't agree. Does it exist? And if so, how many kids have it? Against this controversial backdrop, we profile three kids with the diagnosis and their parents, who are looking for answers, and not always getting the ones they want. We return to reporter Karen Brown and "A Mind of Their Own."

Sherry: I was told that she was very sensitive to others. She was sensitive to stimuli and what people say. Great diagnosis. Yeah, that was a big help.

Karen Brown: The parents of Erin, Eric, and Athena say, at first, they felt comforted by doctors and teachers who assured them their kids would grow out of their volatile behavior.

Conni: "This is all normal stuff, relax, you are older parents with only child, you're highly educated, you're being over-protective." Sometimes the message felt like, "Get a life."

Brown: But Conni Rancke, Eric's mom, became convinced it was more than that.

Conni: He was doing things like, it sounds silly, stabbing himself in the stomach with pencils in school. And saying to the nurse, "I just want to die." I mean clearly, he was suicidal.

Mary: She didn't want to go to school. She was in first grade. She said she didn't want to go to school. She said she was going to kill herself if I sent her to school. So she ended up in the hospital. The doctor then diagnosed her ADHD and the anxiety disorders.

Sherry: I was not looking necessarily for a diagnosis, but when we got a diagnosis, we felt like at least maybe now we know what to treat. So on one hand, it was a little bit of a relief, and then you realize, "My daughter's got a mental illness." And you know, that kind of hits you in the gut.

Brown: One of the first doctors to identify bipolar in children was Harvard-based psychiatrist Linda Zamvil.

Zamvil: I think people just kind of thought I was a funny doctor.

Brown: In the early 1980s, Zamvil decided that many kids previously thought to have attention deficit disorder, substance abuse problems, or unusually irritable behavior should be diagnosed as bipolar instead. This raised some eyebrows among her peers.

Zamvil: People feel that it's like a curse, and that children are in the midst of their development, and it's unfair to label them - to give them a diagnosis like this. And I feel on the contrary, that it's better to say, "This is what this is," and identify that this is an extremely high risk population. These are the kids who hurt themselves. They drive fast, they drink, they drug, they get pregnant, and wind up in Department of Social Services and lock ups.

Brown: Zamvil's approach is much more common now. In fact, some say the pendulum is swinging the other way and doctors should be careful not to over-diagnose bipolar illness. That's why Dr. Barbara Geller, a child psychiatrist at Washington University in St. Louis, is developing a clinical checklist for the adult and childhood versions.

Dr. Geller: Adults who are depressed stop enjoying life. A housewife stops cleaning the house. A person at work can't keep up. People don't get good sleep. They feel guilt ridden. And then they have the other side: they're the life of the party, they start grandiose business schemes.

Brown: So the question Geller faced was, "What's the equivalent of those symptoms in a child?"

Dr. Geller: A young child may unexpectedly start having very flirtatious behavior. A young child may not start business schemes, but a young child can very grandiosely go up to the school principal and say, "I don't like such and such teacher, you really have to fire them." They act as if it's the day they're going to Disneyland, or as if it's Christmas morning, but they act this way every day.

[music]

Erin: I know I need to be on medication. Whatever. I'll go once a month or once every two months to the fricking psychiatrist.

Athena: Like one of the pills I was so shaky on, oh my god, I'm like, "Uuuuh."

Eric: Thanks to the pills I'm taking, I'm really good at picking out when I'm feeling depressed or feeling hyper so I can just say, "Ok, I'm feeling depressed or feeling hyper," and they can help me out.

Erin: They'll take me off medication and put me on new stuff, and I'll get violent, and I have bad reactions to medication. I don't even remember all the stuff I've tried, but a lot of it makes me pretty psychotic.

Brown: Once a family gets a diagnosis of bipolar, even the experts aren't sure what to do about it. Psychiatrist Linda Zamvil begins by trying out different mood stabilizers such as trileptol, lithium, or seraquil.

Zamvil: I, like most doctors, use sometimes a lot of trial and error, and you have to tell families that from the beginning.

Brown: The problem is that psychiatric drugs, like most drugs, have never been tested in children for a variety of logistical and ethical reasons. That creates a dilemma: children have distinct metabolisms and react differently to medication, so kids become pharmaceutical guinea pigs.

Conni: I am looking at my 11 year old child and thinking, "I am going to be putting these chemicals in my child's system."

Brown: Eric's mom, Conni Rancke.

Conni: I think part of it was, we were still reeling from the diagnosis. But part of it was to try the most benign approach possible, to tamper as little as possible with this young growing body.

Brown: Psychiatrist Demitri Papolos, author of The Bipolar Child, says parents like Conni Rancke should be cautious. The FDA has warned that some anti-depressants can lead to suicidal tendencies in youth. Dr. Papolos says children who are prone to mania are especially vulnerable. Unfortunately for many of these kids, when you put a child on stimulants or on antidepressants, you can make the course of the illness worse.

For the first time, the National Institutes of Health are sponsoring a drug trial to treat bipolar disorder in children, focusing on anti-psychotic medications. Dr. Barbara Geller is lead researcher.

Dr. Geller: We're seeing a child who can't function in any sphere of life. Many of them have written notes of how they will kill themselves, of where they want to be buried. So that you are weighing these factors, what the child looks like, against the risks of the medication.

Brown: Geller's hoping to find a regimen that could actually stop the illness from progressing. Meanwhile, Dr. David Miklowitz of the University of Colorado is one of the few researchers looking at the benefits of talk therapy.

Dr. Miklowitz: When I started in this field doing work on bipolar in early 80s, it was all medications. That's all anyone talked about. I think the zeitgeist is changing and psychiatrists are realizing this is a difficult illness to cope with, and that the medications are gonna be more effective if delivered in conjunction with therapy.

Brown: Miklowitz uses a method he calls family psycho-education. He first tries to educate families about the disorder, then help them communicate calmly with each other - solving problems without moods escalating.

Dr. Miklowitz: Really the view in traditional family therapy is that the disorder reflects a dysfunctional family. And we don't believe that about bipolar disorder. This is a biologically based illness, and the family is doing its best to cope, and our job, as we see it, is to help the family find the most effective way to cope.

[music]

Erin: I took a knife out of the drawer, it was maybe six, seven, maybe eight inches long and really sharp. I went outside to our wooden deck, and just took it and boom, right into the deck. Big gashes and my mom flipped. I told her, "You told me that if I ever get mad, to just take a dish and break it on a tree or whatever." "But I don't want you doing that!" "Whatever." "Don't ruin my house!" "Whatever, leave me alone. Here's your knife."

Athena: She'll get like all freaked out over nothing. Like I put the mattress on the floor the other day to go to sleep. "Why'd you do that? You had no reason to do that!"

Eric: My parents did a really good job like, they're always like studying, and what medications do what, and they've learned all the vocabulary of mania or whatever.

Erin: They've never done everything right, but they try. I have to give them credit for that.

Brown: One of the hardest things about loving a child with bipolar disorder is that, quite frankly, they aren't always lovable.

Sherry: I mean right now, things are quiet in the house. You know, I can let my guard down. And every time that happens, she throws a monkey wrench in and stirs up the waters. And, you know she lets us know, "Hey, I'm back."

Brown: Sherry and Erin Reddick have had a rough couple of years, beyond what you'd expect between a rebellious teenager and her mother. Erin is just back from her second hospital stay in two months. Police took her to a psychiatric unit by force.

Sherry: I had to call the police because she almost hit me.

Brown: Sherry and Erin, sitting next to each other on a couch but looking straight ahead, still can't agree on what happened.

Erin: She knew I wasn't gonna hit her. I wasn't even facing her when I raised my hand. I wasn't even raising my hand. I was picking up the phone and throwing it.

Dr. Miklowitz: When you have a kid who's being very nasty to you, has threatened you physically, and is making it difficult to parent your other kids, embarrassing you in public, yeah, eventually parents are gonna say - feel like they don't like the kid anymore.

Brown: Psychiatrist David Miklowitz.

Dr. Miklowitz: When they try to set limits on a kid who's really raging, it seems to make things worse, and so they end up feeling like they're walking on eggshells to not provoke the kid.

[sounds of walking in house]

Brown: Sherri Reddick has tried to give Erin space to express herself, including physical space. We go up the steep stairs of this earth-toned split level house, come to a wall of beads, and enter an arresting bedroom.

Sherry: Every inch of Erin's wall is full of magazine pictures and comics. All of them of violence. There are skulls on her walls, there's, uh, people with skin being torn off on her walls, her pop idol is Kurt Cobain. [music] I, she thinks he's fabulous. He killed himself and you know that's someone to have as an idol.

Brown: Cobain was the Nirvana lead singer who shot himself in 1994. Erin's room is full of photos of his anguished face, screaming into a microphone. His song lyrics are scrawled on Erin's walls.

Sherry: In large type, it says, "Pain, pain, pain, you know you're right, you know you're right." I guess that's the chorus.

[Nirvana music]

Erin: All his music speaks to what I feel.

Brown: Among the band posters, she's hung a few dark, atmospheric paintings including a self-portrait.

Erin: One eye is yellow and orange and red, and the other is green and blue and black, and it's just, I don't know, two different moods.

Brown: Erin spends most of her afternoons in this room. That's her parents' rule following a year-long downward spiral. They discovered she was abusing drugs and alcohol and not taking her psychiatric medication. She was arrested for being drunk and disorderly, and then raped by a boy she knew. Erin says she stopped the drugs and drinking, but things continued to deteriorate.

Erin: Recently I've been really anxious, and really depressed, and unable to sit still and focus and do everyday stuff. So I decide I need to intervene in my life, my own life, and checked myself into a hospital.

Brown: She was placed in an adult psychiatric unit with elderly dementia patients and traumatized veterans. Sherry says it was frightening for Erin, now old enough to be admitted as an adult but still a child, in so many ways.

Sherry: You know with all this violence, you can look around and still see teddy bears, dolls, that she won't get rid of. There's still a little piece of her inside that's - I think that wants to be a little girl. I think in a way, she missed being a little girl. She had so much turmoil in her that she had to deal with it like an adult.

Conni: Tea, hot chocolate?

Brown: You have choices?

Eric: We have every kind in the world.

Brown: The fact that Eric and Conni Rancke can sit politely in their kitchen and offer refreshments is a sign they're past the worst of Eric's illness. At least Conni hopes so.

Conni: I can't tell you for how many years we didn't go out. We didn't invite people over. Somebody from work invited us to Easter dinner, which was a really lovely thing. Well, we got up that day, and Eric was a mess, and I had to call these people. I didn't know them well, so I wasn't comfortable saying, "My son is bipolar and he is severely depressed today so we won't be coming." So, I just called and said, "I'm sorry we can't come." People don't invite you anymore.

Brown: Now, Eric has sleep-overs with friends. Even holidays with extended family have become bearable. But Conni still takes nothing for granted. Eric recently felt well enough to start cutting back on his lithium, and when he did, Conni noticed some backsliding.

Conni: Something was going on, and he was getting out the door, and I was trying to get him to take his pills or do something normal in his morning routine. And he was not happy, and took everything in his arms, his books and lunch, and threw them onto the floor, and stomped on them.

Eric: I don't remember what happened much. When those things happen, I kind of block them out of my head.

Conni: He doesn't remember any of the stuff from when he was little. It's kind of like an epileptic seizure. But I also think, to some extent, it's sort of a coping mechanism, and he needs to move and get back to his level self.

Brown: It's not uncommon for parents of bipolar children to have a mental illness themselves. Athena's mom, Mary, also has bipolar disorder, which she says helps her understand Athena. But, it doesn't necessarily help her raise Athena.

Mary: If our moods are opposite, then we'll fight. If we're both in the wrong mood at the same time we can clash there, too. If we're both in a mania, and we've got energy and someplace to go, something to do, then we get along fabulous. It's a fantastic day.

Brown: In their trailer, piles of papers, empty soda bottles, pizza boxes, and clothing take up almost every inch of floor space. Dirty dishes and loose cereal are scattered through the rooms.

Mary: I've been trying to find my summer clothes, so I have the boxes all sitting underneath other boxes here - Athena's toys.

Brown: Is that breakfast?

Mary: Yeah, it looks like the box got kicked off the end of the bed, or knocked off by one of the cats. One or the other.

Brown: Amid this clutter they have a snake, a hamster, two parakeets, and four cats. These days, Athena plays more with her pets than with other kids. Her mood swings have turned her into a social outcast.

Mary: She was invited to a birthday party by a friend. This girl then invited some other kids from the class. Those kids said they wouldn't go if Athena went, so she uninvited Athena.

Athena: Hi Sarah!

Brown: Athena has one friend who's stuck by her: Sarah Guernelli. She's visiting this afternoon, and plops down on Athena's bed.

Sarah Guernelli: Oh my god, Athena, I hate this song.

Athena: I know.

Brown: Sarah and Athena met when their moms were in a support group for difficult toddlers. While Sarah grew out of that phase, Athena did not.

Athena: You were on the computer, and you were online, and I'm like, "Sarah, can I go on?" And you said, "In a minute."

Brown: Even in the company of her only friend, Athena can't always restrain herself.

Athena: And it was a minute for like, half an hour. I was mad, but I was laughing at the same time. I just shoved her so hard, and she went right into the wall.

Sarah: I don't know, I just smacked against the wall. It hurt for a few seconds, but after that it was fine.

Brown: Sarah says she knows Athena can't always control her behavior. And mostly, they get along fine, like this afternoon when they decide to sell chocolate bars to raise money for a local charity. They walk door-to-door through the rows of mobile homes in Athena's neighborhood.

Athena: We're selling candy bars, they're a dollar a piece.

Brown: But Athena has few after school options. She was kicked out of the local Boys and Girls Club, and even her beloved cheerleading squad, for fighting with kids and coaches. Her mother Mary, who doesn't work, says she can't afford private after school programs.

Mary: She's really not doing anything but coming home after school. If she happens to have a friend that particular day, she may have someone come over for a little while, but friendships are up and down from day to day.

Athena: [selling candy] Have a nice day.

Amos: I'm Deborah Amos. You're listening to "A Mind of Their Own," a documentary about children with bipolar disorder.

To see pictures of the families profiled in this program, or to tell us your story, visit AmericanRadioWorks.org. You'll also find information on ordering a CD or MP3 of this program. That's at AmericanRadioWorks.org.

Major funding for American RadioWorks comes from the Corporation for Public Broadcasting. Additional support for "A Mind of Their Own" was provided by the van Ameringen Foundation and the American Psychiatric Foundation.

Our program continues in just a moment, from American Public Media.

Amos: This is "A Mind of Their Own," an American RadioWorks documentary about children with bipolar disorder, from American Public Media. I'm Deborah Amos.

One institution on the front-lines of dealing with mental illness is the public school, which can be a whole different battleground for kids with bipolar disorder. Children's rapid mood swings can make it very hard to learn, and their unpredictable behavior can turn teachers or administrators into adversaries. Karen Brown reports, as the number of diagnoses climbs, schools are often at a loss as to how to respond.

[music]

Eric: I got in trouble more than, like, anyone in the school, during like middle school. Uh, it kind of gave me the trouble maker reputation.

Erin: My teachers were telling me, "Erin you're going like 0 to 60. You need to calm down and think before you act." And it was just like impossible for me. You know I'm like, "Well, let's see how you feel when you know your medications are being switched and you were bipolar."

Athena: One of my teachers that I hate, was like, "Well, you need to calm down, you need to calm down. Do you want to color?" And I'm like, "I don't need to [bleep] color!" And then she sent me to the principal's office, and I got all mad at him, and started yelling and swearing at him, and he just locked me up in a room and wouldn't let me out.

Erin: It got to the point where I was fighting with some of the kids in the school. And they were like, "Ok, we can't help this girl."

[school hallway: "7th graders, ready for dismissal"]

Brown: Wilbraham Middle School is where, two years ago, Eric Rancke won the dubious distinction of third most detentions of all time. Today, he considers that a badge of honor. But his mother Conni doesn't remember that period so fondly.

Conni: The principal didn't buy any of this stuff about his illness. Eric got labeled in the principal's head from day one as a brat. Everything my husband and I tried to do he saw as over-indulgence.

Eric's sixth grade social studies said to me in a meeting, "I have to tell you, I think he has you completely snowed. He's manipulating you. He's fine." Not only was he not fine. He was actively hallucinating in her class.

Brown: For Erin Reddick, school had always represented one more wall of people who didn't understand her. Her mother Sherry could barely get her out of the house in the morning.

Sherry: She was paranoid. She was stressed. She wasn't learning anymore, at all.

In 7th grade, I wrote that I wanted her tested. They said that she was very bright and this was not affecting her education.

Brown: Sherry, Conni, and Mary each found out, through different avenues, that federal disability law gives their children some rights. They asked their schools to provide accommodations to help their children learn: anything from daily counseling sessions to longer assignment deadlines. But schools have discretion in applying the law, and with all three children, the administrators at first balked.

Tom Philpott directs special education for Eric Rancke's home district.

Tom Philpott: When parents come in and ask for certain considerations, it can be misinterpreted that the parents are asking for a coddling, or we use the term "enabling."

Tammy Seltzer: Basically, schools have done an abysmal job addressing the needs of children with emotional and behavioral disorders.

Brown: Tammy Seltzer is an attorney with the Bazelon Center for Mental Health Law in Washington, D.C. and author of a 2003 report on how schools cope with mentally ill children.

Seltzer: National studies have shown that anywhere from five to nine percent of all children have a serious emotional, behavioral problem, but schools identify only less than one percent of those children. Schools tend to view children with behavioral problems as problem children rather than as children who have a condition that needs special attention.

Brown: Schools admit they were caught off guard by the number of children coming in with a bipolar diagnosis. William Pfohl is president-elect of the National Association of School Psychologists.

William Pfohl: Before, it was "attention deficit." That was the diagnosis that was popular five to 15 years ago. The schools did accommodate and adjust to that, and I think it's gonna take the same period of time for schools to adjust and accommodate to this particular diagnosis. But we really have to know how many kids does this actually involve, and I think the jury's still out on that.

Brown: Following several appeals, Eric now sees an academic counselor several times a week, and his parents have taught his teachers to recognize Eric's oncoming mood shifts.

Eric: They don't think of me as being like a bad kid, they think of me as going through a manic time.

Brown: And last year, Eric made the honor roll for the first time.

Mary: What happened?

Brown: Things are not going as well at school for Athena.

Athena: I walked on the bus, and he called me a child molester.

Brown: Athena bounds through the door of her trailer this afternoon, looking upset.

Athena: He sat down, and he walked by up the aisle, and punched me on the nose.

Brown: Her mother, Mary pulls out a notebook and pen.

Mary: You got on the bus. This guy punches you, and he called you a child molester?

Brown: Mary says she knows Athena's version of her bad encounters can be suspect, but she feels school administrators never give Athena the benefit of the doubt.

Mary: The other kids tease, harass, taunt, call her names, do all kinds of stuff to her, and nothing's been done about it. So they figured out easily, "We can harass Athena. She'll explode, and she'll get into trouble."

Brown: Athena and Mary are especially on edge following a recent incident in the school cafeteria. As Athena tells it, a boy kicked her under the table. She went to kick him back, but she kicked the wrong boy, and hard. The upshot is, Athena is facing assault charges in juvenile court. She could end up in a disciplinary program, or worse, a juvenile lock down. Meanwhile, Mary has been called by the school's truancy officer on another problem and could be charged with neglect. That's because Athena doesn't always make it to school, and often shows up late.

Mary: All I can do is explain to him that "Yeah, I have a hard time getting her up in the morning." And I was telling him that she's been very upset, very depressed, particularly since these incidents have happened. And I do my best to get her up in the morning. I yell, scream, rant, rave, kick the bed. I mean, I can't physically drag her across the room.

Brown: Athena could soon be moved out of her regular school, just as Erin Reddick was four years ago.

[school hallway noise]

Erin: These guys are always picking on me.

Brown: Erin's family lobbied to get her placed in the Merrimac Collaborative School, an alternative public school about half an hour from their home in suburban Boston.

Principal Emma Weiss.

Emma Weiss: I have a range of kids. Kids involved with the Department of Mental Health, kids involved with the Department of Youth Services, with the court systems.

Brown: Weiss says about half her students are diagnosed with bipolar illness, but she's not convinced they all have it. However, Erin Reddick, she says, is a clear-cut case.

Weiss: When she's on medication, Erin is able to have conversations with you, participate in our community meetings, and add a lot of good insight, and remain calm if somebody says something to her that may not be the nicest thing in the world. When Erin goes off of her medication, she can be laughing one minute, sobbing the next minute, the minute after that screaming because she's so angry about something as small as, "He looked at me the wrong way."

Brown: The ratio at the Merrimac School is five students to one or two staff, so it's expensive. A school district can pay up to $29,000 to send one child here, compared to four or five thousand in the regular public school. But that ratio typically means staff members are more attuned to each student's mood swings.

Weiss: If it's a student we know well, and we start seeing the true signs that they're either heading into a manic phase or they're getting a little depressed, we would be notifying parents, having regular contact with therapists and psychiatrists.

Brown: Of course, even special schools have limits. Before Erin's last hospital stay, she had a tantrum at her school that ended in her slamming a glass door and kicking a trash can. When Erin found out she was almost suspended for that, she told her mom she was furious.

Erin: Tomorrow I'm gonna go in and talk to Emma about that.

Sherry: Well, I suggest you approach it in a gentle manner, or not approach it at all and let me take care of it. The fact is, the only thing that will happen if you confront her is you'll get suspended again.

[school ambient noises]

Erin: If you wanted me to buy a soda, I would've.

Brown: Erin's teachers say she's learning to control her behavior, especially during her weekly community service where she tutors severely autistic children.

Teacher Betsy Lytle is her advisor.

Betsy Lytle: Erin has worked really hard to establish some sort of relationships or friendships at the school. This is a kid that came to us from the middle school, that used to kick holes in the wall, and has never kicked anything here. This is a kid who was very isolated and ostracized from a good share of the population. So there was many trust issues for her to even stick her neck out a little bit to form relationships. And as any good bipolar will do, it's either all or nothing.

[music]

Brown: In many ways, bipolar illness is a solitary struggle. Children, and the people who love them, have to face up to demons that others never even know about. But families say society can help in a few concrete ways. For one, offer children with bipolar disorder the same sympathy and respect as kids with cancer or diabetes. Fund special education so that schools can give these volatile children a better place to learn. Push for more scientific research on childhood bipolar to help doctors, teachers, and parents identify the illness early and accurately. And remember that a bipolar diagnosis does not represent the end of hope.

Janice Papolos: These children are delightful, charming, wonderful senses of humor. So I think that we should look at the positive as well as what can be the hugely negative for these children.

Brown: Janice Papolos is co-author of The Bipolar Child.

Papolos: And I don't know how these children get up and face the day. They don't know how the day is going to go. They don't know what the next 20 minutes is going to bring for them, nor do the parents. But with proper diagnosis and treatment, they have every chance for a really good life.

Brown: In the meantime, Athena, Eric, and Erin are just focused on growing up.

Athena: When you have bipolar, life is like one huge adventure, it's like, okay what's gonna happen today?

Eric: I like making people laugh, so if I can do that for a living and get paid for that, then that will be wonderful.

[applause from television]

My hero, Conan O'Brien, has bipolar disorder.

[Sound of Conan O'Brien show]

I love him, he's the coolest guy in the world. And if the coolest guy in the world has bipolar disorder, then like I have it too, so it's cool.

[Erin's guitar music]

Erin: I see bipolar as like a gift and a curse. It's like you know you're given this horrible burden of, you know, living with this life altering disorder. But, on the other hand, it gives you all this creativity, and all different, you know, views of the world. You know, there's so many great people in history who were bipolar, and it just gives you something that other people don't have.

Brown: For now, Erin is learning to play more Nirvana tunes on guitar. She's thinking about going to college. Some days she's not sure she could handle it. Other days she figures, "Why not?" Maybe there she'll get answers to questions she's had her whole life.

Erin: I want to go into special ed teaching and then after that, go to school to do psychological research to learn like why I'm the way I am, and why the kids I work with are the way they are. And maybe help some people, and you know, find out why they need certain things. The brain is just so mysterious, nobody really knows how it works.

Brown: Thousands of parents today are holding out for new research on such questions as, "Can kids as young as preschoolers be diagnosed with bipolar illness and treated? Is there a drug that can change their brain chemistry back to normal, before they miss out on critical developmental milestones?" And, "How can families learn to control manic outbursts and deep depressions?" With luck, say the parents of Erin, Eric and Athena, these answers will come out in time to put their own children on a healthy and stable path to adulthood. For American RadioWorks, I'm Karen Brown.