Hi Dr.Phelps,

Your expertise is much needed. My three children ages 16,14 and 10 are all bipolar and take meds like lithobid just started recently on my two younger children with depakote or tegretol and resperdol. My youngest still cycles. I know its a lifetime thing but will they ever be able to function in life? My two oldest children tested 99% on standarized tests in the fifth grade and the youngest one too but now school work is so frustrating to them. Will that get better over time? They are being homeschooled now with a tutor because of the stress of keeping up and they could not handle the sounds or stimulation at school.

Thank-you for your response.

Dear Ann -- 
As an adult psychiatrist, I'm not so well equipped to answer this, but can send you somewhere that I think will yield you much more than any single psychiatrist ever could:  Dr. Dimitri and Janice Papalose have worked very hard to put resources on the internet that can help parents of bipolar children.  

Their website (The Bipolar Child; bipolarchild.com ) does look a little commercial, but it has some very useful stuff too.  And their .org spinoff, the juvenile bipolar research foundation site (www.bpchildresearch.org), is another great resource.  It has an educational forum where other parents who've been through what you're going through can also participate and try to help you: 

"The purpose of the forum is to establish and encourage an ongoing national dialogue that will promote a better understanding of the educational challenges that confront children with juvenile-onset bipolar disorder."

The Papalose's site has other useful information, including their newsletters, which are very well done (the October issue on bipolar kids' "Mission Mode" is particularly stunning, I thought).  For example, they even have a "model IEP" to use working with your kids' schools.  

And what of your question:  "will they ever be able to function in life?"  At this point surely you'd want that answer to be yes, and it would be terrible of me to even suggest otherwise, if I could possibly be wrong, you see?  It is crucial to go on believing that if the answer can possibly be yes, that you and your children's providers do everything they can do (short of burning out in the process, an important factor to keep in mind also) to make the answer yes.  At the same time, you are asking for a realistic appraisal; an honest answer would include mention of the fact that this illness can interfere terribly in people's lives.  And yet my worst-off patients manage to make their way, somehow, and many people around the world would probably look at the existence of my patients even at their worst and think that what my patients have is better than poverty and war.  

You can see how lost one can become, trying to think that far out into the future (I had to just edit out more musing on sustained injustice that you don't need to think about right now...).  Instead, when you're able to return to it, as you've learned over and over by now I'm sure, the task is to come back to the present and do what you can -- including taking care of yourself well enough in the process that you can be there to continue the process!  

I hope these resources will help.  Note that the Papoloses grasp your incredibly tough job;  as they put in their newsletter: "we are in awe of your sheer stamina and determination to make things right."

Dr. Phelps