Both of my daughters are bi-polar and I have chronicled our struggle here before. Now we enter puberty and Madeleine, Dean's blog-daughter, is in a particularly rough spot. To preserve her privacy, I'll spare you some of the behavior that's come up. I will say it's serious. This post on her blog chronicles what she sees as the problem. She keeps asking if anyone has responded. Head on over and share some perspective if you can.

The reason why I'm doing this is here. Part 1 of the Diagnosis story is here.

By Christmas when Amanda was 9, things were deteriorating again. The hardest thing I have found is explaining to the doctors how I know the medication needs adjusting. There's usually no bright moment. Life just becomes progressively more difficult. That's where we were then. I told the neurologist and she was reluctant to increase the medicine because the blood levels were fine. Of course, in hindsight, she was treating a different condition than I was living with. She recommended a psychologist. I didn't think it would help but my view was "fine, we'll do eveything they want because it's only through that process that we'll get the increased medication."

We trooped off to the psychologist who told me how some parents of ill children don't discipline enough. I had heard this before. I was unable to convince people that when things were good, discipline worked and that when things were bad, discipline was ineffective. It's difficult to punish or reward a child that isn't acknowledging that you're her mother. He set out a system. Sticker charts, rewards. We agreed. I was feeling desperate. I couldn't explain why but I felt like we were on the verge of a crisis and I was willing to comply with anything.

That night, I couldn't sleep. I paced all night, wondering how I'd gotten into a place where no one understood that stickers weren't doing the trick. I also prayed a lot, but that's another topic.

In the morning, Amanda woke up reenergized and told me she thought the new plan would work. If she thought about the reward, she could stop herself. She was sure of it.

That optimism lasted 5 hours. In the early afternoon, the school called. Something had upset her in science. She had gotten enraged and was throwing chairs and wrecking all the science projects. It took three teachers to wrestle that 9-year-old girl to the the ground. They needed me to come get her and come get her NOW.

In the principal's office, I told her I was mortified (probably the only time I've used the word seriously) and started to cry. She was wonderful and we talked out the issue. Rather than suspension, her record would show a medical problem and she was to stay out of school until it was resolved, just like a contagious disease.

Then I had to get Amanda, who was now running free, corraled and into the car. It took about 40 minutes. I got her, subdued but uncommunicative to my office. I called the neurologist and said we had to come in NOW.

At the neurologist's parking lot, she became violent again. Fortunately, she was close. I have trouble catching her but I've always been able to pick her up kicking and squirming and carry her. At the time, she weighed about 100 pounds.

I learned one thing later that I wish I had known then. Neurologists and Psychiatrists do not overlap as much as I had thought. They had never seen anything like Amanda in that office. Other patients in the waiting room left, some of them running. The receptionist tried to convince us to come back another time when she was calmer. I was insistant we see the doctor though. The doctor was the source of medication and I was pretty sure that's what we needed.

The neurologist was as horrified as the people in the outer office. In the examining room, Amanda lay under the examination table kicking it until we thought it would break. This manifestation was clearly NOT what the doctor thought she was treating.

The doctor wanted to hospitalize her. My husband thought maybe it was a good idea. Maybe it was but I could not make the leap from we needed a sticker chart to we needed to hospitalize my daughter for some indeterminate period of time. At least not in the allotted 30 seconds. The doctor went to locate hospitals. I started to cry. That shocked Amanda into some semblance of rationality. The doctor returned and was willing to consider other options.

We got heavyduty tranquilizers. It took us a couple of hours to find a pharmacy that had tranquilizers in cherry drinkable children's form. I had to promise to take Amanda to the hospital if she got worse. I ignored the instructions and held tightly to her hand in the pharmacy parking lots when she tried to throw herself in front of cars.

It's true that it's darkest before the dawn. After that day, after a week of tranquilizers, we found a psychiatrist who diagnosed her properly and kept her medicine well balanced since then. I don't think we've had a day since then that was as bad as most of our days before then.

I have been wanting to tackle this topic head-on for a long time. I have my children's permission to do so now. We've waivered between wanting to protect our privacy and wanting to reach out to other people who are in difficult positions. Maddy just wants some publicity for her blog. Not surprisingly, she is the more manic of the bipolar twins.

Amanda tends towards the depressed end of the spectrum. She just doesn't want to feel like there's a secret. About 4 years ago, a soap opera star she really liked went public with his bipolar. I showed her the article. She read it, looked at me, and said "you mean when I grow up, I can have a regular job." I never knew she had that doubt. She's now well-medicated and a mostly A, occasional B kind of student. She's never had to have special ed. Yet, she thought she was crippled for life.

Besides their permission, enough of their symptoms and worst days have been public that a lot of people know and word gets passed around. Keeping it secret tends to fuel the rumor mill. So we're going public. If you want to read Maddy's point of view, she's starting to post about it on the twins' site.

From what I have read, most bipolar children show symptoms during puberty. Amanda has what is called "early onset" bipolar. I think she had it as an infant. She'd be fine and then she'd scream miserably. She wouldn't eat. Back and forth to the doctor. The closest we got to a diagnosis then was colic. At one point, she was borderline failure to thrive. She was supposed to gain 1/2 ounce a day. 7 ounces in 14 days. In 14 days, she gained 6 1/2 ounces. Not enough to be considered healthy Not enough to start testing.

At 2, she was so miserable, I decided she was suffering from being left in the care of nannies. I took the next two years off of work. It was a disaster for a lot of reasons, not the least of which was that I wasn't cut out for not working.

In preschool at 4, she worsened. Many days, she went to school looking like a wild animal because she wouldn't let anyone brush her hair. She ran off frequently. She would freak out and fail to recognize me as her mother. After one day in kindergarten when we picked her up at school, and literally wrestled her screaming into the car, she began throwing things from the back seat. A shoe hit the accelerator causing a sudden jump ahead. We didn't get into an accident but I figured we needed more help. Off we went to our family physician, who heard the tale, announced it was ADD and insisted we try Ritalin.

I wasn't opposed to Ritalin but it seemed lke we ought to have more investigation than that. We switched doctors. We decided to got through various testing procedures.

The first step was testing for food allergies. We went on a diet that started with fruit, vegetables, rice and a few proteins. How a 5 year old manged to eat like that, I'll never know but she improved for a while. Then we started adding foods. Nitrates resulted in hysteria about 90 minutes after ingestion no matter what. Artificial sweeteners like aspartame also resulted in a mood swing. That was problematic in a preschool that believed sugar was bad and handed out sugarfree candy.

We controlled her food and bought ourselves a few months of peace. In first grade, however, disaster struck again. the class was on a split schedule. One group started at 8 and left at 2. The other group started at 9 and left at 3. Amanda was in the later group. She'd return from gym, half the class would leave and she'd fall apart, rolling and screaming on the floor and trying to run away.

Once again we did a massive effort at figuring out the problem. The principal and her teacher were very supportive. We pulled her out of gym and sent her to the office with a book for that hour. The rest enabled her to control herself and she could make it through the day. After two weeks though, the gym teacher complained. In addition to the need for exercise, gym was an important way to learn how to interact with her peers, according to the gym teacher. Fortunately, saner heads prevailed and the principal and her classroom teacher understood that any learning to fit in she got at gym was quickly undone by the sight of her curled into the fetal position at the classroom door afterwards.

A year later, she started having trouble again in the afterschool program. Again, her moods seemed to arise out of nowhere and be uncontrolable. Off to the doctor and this time, the EEG. She didn't pass and showed signs of temporal lobe seizures which could cause emotionally volatile episodes. I read all I could and learned of a theory that many violent criminals suffered from such seizures. Off to a neurologist. Anti-seizure medicine. Another few months of peace.

If, as we now know, she is bipolar, why did all of this work? No one knows for sure but by controlling her environment and controlling the chemicals in her system, we were able to reduce the environmental stresses enough that she could control her emotional instability. In fact, the anti-seizure medication she used is one of the group of medicines she needs for her bipolar. As she grew though, and her brain matured, the condition worsened and the controls we had would progressively fail.

It all came to a head when she was nine. That incident deserves it's own post.