Dr. Dimitri Papolos of the Albert Einstein College of Medicine and his wife, Janice, are the recognized authorities on early-onset bipolar disorder. They are the authors of "The Bipolar Child" (Broadway, $27.95), which their Web site (www.bipolarchild.com) calls "the acknowledged bible" concerning the disorder. The book is already in its third edition and has sales of more than 200,000. The Papoloses have a devoted following of parents whose children present the symptom picture in question.
The Papoloses believe EOBD is a serious psychiatric illness caused by as-yet-unknown biological abnormalities and routinely recommend a treatment plan that features powerful psychotropic drugs. They claim that the disorder is much more prevalent than previously thought. For example, they assert that 80 percent of children with EOBD are found to meet full criteria for attention-deficit hyperactivity disorder (ADHD), which is to say most kids who are diagnosed with ADHD also have, or really have, EOBD. Especially intriguing is the Papolos' proposed list of "very common" symptoms for EODB including separation anxiety, tantrums (especially in response to the word "no"), defiance, hyperactivity, inattentiveness, unpredictable mood swings, and distractibility. Those "symptoms" will be familiar to anyone who has lived with a toddler. Seemingly, the Papoloses would have us believe that behaviors normally associated with toddlerhood are actually manifestations of a disease that should be treated with drugs that have pronounced negative side effects (e.g., nausea, diarrhea, severe drowsiness, significant weight gain) as soon in the child's life as possible. Are the "terrible 2s" a disease? Should most toddlers be on drugs? I have to admit to having no small amount of difficulty with the reasoning involved here. One thing is certain: The Papoloses are a boon to both the mental health and pharmaceutical industries. I'm not so certain they are a boon to children. In their book and in the May 2007 issue of their newsletter, available through their Web site, the Papoloses recommend against using the word "no" with a bipolar child "because it will trigger a meltdown." When they were toddlers, my children often suffered wild seizures at the sound of "no." Interestingly, however, these seizures were eventually cured with regular doses of that very word in combination with consequences the Papoloses would probably consider draconian. My wife and I were unaware that we should have been giving them drugs. In the same issue of their newsletter, the Papoloses say that parents of bipolar children should "suffer the physical abuse" of their children. Over the past few years, I've consulted with quite a few parents of children ages 2 and older who were prone to hitting and kicking their parents when their parents did not give them their way. In nearly every case (I actually know of no exceptions), these kids were cured of their criminal tendencies in short order by parents who did not suffer this abuse, parents who administered not drugs but quite old-fashioned discipline. An unknown author (sometimes identified as Jordan W. Smoller, University of Pennsylvania) has posted on the Internet a satire titled "The Diagnosis and Treatment of Childhood" in which he proposes, with tongue in cheek, that childhood itself is a disorder with congenital onset. "Smoller's" symptoms include knowledge deficits, dwarfism, emotional lability, and legume anorexia, to which I would add separation anxiety, tantrums, defiance, hyperactivity, and every other thing associated with the so-called "terrible 2s." The satire is truly funny, even hilarious. The question becomes: Is it also prophetic?