A reader asked:
"My son was diagnosed with BP when he was 4 and is now five. The doctor keeps prescribing risperidol which has helped the sillies but not the irratablilty and anger. I am thinking we should be doing something else."
Unfortunately, medications used to treat bipolar disorder are not yet FDA approved for 5-year-old children. Your child psychiatrist should have an open discussion with you about the risks and benefits of each medication for your child. The following are some general principles for treating bipolar disorder in kids- these may or may not apply to your child.
First, diagnosing bipolar disorder in young children is very difficult. Silliness and irritability in young children can have many causes, so the first thing to consider is whether the diagnosis is accurate. You may want to get a second opinion on your child's diagnosis.
Let's assume for a moment that your child does in fact have bipolar disorder. Then, the first line medications are usually those with mood stabilizing properties. Treatment may include a neuroleptic (Risperdal is an example in this class), a traditional mood stabilizer such as lithium, or an anticonvulsant agent with mood stabilizing properties (valproate, for example). At times, antidepressants may be used in combination with mood stabilizers for those who are having depressive symptoms, although one must be cautious as antidepressants may bring on a manic or hypomanic episode in the bipolar patient, especially if used without an adequate dose of a mood stabilizer. If a child has other psychiatric diagnoses with significant symptoms that are causing impairment (for example, ADHD), other medications (e.g., stimulants) may be necessary as well.
Medications are chosen for a child based on the child's history and the medication properties, so it would be difficult for us to say which medication would be correct for your child without examining him ourselves. If one medication is not effective or if a child is having an adverse side effect, we would consider switching to a different medication. We prefer that a child always take the minimum amount of medication necessary to treat his/her symptoms, but some children with serious illness may need a combination of medications from different classes to control symptoms.
You may also want to consult a behavioral specialist (for example, a clinical psychologist) who can assess whether your child's irritability is being triggered by certain environmental changes, and who can recommend contingencies (patterns of reinforcement) to reduce this behavior. Best of luck to you.