Question: My teenage boy has just been hospitalized and diagnosed with bipolar disorder. He was discharged to a partial hospital program. But he refused to go, and just wants to get back to school and “be like a normal kid”. He is giving me a hard time about taking his medication, even though it helps. His father doesn’t want him to take medication, either. What should I do?

Anne Fenton, MD: There are times when, due to the child’s opposition to treatment, and minimal cooperation or support from other family members, it can truly be impossible to enforce treatment. In such circumstances, a child my have to fail before he and others are willing to accept the reality of the condition and need for treatment.

Obviously, this is neither the ideal nor the preferred outcome. I therefore suggest that you try to enlist the support of anyone you know, friends, other family members, your pediatrician, your and your husband’s primary care physician, your spiritual counselor, and anyone else you can think of to speak with your husband about your child’s need for treatment. Once your husband understands and is “on board”, it will be easier for the two of you as parents to present a united front to your child. Many times, parental ambivalence is very transparent to the child. It confirms his or her worst fears and erodes trust in the treatment experience. On the other hand, when parents stand united on any matter, the child feels more secure and safe, and therefore more willing to turn his care over to the treaters his parents trust.

Question: How young is too young to have a child evaluated? I have a 4 year old.  He is very wild and hyper, and he has never slept through the night. Now he is starting to have terrible tantrums. Our family is paralyzed. We can’t take him anywhere, because he has a fit whenever he knows something is about to change.

Anne Fenton, MD: Without exaggeration, no one is too young or too old for an evaluation. Of course, the younger the child, the more his or her parents are integrally involved. Much of what we do, therefore, is parent guidance. However, we are also learning that many psychiatric disorders we formerly thought affected only adults actually are identifiable in early childhood. Such conditions as autism, bipolar disorder, and anxiety manifest in various ways in infancy which are predictive of certain symptom trends in later childhood and adolescence. Obviously, early detection and intervention can help a good deal to prevent complications later on. For example, mood dysregulation (inability of the child’s nervous system to regulate mood and respond with resilience to various stimuli) in early childhood seems to adversely affect learning in school later on. One mechanism may be due to the interference of mood in the child’s ability to focus in the classroom. An ounce of prevention is worth a pound of cure.