I really have two needs right now. It seems like her Psy is really against labeling her as JBP and it is totally frustrating to me. We are medically treating her like she has it but all he will call it is a mood disorder. If in fact this is what she has, I want to educate her about it so she can see it's not her and she is not "bad", but that she has a condition and will need help and to work on dealing with this. I would like to get her fully evaluated but there doesn't seem to be any medical resources I can find in Austin who deal with JBP. Her psychologist is mainly addressing the ADHD issue, and the Psyc Dr will only go so far as to say it is highly likely she has a mood disorder (statement he made for the 504 committee meeting that I requested). Therefore I have allotments for her for attention issues but none for "mood disorder issues". She starts middle school next year and I am very worried about the changes affecting her in a bad way, especially when you add hormones to it. I am willing to travel within Texas if needed.

The other reason I would like to get her tested is for cognative (sp?) issues. I think this condition greatly affects her in math. She can not seem to process what is in her brain to translate it on paper. We have barely eeked by the end of year testing in this area each year. Is this something BP affects?

I feel like it has been such a battle to help my child and that is just wrong. I understand the DSMIV doesn't really cover kids with BP symptom wise (mostly written for adults is what I have been told) but there has to be some way to determine if this is what she has so I can actually help her instead of throwing a band-aid on the problem.

Sorry to rant so long, any words of advice or resources (especially for a kid) I could use would be greatly appreciated.

As much as we want and expect our doctors to study symptoms carefully and to engage in a thoughtful and deliberative process when diagnosing and treating our children, it is very frustrating when only symptoms are treated, and no diagnosis is forthcoming. Maybe this practice makes sense to psychiatrists, but if so, they need to do better PR for themselves because to parents, treatment without diagnosis is like archery without a target.

If you do an internet search on the words "children" and "rage," you'll find that rages are symptoms of various disorders. Similarly, paranoia may be a symptom of bipolar disorder, but it could be other things too. This is what your doctor needs to sort out. It's frustrating when you see your child's symptoms jump out from the pages of The Bipolar Child and your doctor agrees she has symptoms of bipolar disorder — but he's not ready to call it bipolar. Caution is good. Too much caution leads nowhere. And right now, that's where you feel like you are: on a ride to nowhere.

What you need from this doctor is a roadmap and a timeline. The destination is Diagnosis (singular or plural), and for your peace of mind, that means bipolar disorder needs to be confirmed or ruled out. Ditto with anything else the pdoc is considering. Your roadmap needs to tell you the places the doctor wants to visit (i.e., the diagnoses he wants to consider), and the timeline may not be real short, but it shouldn't be open-ended either. New symptoms may add clarity or may cloud the picture, so the timeline could expand or contract. You need to figure out what your tolerance for uncertainty is and push for that. The pdoc, as driver/guide on this roadtrip, needs to spend more time telling you where he plans to take you along the way to Destination Diagnosis.

You need to understand your doctor's philosophy. Ask the pdoc what he thinks about the controversy surrounding the over- or underdiagnosis of bipolar in children — where does he sit on the continuum? Find out how many kids he has diagnosed with bipolar disorder, and how many kids have come to him misdiagnosed as having bipolar disorder. (The numbers probably don't mean anything other than to tell whether he's dealt with many cases – or noncases – of bipolar disorder. You already know that he is slow to say "bipolar," so what you need to find out is whether he almost never says "bipolar" or if he is also comfortable saying "bipolar.") You said he thinks it is "highly likely" that your daughter has a mood disorder, so what keeps him from diagnosing that? How long will he be content to have no diagnosis other than ADHD? (Is he sure it's ADHD instead of bipolar?) Ask him to explain what symptoms he thinks are missing that makes him reluctant or unwilling to diagnose bipolar disorder in your daughter. Find out his tolerance for no diagnosis of the various symptoms that individually don't rise to the level of a full-blown disorder, such as symptoms of paranoia vs outright paranoia.

It's not that you want your daughter to have bipolar disorder, but you and she need an explanation (not a bundle of symptoms), so that you can get on with your lives and her treatment. Her symptoms will continue to change over time for better and for worse, because that's the nature of growth and illness. But no diagnosis leaves you in limbo, and if your pdoc isn't sensitive to that, then you have the wrong pdoc.

Ask if there's anyone whose judgment he trusts who specializes in juvenile onset bipolar disorder from whom you might seek a second opinion. If he gets huffy, you'll know you have the wrong pdoc.

For a new doctor, try http://www.bpkids.org/connect/find. Contact the NAMI chapter in your area: http://www.nami.org/MSTemplate.cfm?Site=NAMI_Austin. I

Daunna Minnich
Moderator, JBRF Education Forum