Heather always was a difficult child. Hard to please. Defiant. Combative. Angry. Stubborn to a fault. "By the time she was 4 she had been kicked out of preschool and day care," recalled her mother, Leslie Byers of Fort Calhoun.

Heather's behavior was so different from her brothers', that Byers and her husband, Steve, often questioned their own parenting abilities. They sought professional help. Doctors, and even a therapist, suggested Heather (not Byers' daughter's real name) was "going through a phase." That Leslie and Steve "were not firm enough" with their strong-willed child. That they "were overexaggerating" the degree of Heather's outbursts, temper tantrums and full-blown rages that lasted for hours on end.

Heather was suspended from kindergarten and first grade almost more times than Leslie Byers can recall.

She threatened children. Cursed out adults. Pinched and hit classmates. Attacked teachers. Climbed up a 10-foot bookcase and threatened to jump. And once demanded that her older brother "kill Mom."

Over time, the frequency, duration and severity of outbursts increased, with each new outburst becoming more serious and lasting longer, Byers said.

It took eight years for the Byerses finally to get the official diagnosis on Heather — bipolar disorder — more commonly known as manic-depression.

Byers, who tells her family's story in her book "Heather's Rage: A Mother's Faith Reflected in her Daughter's Mental Illness" will share her family's trials, tribulations and triumphs in a program at BryanLGH Medical Center East on Thursday.

Her hope is to help families, educate teachers and day-care providers and even get Nebraska laws changed so that other families do not have to do what the Byerses were forced to do with Heather — relinquish custody to the state, so Heather could receive the treatment she needed.

Most people think of bipolar disorder as an adult illness. Even the DSM4 — the official diagnostic manual in determining mental illness does not have specific criteria for identifying bipolar disorder in children.

And kids — as is so often the case — have symptoms that differ greatly from those of adults with the same mental illness.

Whereas adults have manic highs that cause them to go on spending sprees and trips, followed by morose lows, bipolar children frequently have intense volatile mood swings going into out-of-control rages destroying things, harming themselves or harming others over something as simple as not liking what is served for dinner.

 And while adults can go for months or even a year before swinging from manic to depressive, kids can go through these swings numerous times a day, said Sheryl Gurrentz, co-author of "If Your Child Is Bipolar: The Parent-to-Parent Guide to Living with and Loving a Bipolar Child."

No one knows exactly how many children suffer from childhood onset of bipolar disorder, but according to the American Academy of Child and Adolescent Psychiatry, about 3.4 million children and adolescents in the United States suffer from depression. And it estimates that up to one-third of those may actually develop bipolar disorder.

The illness often is misdiagnosed as other behavioral disorders — oppositional defiance disorder, conduct disorder, panic disorder, attention deficit disorder and others.

Frequently children with bipolar disorder also have one or more of these other disorders — especially ADD or ADHD, said Cindy Singer who co-authored "If Your Child is Bipolar" and is the mother of a child with bipolar disorder.

Singer's daughter Julie, now 14, was first diagnosed with oppositional defiant disorder. Later she was diagnosed with ADD. Finally, at age 6, she was diagnosed as bipolar and placed on medications that have helped level her moods and perhaps just as important, allow her to sleep.

Finding the right diagnosis and the right medication is often a matter of elimination and trial and error that feels like Russian roulette.

Just when you think you've got it figured out and under control, everything changes, said Gurrentz.

For a long time teachers, day- care providers, doctors and parents thought Heather was simply a naughty and manipulative little girl. Professionals doubted the Byerses' stories of Heather's rages — ripping her hair out in fistfuls, screaming expletives and slicing herself with knives and razor blades.

When Heather was 7, Byers asked the school to test her daughter to see if she was eligible for special education services.

"At first they told us no, that her behavior had not been of concern long enough to merit it," Byers recalled.

The school waited until the following fall to test her, and finally labeled Heather behaviorally disordered and put her in special education classes.

When Byers asked a doctor whether Heather could have bipolar disorder like her aunt, the doctor "pooh-poohed the idea" and even became defensive over the audacity of Byers making a diagnosis herself.

Next Heather was diagnosed with ADHD and placed on Ritalin.

"That was hell. A stimulant for a manic-depressive is like throwing fuel on a fire," Byers said. "She had hallucinations. She lost 20 pounds. Her manic outbursts became very severe."

Ultimately, it led to the first of many hospitalizations for Heather.

For the Byerses it became an all too familiar story — Heather would go out of control, police would take Heather to the hospital, where she would be sedated and send home to sleep it off. She'd stay in a treatment center until the insurance ran out.

Doctors recommended the Byerses relinquish custody and make Heather a ward of the state. They fought it for one year, but in 1996  after Heather was hospitalized five times in six months and they had used up Heather's lifetime of insurance, the Byerses turned Heather over to the state of Nebraska.

"She (Heather) took it extremely hard," Byers said. "She thought we had given her away."

Then, because there was no room in the treatment center, Heather returned home. Days later Heather went into another rage. Police took her to the hospital and she was sedated.

It was Heather's caseworker who stopped the cycle and demanded Heather receive medication for bipolar disorder.

Heather had almost two years of normalcy before she decided at age 14 to stop taking her medication. After assaulting her mom, dad and brother, she spent 27 months in a treatment center, finally coming home in July 2002.

"Since then she has religiously adhered to her treatment and medicine and therapy," Byers said. "She is doing wonderful and working full time."

She knows the risks of not taking her medicine. Despite all the successes, Heather, now 19, still struggles with depression.

"You just take it one day at a time," Byers said. "Sometimes you take it one minute at a time."

No parent ever dreams that the beautiful baby they bring home from the hospital will develop a mental illness, Gurrentz said.

But when it happens, parents need to steel themselves. Gurrentz says families need the right parenting techniques, medication and therapy — without all three nothing will change.

They also need a strong support system of family and friends, because a child with mental illness can destroy a marriage and family relationships.

Families need to educate themselves. They need to find the right doctors, dentists and therapists. They need to be excruciatingly honest and open, Gurrentz said.

And Byers recommends parents document everything.

"Get a video recorder," she said. "Document for yourself, and the teachers and the doctors and say, ‘I am not an idiot. I need help.' Shove it in their faces. Force them to listen to you.

"You have to take control," Byers said. "If you walk away, your child does not have much hope."

Reach Erin Andersen at 473-7217 or eandersen@journalstar.com.

If you go

What: "Heather's Rage" — Leslie Byers talks about the challenges of raising a child with bipolar disorder.

When: 7 to 8:30 p.m. Thursday

Where: Plaza Conference Center, BryanLGH Medical Center East, 1600 S. 48th St.

To register: Program is free, but people are asked to call 481-8886 to reserve a seat.

Is it my parenting?

Or does my child

need help?

Deciding whether your child is just "difficult" or is in need of help often is hard to determine. Authors Cindy Singer and Sheryl Gurrentz say if any of the following descriptions characterize your life as a parent, you're probably right to think that what you're dealing with is beyond the scope of "normal," even for a difficult child.

* Your everyday life seems different and much more difficult than that of your friends with children the same age.

* Daily routines that should be easy are almost always a struggle.

* You own shelves full of parenting books with techniques that are ineffective for your child.

* You use all the same parenting techniques your friends use. They succeed while you fail.

* Your child's problem behaviors may be similar to those of other children, but they are more intense, last longer, and are harder or impossible to control.

* You feel like your family life is out of control. Your child's moods and behaviors dictate family activities and control the atmosphere of your home.

* People comment on how bright your child is, but you'd gladly deduct 20 points from her IQ if it would make life easier for both of you.

* Intellectually you know you are a good parent, but you are beginning to feel like a failure.

*  You think it's possible that something really may be wrong with your child.

* Your child's behavior is at its worst when he's with you.

* Your child is fine all day at school, but the minute she sees you, she falls apart.

* You're nervous about sending your child to friends' homes because his behavior is so unpredictable.

 Source: "If Your Child is Bipolar: The Parent-to-Parent Guide to Living with and Loving a Bipolar Child"

Bipolar behaviors

 Behaviors reported by parents in children diagnosed with bipolar disorder may include:

* An expansive or irritable mood

* Extreme sadness or lack of interest in play

* Rapidly changing moods lasting a few hours to a few days

* Explosive, lengthy and often destructive rages

* Separation anxiety

* Defiance of authority

* Hyperactivity, agitation, and distractibility

* Sleeping little or, alternatively, sleeping too much

* Bed-wetting and night terrors

* Strong and frequent cravings, often for carbohydrates and sweets

* Excessive involvement in multiple projects and activities

* Impaired judgment, impulsivity, racing thoughts, and pressure to keep talking

* Dare-devil behaviors (such as jumping out of moving cars or off roofs)

* Inappropriate or precocious sexual behavior

* Delusions and hallucinations

* Grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

Symptoms of bipolar disorder can emerge as early as infancy. Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizurelike tantrums or rages out of proportion to any event. The word "no" often triggered these rages.

 Source: Child and Adolescent Bipolar Foundation

What makes a behavior a ‘problem behavior'?

* It interferes with doing other things.

* It interferes with positive interaction with peers and/or family members

* It interferes with the family's ability to go out into the community.

* It inhibits learning and academic achievement.

* It limits participation in social activities.

* It inhibits success.

* It is dangerous to oneself or others.

* It makes family life unhappy.

* It is detrimental to the child's self-esteem.

 Source: "If Your Child is Bipolar: The Parent-to-Parent Guide to Living with and Loving a Bipolar Child" by Cindy Singer and Sheryl Gurrentz

Need more information?

For more information on mental illness or bipolar disorder:

* National Institute of Mental Health, (800) 411-1222 or www.nimh.nih.gov

* The National Alliance for the Mentally Ill, (800) 950-NAMI or www.nami.org.

* Juvenile Bipolar Research Foundation, (203) 222-7179 or www.bpchildresearch.org.

* Child and Adolescent Bipolar Foundation, (847) 256-8525 or www.bpkids.org

* Bipolar Disorder Information Center, (800) 933-2632 or www.mhsource.com.

* National Depressive & Manic-Depressive Association, (800) 826-3632 or www.ndmda.org.

* American Psychiatric Association, (202) 682-6000 or www.psych.org.

* American Psychological Association, (800) 964-2000 or www.helping.apa.org.

* American Academy of Child & Adolescent Psychiatry, (202) 966-7300 or www.aacap.org.