To treat Cole's outbursts, Swihart prescribed a mix of psychiatric drugs, including Lithium, Adderall to treat his ADHD, and Seroquel to stabilize his mood. It was a very controversial move since Cole was just three-and-a-half at the time.
Swihart also admitted that some of the drugs Cole now takes are largely untested in children and it's not clear how they could affect his developing brain. Initially, his father was horrified.
"Obviously, I said, 'Heck no, my kid will never go on medicine,'" Evavold said.
"I was scared too," his wife added. "Every medicine we give him, there is always a death warning...but we really didn't have the luxury of time. We have another child in the house and he hits her in the head with a shovel and even with our friends' children, he took a croquet mallet to one of our friend's kid's head and luckily she missed it she got out of the way but you know we're thinking we have to control it."
Dr. Swihart and the Evavolds both agreed it wasn't an easy decision to medicate Cole, but they felt it was their only choice. The lack of a diagnosis for juvenile bipolar disorder and the issue of medicating children as young as Cole are greatly debated in the psychiatric community.
Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University, urged caution.
"It's important to emphasize that most of these children, almost all of these children, are getting the medications for things that haven't been studied so we don't know how effective they are, we don't know how safe they are," he said. "On the other hand, there are rare cases, extreme situations where there may be few other alternatives."
Cole takes medication in the morning before school and in the evening before dinner. His behavior has improved, particularly since he was prescribed Lithium at age six-and-a-half, but he still can be highly irritable and still has violent outbursts.
"He gets better with Lithium," his mother said. "If he has the rages now they are much more subdued."
For Cole and his family, the future is unclear. His mother thinks her son is now as stable as he can be. "We can't go any higher in these doses without things falling out of whack."
The prospect of Cole having a "normal" life and being able to support himself are slim. The Evavolds say they are prepared to care for him forever if that's what it takes.