Two years had passed, but Ethan didn't appear to be nervous about returning to the familiar grounds of Roadrunner Elementary School. His mother, though, was worried about what other kids might say.
"Hey, Ethan!" one boy called out. "Are you going to get in trouble all the time again?"
Ethan, unruffled by the question, answered simply, "No, I'm not that way anymore."
Students who knew Ethan as a third-grader remembered an angry child who swore on the playground, threatened classmates and destroyed school property. But two and a half weeks in the psychiatric unit of Phoenix Children's Hospital, regular sessions with a PCH psychiatrist, and two years in a special classroom for emotionally disturbed children had changed all of that.
Ethan's problems had begun early in his third grade year, shortly after his uncle died. At first there was a sadness that seemed a natural part of grief. "From there, he just changed," his mother, Yvonne, said. "We went through a really, really rocky time and wondered, 'Will we ever come out of this?'"
The sadness spiraled into deep depression. Ethan's face was expressionless most of the time, but in the shower he cried hysterically and begged to be killed. Yvonne wondered if her son might commit suicide, as her father had two years before.
"It was very scary," Yvonne said. "He wanted to die."
The family's insurance plan covered in-home mental health care, but the medications prescribed through the program had little effect. Finally, Yvonne took her son to a behavioral health facility, where a therapist dismissed the seriousness of Ethan's condition.
"Children don't commit suicide," she said, and sent them home.
Yvonne wasn't convinced. Ethan's behavior was becoming worse and worse - by now he was spending most of his school hours in detention. One day he told his mother he was going to run away from home, and Yvonne knew her son was making more than an idle threat.
"The look in his eyes - I knew he was either going to be dead or in the streets," she said. In one more desperate attempt to find help, Yvonne called Ethan's pediatrician and gave a tearful description of his behavior.
"I want you to call Phoenix Children's Hospital and get him in today," the doctor said, his voice full of urgency. The psychiatric unit was full when Yvonne called, but a discharge that evening made room for Ethan.
"I was amazed that PCH took him so fast," Yvonne said. "We were basically off the street."
Yvonne and her husband were reassured by their frequent meetings with the psychiatrist who was overseeing Ethan's treatment.
"He was calm," Yvonne said. "He told us, 'This is going to be OK.'"
In time, it was. Ethan was diagnosed with bipolar disorder, once known as manic depression. By observing his behavior, staff at PCH were able to prescribe appropriate medications. They also taught coping skills, such as taking 10 minutes to think through a situation before reacting to it.
Yvonne admitted it was difficult to leave her child in a psychiatric unit - especially since visiting hours for parents were, of necessity, restricted. But she was confident that Ethan was, at last, getting the help he needed.
"We felt really secure with him in there," she said. "All the nurses there were wonderful." She was impressed, too, that costs did not appear to be an issue. When Yvonne told Ethan's psychiatrist that their insurance plan only covered 50 percent of mental health care costs, he quickly squelched her concerns.
"We'll work with you," he said. "Whatever he needs, he's going to get that help."
Ethan is now a different child. Once known for how much trouble he got into in school, he is now a top student in his sixth grade class. Even more important than his academic success, he has regained his easygoing composure. His mother takes delight in the simplicity of hearing him laugh with his friends.
"It's just so nice to hear," she said. "This is the way it's supposed to be." In light of the darkness behind them, Yvonne realizes the value of her son's happiness.
"To be alive and have joy in life - those are very special things that we don't take for granted anymore."