Be a collaborator
Separate the child from the symptoms
Be willing to refer
Don't talk about the child in front of the child.
Don't ignore mood
New nodeDon't blame children for lack of treatment success
Common Presenting Symptoms in Children, Episodes of deprssed mood/hopelessness, Excessive mood lability, Periods of increased or decreased energy, episodes of decreased need for sleep, anger dyscontrol, markedly irritable moods, frequent argumentativeness, bold/intrusive/demanding behaviors
Adolescent Presentation, discrete episodes of mania and depression, rapid symptom onset, mood-congruent psychotic features, hospitalization more common due to severity
Early Onset BPD vs. Adult BPD, Less discrete episodes, often mixed states, ultrarapid cycling, sometimes cycling more then once a day (ultradian), irritability across episodes, emotionally labile, explosive outbursts
Why?, Low base rate, Variable clinical presentation, Effects of development on presentation, High comorbidity!, ADHD 40-90%, Anxiety disorders 20-40%, Conduct Disorders 20 to 50%, ODD 20-60%, Disorder not clearly defined by the profession
ADHD, persistent vs. episodic in nature, ADHD earlier onset
Conduct Disorder, CD usually longer standing, BPD more likely to have family history of affective disorder
Psychosis/Schizophrenia, Hard to differentiate during mania--need to observe closely, BPD commonly misdiagnosed as schizophrenia, look for family history of schizophrenia or schizotypal disorder, Determine premorbid symptoms
Young Mania Rating Scale (YMRS), Parent Version (PDF)
Child Mania Rating Scale (CMRS), Parent Version (PDF)
K-SADS Mania Rating Scale
Child Behavior Checklist (CBL)
healthyplace.com mood journal
moodchart.org, part of a research study, Sends daily email summaries., Allows easy restrospective charting.
Software, bStable, Comprehensive system for, patients, family members, health care providers, Tracks:, moods, exercise, medication, hospitalization records, clinical notes, from McGraw Systems for $99
Printable, Monthly charts, Excel or PDF, Succinct introduction to charting, Charts for children, Very accessible for kids!, Blank chart and example, Mass General Mood Chart (PDF), NIMH Mood Chart (PDF)
MONITOR CLOSELY!, Encourage parents to monitor and chart symptoms and side effects, Don't let side effects settle in too long., Small changes in meds can sometimes make a big difference.
Encourage use of Pharmacotherapy Algorithm, Algorithm Diagram (PDF), Link to more info
Know principles of EOBPD prescription hygiene, Obtain history, Rapidly wean off all ineffective medications, Discontinue SSRIs, Discontinue stimulants
Work closely with pediatricians/MHMR doctors/psychiatrists
Let parents know it can sometimes take a long time to get the meds adjusted correctly
Know the meds, Traditional mood stabilzers, Lithium, Only med FDA approved for EABPD, Divalproex sodium (Depakote), Carbamazepine (Tegretol), Lamotrogine (Lamictal), Atypical antipsychotics, Quetaipine (Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon), Risperidone (Risperdel)
CBT Intervention, Psychoeducation, Medication compliance, Mood monitoring, Modify unhelpful thinking, Identify stressors/triggers, Family Communication, Sleep maintenance
Child- and Family-Focused CBT, Grounded in biological theory of excessive reactivity, Description Document (Word doc), Family conflict has high impact on symptoms, High levels of expressed emotion has negative impact too
Multi-family Psychoeducation Groups (MFPG)
Dialectical Behavior Therapy (DBT)
Interpersonal and Social Rhythm Therapy
monitor and assess w/condition-specific instruments
Stabilize BPD symptoms
IF comorbid conditions have negative effect on functioning sequentially treat with, symptom specific medication, may aggravate BPD symptoms, psychosocial interventions, dont' generally cause mood dysregulation
Family involvement CRUCIAL!!
Prescription hygiene critical.
Attack it from all sides., medication, parent education, psychosocial therapy, web-based support
Assess for suicide.
Three lines of evidence, One of the most heritable of the mental illnesses., Adult form more common and earlier age of onset than previously recognized., Efforts to validate the construct warrants additional investigation.
Possible reasons for "popularity" of diagnosis, Scholarly/medical research increased, BPParents ListServ, Papalos and Papalos 1999 book The Bipolar Child, Increased media exposure, Pharmaceutical advertising, Pharmaceutical company provided mood charting
Inconsistent diagnostic criteria
Inconsistent research design
Inconsistencies considered by some to be a black mark on the entire profession
NIMH-Bipolar Disorder in Children
Childhood and Adolescent Bipolar Foundation, About Bipolar Disorder in Children, Bookstore, Resource Links, research articles
Depression and Bipolar Support Alliance
American Academy of Childhood and Adolescent Psychiatry (AACAP) Bipolar Info, Excellent resource page, Facts for Families page
Facing Us, Depression and Bipolar Support Alliance site, An online "clubhouse", "peer-based, recovery-oriented empowering services and resources when, where and how they want them."
Georgia Childhood Bipolar Foundation, Techniques for dealing with a Bipolar Child
Juvenile Bipolar Support Alliance
List of Books for Children
Interactive Book for Young Children
List of Books for Parents
The Life of a Bipolar Child: What Every Parent and Professional Needs to Know. 2000. T. Carlson
Understanding and Educating Children and Adolescents with Bipolar Disorder: A Guide for Educators. 2003. M. Andersen, J.
Rescuing Childhood: Understanding Bipolar Disorder in Children and Adolescents
Bipolar Disorder: A Documentary
Good Growing: Bipolar Disorder
List of DVDs/Audio