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Information
Section: Conditions
Condition:
Mood
Article:
Bipolar
Disorder in
Children
Source: Leslie E. Packer,
PhD (file last updated January 2009)
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Page 1 of 1
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PREFACE
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As anyone parenting
or working with children with Bipolar Disorder
probably realizes, Bipolar Disorder is a more
serious and disabling condition in children than in
adults.
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SOME FINDINGS OF CONCERN
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In a study of 300
children and adolescents, Dr. Boris Birmhauer and
his colleagues found that 2.5 years after diagnosis
of Bipolar Disorder:
- Nearly 1/3 had
recovered
- The remaining 2/3
took about 17 months to recover
- About 80% had at
least one recurrence
- Children
experienced serious symptoms about 2/3 of the
time
- Children averaged
16 cycles of mood changes a year (compared to
3.5 cycles per year for adults)
Other studies have
also reported data that suggest the enormous
challenges that parents, their parents and
educators face:
- In a longer-term
study of 25 children and adolescents who had
presented with mania, Jairam et al. (2004) found
that although all of the children recovered from
the episode, 16 of them (64%) relapsed after a
mean period of 18 +/- 16.4 months. A majority of
the relapses (72.4%) occurred while they were
adhering to their treatment.
- Geller et al.
(2004) followed 86 children over a 4-year
period. They found that manic episodes persisted
for 79.2 +/- 66.7 consecutive weeks, and that
children were symptomatic (met criteria for any
mood episode such as depression, mixed,
hypomania, or mania) 1/3 - 2/3 of time during
the 4-year period.
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OTHER FINDINGS AND IMPLICATIONS
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It is only within the
past 15 years that clinicians and researchers have
begun to recognize that Bipolar Disorder may emerge
in childhood. Hence, there is relatively little
long-term research on treatment strategies or
educational interventions. To keep current on
developments in this area, site visitors are
encouraged to see the Child
and Adolescent Bipolar
Foundation.
Of particular
importance to parents and educators, research on
Bipolar Disorder in children and teens suggests
that regardless of the child's medication status or
mood state, children and teens with Bipolar
Disorder are significantly more likely to
experience attentional, executive function, verbal
learning, and working memory deficits compared to
their peers (Pavuluri
et al., 2006), and that some problems persist even when the child or teen is in a "normal" (euthymic) mood state .
As part of psychoeducational assessment, children
and teens with Bipolar Disorder may need a complete neuropsychological evaluation.
Parents also need to know that many children and teens with Bipolar Disorder have one or more anxiety disorders (including Obsessive-Compulsive Disorder). Anxiety disorders often emerge before the Bipolar Disorder, and can complicate both the course of the disorder and treatment of the disorder. When a young child has an anxiety disorder, do not ignore it or think that the child will just "outgrow" it. Early anxiety predicts adult problems, especially if there is a family history of mood disorders.
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BIPOLAR IN VERY YOUNG CHILDREN: REAL DISORDER OR NOT?
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In another file in this section of the web site, I described some concerns about whether some children were being diagnosed with Bipolar Disorder who do not have Bipolar Disorder as it is currently defined in the DSM-IV. Certainly there are parents who believe that their child is bipolar because if their child has meltdowns or storms, it's a mood disorder. As others have pointed out and as I discuss in the rage section of this web site, having storms does not necessarily indicate that the child or adult has a mood disorder. A certain amount of what may be called Bipolar Disorder in children is probably not a true Bipolar Disorder, but may be something else. And the difference between Bipolar Disorder and "something else" has important treatment implications because approaches that work for one condition may not work for another -- or may make another condition worse.
If the family history is negative for mood disorder, I would hesitate to make a diagnosis of Bipolar Disorder if a child or teen doesn't have discrete mood episodes. I would suggest delaying diagnosis and screening/assessing for other disorders, including language problems, executive dysfunction, anxiety, sensory issues, etc. And I would would encourage the parents to establish consistent routines and structure in the home, as that seems to reduce stress for children. Indeed, some research suggests that if a child is genetically vulnerable to Bipolar Disorder, focused family therapy may be protective and help prevent emergence of problems. While much more research is needed, there is much that parents and schools can do to create a supportive environment that may reduce life stress that increases the risk of problems.
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Information
Section: Conditions
Condition:
Mood
Article:
Bipolar
Disorder in
Children
Source: Leslie E. Packer,
PhD (file last updated January 2009)
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Page 1 of 1
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Syndrome "Plus" © Copyright 1998 - 2009 Leslie
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This page last updated January 29, 2009.
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