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An aspect of the Center for Children and Families

Topic: Bipolar Disorder
Researched and written by:  Stefanie Legge
                                                I attest that the following report is a product of my own original work.

Summary
Full Report
Related Websites

References
 


Summary
 

Bipolar disorder (BP) is a mood disorder that has three different types of stages: manic, depressant, and mixed episodes. A person with BP goes from one stage to another, but it is not a gradual transition, it is the extreme. Approximately 1.3 million children could have BP, but it is not research based yet because many children were misdiagnosed with ADHD or other disorders that have similar characteristics. Boys and girls have equal chances of acquiring BP. Some of the characteristics associated with BP include: irritability, “dare-devil” behavior, euphoria, sleep disturbances, change in appetite, and crying spells. Teaching and learning is exceptionally difficult when a child with BP has an emotional outburst. Some effective treatments are psychosocial treatments and medication.

 

He was experiencing mood swings that almost took over his life. It is not that he was a bad child; it is just that there was a chemical imbalance in his brain that caused him to misbehave. There was a time when he would go to the bathroom, lock the door, and weep because nobody understood him. On the other hand, he felt exceptionally well, on top of the world, with nothing interfering in his flawless world. These feelings of mania and depression acted like a pendulum swinging back and forth, with nothing able to stop the mood swings. Since his behavior was unpredictable, he and his family were suffering. He had problems with making friends, but his mother was supportive of him throughout the days. Finally he was able to control himself and regularly take his medications, but it took years to be able to recover. He had an understanding of what he needed to do to regain control of his moods, and he knew that simply taking medication to keep his moods stable was not the only answer. He needed to evaluate situations and act on them after having enough time to think about possible outcomes. This is Jackie Kelley’s perspective of his disorder after eight years of being diagnosed. What was Jackie Kelly diagnosed with?

Jackie Kelly has been suffering from manic-depression, later called bipolar disorder (BP), since he was 14 years old. BP is a mood disorder that has not had very much research conducted on children because doctors thought that children could not have it; so BP often went under diagnosed or misdiagnosed (Isaac,1991). This paper will further explain bipolar disorder in regards to the definition, statistics, characteristics, classroom issues, and effective treatments.

Overview/Definition of Bipolar Disorder

There is terminology that needs to be explained before going into the definition of BP. There are manic, depressive, mixed, and hypomanic episodes that occur and are evaluated when diagnosing BP. Manic episodes refer to an elevated or irritable mood that could increase activity and suffer from sleep deprivation; whereas depressive episodes refer to a persistently low and hopeless mood as activity decreases and thoughts of suicide increases (American Psychology Association, 1994). A mixed episode is meeting both manic and depressive episodic criteria simultaneously. A hypomanic episode is similar to manic episodes, but not as severe. The hallucinations and illusions are not expressed in a hypomanic episode, like they are in manic episodes; the symptoms should be present for at least four days in hypomania, whereas mania lasts at least a week (American Psychology Association, 1994).  

There are classifications for which type of bipolar disorder the child is experiencing. The child could have one of three different types of bipolar disorder: bipolar I disorder, bipolar II disorder, or cyclothymic disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), bipolar I disorder is a case of at least one manic or mixed episode and at least one major depressive episode, bipolar II disorder is a case of at least one major depressive episode and a hypomanic episode, and cyclothymic disorder is a case of numerous hypomanic and manic symptoms over the coarse of at least one year. Thus, bipolar disorder has different categories that depend on the presence of manic, mixed, hypomanic episodes.

Statistics

            There are many that are affected by BP, but most research conducted can approximate the amount of adults affected and not so much about the children. There are 3.4 million children in the US with depression and of that there could be as much as 1/3 of those children suffering from early onset bipolar disorder (Child & Adolescent Bipolar Foundation, 2002). According to Mash and Wolfe, males and females are equally affected.  When it comes to gender issues with BP, it does not matter if you are female or male, your chances are the same. Although, if the child is diagnosed with early onset bipolar disorder before 13 years old, the boy seems to have a greater chance than the girl (Mash and Wolfe, 2002).  Since this is a somewhat new disorder, the research is limited and there have not been any differences found in ethnicity or culture (Mash and Wolfe, 2002). But studies have shown that in the US, about 1% of the population is diagnosed with bipolar disorder, which includes both adults and children (Child & Adolescent Bipolar Foundation, 2002).

            There are other disorders associated with BP. For instance, if a child is exhibiting BP, the chances of the child simultaneously experiencing ADHD increases; 90% of children and 30% of adolescents experience both disorders (Mash and Wolfe, 2002). There have been concerns that psychiatrists are misdiagnosing the children with ADHD, conduct disorder, or other disorders (Isaac, 1992). If there is a misdiagnosis, then the medications prescribed for the incorrect disorder could actually enhance that disorder, instead of having no effect at all; resulting in a child with another disorder that he or she did not have in the first place. In contrast, according to Wilens. Biederman, Forkner, Ditterline, Morris, Moore, Galdo, Spencer, & Wozniak study, the probability of the preschooler and school-age children experiencing comorbid disorders were common in both age groups. This indicates that comorbid disorders exist with BP and they are spread across all age groups. The most prominent comorbid disorders found were disruptive disorders (e.g., conduct disorder, oppositional defiant disorder), and anxiety disorders (e.g., separation anxiety, panic disorder, agoraphobia, overanxious disorder) (Wilens et al, 2003).

            There are also biological influences that increase the chances of inheriting the same gene. So if the parent has BP, then the chances of the child being diagnosed with BP is greater. Issac (1991) indicated that 80% of the participants had at least one parent diagnosed or qualified for having BP or cyclothymia. Bipolar disorder can skip generations, but the risk of a child having BP is 15-30% when BP is present in at least one parent; when BP is present in both parents, the child increases his/her chances of inheriting the gene to 50-75% (Child & Adolescent Bipolar Foundation, 2002).

Characteristics of Bipolar Disorder

 

Characteristics of bipolar disorder include manic and depressed phases. Some of the characteristics associated with mania include: irritability, dare-devil behavior, euphoria, hallucinations and delusions, decreased sleep, rapid speech, plenty of energy, grandiosity, poor judgment, or hypersexual feelings (Child & Adolescent Bipolar Foundation, 2002). If not controlled, mania can escalate and become a severe condition with psychotic behavior. Some of the depressive characteristics are: sleep disturbances, change in appetite leading to weight gain or weight loss, severe sadness, crying spells, agitation and irritability, inability to concentrate, thoughts of suicide, and loss of interest in activities (Child & Adolescent Bipolar Foundation, 2002).  

Classroom issues:

            Since these students are being diagnosed with BP and often times ADHD or CD, the child becomes highly problematic in the special educational facility. A child with ADHD has inattentive and hyperactive tendencies which are hard for teachers to control in the classroom setting. These children with BP are disruptive in school because of their unpredictable mood swing. Teaching and learning is exceptionally difficult when a child with BP has an emotional outburst (Schlozman, 2002). When there is an emotional outburst, the teacher should remove the child from the classroom, so that it’s not as disruptive, and allow the child time to calm down (Schlozman, 2002). This means that the teacher would need to leave the room or student unattended, which could result in chaos with the students. It is hard for the children with BP to form friendships, which puts a strain on the child in the classroom. The child is deemed a failure because he or she is a distraction, lacks social skills (friends), and therefore inhibits learning in school (Schlozman, 2002).

            The classroom impacts BP because teachers do not know how to respond to the child. Since the child has a mood disorder, it is important that the teacher communicates with the child appropriately. For instance, instead of the teacher saying, “I know you’re not trying hard enough,” the teacher could say, “It looks like this is getting frustrating for you. Would you like some help?” Teachers need to understand how to effectively teach all types of students, that includes the ones with mood disorders. Some tactics work better with other students, but instead of continuing to use the tactics that work, the teacher should use trial and error (Child & Adolescent Bipolar Foundation, 2002).

Treatment Issues:

            There are many different methods of treatment for children with bipolar disorder. The most common treatment used is likely medication, but there have been difficulties with the medications used to stabilize moods. There are anti-manic medications that regulate the intensity of manic episodes and anti-convulsant medications that treat seizures. An example of an anti-manic drug is lithium, which is widely used when treating BP. There are side effects though, such as: excessive thirst, excessive weight gain, nausea, dizziness, slurred speech, fatigue, irritability, etc. An example of an anti-convulsant drug is carbamazepine or valproic acid. (Health Resources and Services Administration, 1997). It is important to know that the safety of anti-manic drug is not determined for children below the age of 15, so this makes it difficult for children with BP to stabilize their moods in the classroom setting.

            Since there are comorbid disorders with early onset BP, like ADHD and CD, the medications are often overlapped with medications for other disorders; this is considered a combined pharmacotherapy approach (Wilens and Wozniak, 2003). The child should be treated with BP first, so that the moods are somewhat constant. BP is hard to treat with medications because BP changes from depressed to manic and the medications used are anti-manic and anti-depressants which if incorrectly used, could cause mood instability.

Parents and children with BP should learn about the disorder and treatments so that they can better understand the importance of controlling their mood swings. When a child with BP is in the classroom, and goes from manic to depressed within minutes, the child needs to develop effective coping strategies. Psychosocial treatment focuses on both the mind, in regards to the mood swings, and the social aspect, because people with BP have a hard social life. Some various types of psychosocial treatments are: psychoeducation, cognitive-behavioral therapy, group therapy and self help groups, and psychodynamic therapy (Psychosocial treatment of bipolar disorder, 2004).

            An article was written in the Brown University Child & Adolescent Behavior Letter that explained how to go about acquiring proper education for a child with BP. There are laws passed to enforce the equal opportunity of disabled or non disabled children to maintain free and appropriate education, such as: Individuals with Disabilities Education Act (IDEA), No Child Left Behind Educational Act of 2002, and Section 504 of the Rehabilitation Act of 1973. IDEA was the first law passed that requires the school system to provide an accessible school facility for children with disorders. For instance, a child that is in a wheelchair needs a ramp to get into buildings, or an elevator if there is more than one floor. For a child with BP to maintain proper education, medication is not the only treatment to use. The child and their family should build a collaborative relationship with the school, meaning that the family and school should work together to guarantee appropriate education. Within the school system, some accommodations for the child with BP could be: permitting unlimited bathroom use, providing access to water as needed, shortening the schedule, modifying homework, testing in small groups, using homebound instruction with tutor, or providing a safe place for the child to go when feeling overwhelmed or experiencing severe symptoms of BP.

In conclusion, there are many children diagnosed with BP that are suffering from another disorder. In comparison to other child prevalent disorders, there is not a lot of research conducted on children with BP. It is important to become educated about BP and “shop around” with professionals. One doctor could be off with his or her diagnosis, so ask for a second opinion from another doctor. There are several resources that offer assistance related to bipolar disorder:


Related Websites

www.bpkids.org

www.bpchildresearch.org

www.dbsalliance.org

 

 


References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed., Text Revision). Washington, D.C.: Author.

Child & Adolescent Bipolar Foundation (2002). Cabf learning center - about early-onset bipolar disorder. [online]. Available: http://www.bpkids.org/learning/about.htm. (November 10, 2004)

Education and your bipolar child (2004).  Brown University Child & Adolescent Behavior Letter, 20(7), 9.

Health Resources and Services Administration (1997).Students and psychotrophic medication: the school’s role. a resources aid packet (DHHS Publication No. BBB32080). Washington, D.C.: Material and Child Health Bureau.

Isaac, G. (1991). Bipolar disorder in prepubertal children in a special educational setting: is it rare? [Electronic Version]. The Journal of Clinical Psychiatry, 52 (4), 165-168.

Isaac, G. (1992). Misdiagnosed bipolar disorder in adolescent in a special educational school [Electronic version]. The Journal of Clinical Psychiatry, 53 (4), 133-136.

Kelley II, J. R. (1997). Learning to conquer my demons [Electronic version]. Essence, 28 (1), 1.

Mash, E.J., & Wolfe, D.A. (2002). Abnormal child psychology (2nd ed.). Belmont, CA: Wadsworth.

Psychosocial treatment of bipolar disorder (2004). Harvard Mental Health Letter, 20 (9), 4.

Schlozman, S.C. (2002). An explosive debate: the bipolar child [Electronic Version]. Educational Leadership, 60, 89-90.

Wilens, T. E., Biederman, J., Forkner, P., Ditterline, J., Morris, M., Moore, H., Galdo, M., Spencer, T., & Wozniak, J. (2003). Patterns of comorbidity and dysfunctional in clinically referred preschool and school-age children with bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 13 (4), 495-505.

Wilens, T. E., & Wozniak, J. (2003). Bipolar disorder in children and adolescents: diagnostic and therapeutic issues. Psychiatric Times, 20 (8), 55.

 





This website is a service learning project by the students of "Psychology of the Exceptional Child" at Frostburg State University.  Manager of web page and project: Dr. Megan E. Bradley