|
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:
|
