Diagnosing Bipolar Disorder In Children – KCA Conference October 26, 2007

Tammy Shaffer Ed.D. LPCC, LPC, LCDC,NCC, ACS

Prevalence NAMI reports that approximately 7% of children seen at psychiatric facilities fit bipolar disorder using research standards.

Symptoms of Bipolar Disorder in Children

Very Common Distractibility Hyperactivity Impulsivity Restlessness/ Fidgetiness Silliness, Goofiness, Giddiness

Very Common Racing Thoughts Aggressive Behavior Grandiosity Carbohydrate Cravings Risk-Taking Behaviors

Very Common Separation Anxiety Rages & Explosive Temper Tantrums (lasting up to several hours) Marked Irritability Oppositional Behavior Frequent Mood Swings

Very Common Depressed Mood Lethargy Low Self-Esteem Difficulty Getting Up in the Morning Social Anxiety Oversensitivity to Emotional or Environmental Triggers

Common Bed-Wetting (especially in boys) Night Terrors Rapid or Pressured Speech Obsessive Behavior Excessive Daydreaming

Common Compulsive Behavior Motor & Vocal Tics Learning Disabilities Poor Short-Term Memory Lack of Organization Decreased need for sleep –(4-6 hrs night)

Common Fascination with Gore or Morbid Topics Hypersexuality Manipulative Behavior Bossiness Lying

Common Suicidal Thoughts Destruction of Property Paranoia Hallucinations & Delusion

Less Common Migraine Headaches Binging Self-Mutilating Behaviors Cruelty to Animals

(Papolos & Papolos, 1999). A Word of Caution “Bipolar disorder should be ruled out before any of the stimulant drugs or antidepressants are prescribed. Instead, mood- stabilizing drugs such as lithium, Depakote, or Tegretol should be considered as a first line of treatment…

Mislabeled, Mistreated & Misdiagnosed ADHD OCD ODD CD GAD

Childhood BP Disorder Children cycle more quickly Manic behavior may mask as agitation

Cycle of BD in Children More chronic than adults More rapidly than adults –4 times annually Ultra-Rapid –Within a week/month Ultra-Ultra-Rapid –Ultradian –Within 24 hr period

Mixed State The child may cycle so quickly that he or she becomes emotionally confused. The child may likely not have the vocabulary or self-awareness to put words to his or her feelings. Child behavior may appear odd – –Crying and laughing simultaneously

Hallucinations The presence of hallucinations schizophrenia

Suicidal Ideation May occur as young as 4 years old “If this situation ever happens, hold them still until they calm down and stop wanting to kill themselves. Hold this until they feel a part of this world.” 9 Year old girl diagnosed with BPD

Illustrating Depression or Mania

(Faedda & Austin, 2006) “Rebalancing the pendulum means reducing stimulation and removing every known cause of instability.”

Emotional Shock Absorbers Ability to respond to soothing or reassurance Degree of language development Ability to inhibit emotional responses Ability to self-soothe Cognitive maturation & fear of consequences

(Papolos & Papolos, 1999) “It’s as if the arousal system of the child is set at such a threshold that any kind of physical sensation that is not ‘just right’ is extremely irritating and threatens a sense of bodily integrity.”

Interesting Observations: Temperature BD kids may have temperature dysregulation –All foods must be the “just right” or will be refused –Reactive to heat and cold Leave house in winter w/o coat/gloves

Interesting Observations: Food Strong cravings for sweets/carbohydrates Food aversions Sudden demands for certain foods Sudden exclusion of previously liked foods

School As child gets older, academic & social demands exacerbate BD –Hinders socialization –Hinders learning

Legal Help for Students Section 504 of the Rehabilitation Act of 1973 Individuals w/Disabilities Act (IDEA) Americans w/Disabilities Act Other state & federal laws concerning disability rights/special education

School & Depression Lack of interest in material Poor retention of material Lack of ability to concentrate/focus Low motivation to achieve Low self-esteem

School & Mania Mind is overactive –Racing thoughts Grandiosity Distracted Overconfident Restless

Therapeutic Goals Discuss nature of the illness & tx Identify personal mood-swing triggers Identify ways to prevent/shorten mood swings Identify/Stop negative thought patterns

(Waltz, 2000) Therapeutic Goals Cope with symptoms and side effects Improve behavior at home, school, elsewhere Obtain support for making lifestyle changes Develop personal strengths, resiliency & self-esteem