Please feel free to add links to websites that you have found to be helpful, and to add any information about Bipolar Children or being a parent of a bipolar child.

There is more at the site beyond what I quoted here.



The Bipolar Child Newsletter
November, 2006 Vol. 23

--Janice Papolos and Demitri F. Papolos, M.D.

http://bipolarchild.com/newsletters/0611.html
What Does the DSM-IV Say About Children and Mood Disorders?


Children are mentioned in the DSM-IV, but they are to be diagnosed according to adult criteria. And this is where huge problems develop. Clinical investigators are beginning to realize that bipolar disorder in childhood presents in a very different pattern--one that bears little resemblance to classical cycles of mania and depression as they are expressed in adulthood. For instance, children have more irritable moods with explosive outbursts, and their cycles of mania, hypomania, and depression are far more rapid than the typical adult presentation. Yet the DSM-IV specifies that a mood episode must last for a specified period of time.

For instance, duration criteria for the diagnosis of a hypomanic episode requires a "period of persistently elevated, expansive, or irritable mood lasting throughout at least four days." (Italics ours.) Yet a significant proportion of early-onset bipolar children have a form of the condition that is marked by frequent mood and energy shifts that occur multiple times throughout the day.

For a depressive episode, the DSM-IV duration criteria is even more demanding: The manual requires at least a two-week period with five or more depressive symptoms. Therefore, by definition, an individual who has rapidly shifting mood states of less than the required duration cannot be formally diagnosed as having bipolar disorder.

A separate and distinct category--Bipolar Disorder Not Otherwise Specified (NOS)--was established to include disorders with bipolar features that do not meet full duration criteria. While most children with bipolar disorder fit into this category, still it is not an accurate description of the condition as it presents in childhood.

So, Haley's doctor and other clinicians and researchers are in an extremely difficult position: When they attempt to diagnose children with bipolar disorder, either they cannot use DSM-IV criteria and must describe these children as having "mania-like symptoms," or they must modify other diagnostic instruments in order to treat the primary problem. Alternatively, they can diagnose BP-NOS.


How Does Bipolar Disorder Actually Present in Childhood?


Children with bipolar disorder veer from irritable, easily annoyed, angry mood states to silly, goofy, giddy elation, and then just as easily descend into low energy periods of intense boredom, depression and social withdrawal, fraught with self-recriminations and suicidal thoughts. These abrupt swings of mood and energy can occur multiple times within a day, and intense outbursts of temper (rages that can go on for hours), poor frustration tolerance, and oppositional defiant behaviors are commonplace. The children frequently suffer severe anxiety--separation anxiety, generalized anxiety, and panic disorders--as well as obsessive-compulsive symptoms, particularly aggressive obsessions, hoarding, the need for symmetry and ritual requests for reassurance.

Moreover, many of the children have sleep disturbances, often accompanied by night terrors, nightmares filled with blood and gore and themes of pursuit and abandonment, as well as other arousal disorders of sleep.

Accompanying elevated periods of mood may be an increased sexuality (hypersexuality). It is an accepted fact that hypersexuality is a symptom of hypomania or mania in an adult who has bipolar disorder. In young children, the symptom may manifest as a fascination with private parts and an increase in self-stimulatory behaviors, a precocious interest in things of a sexual nature, and language laced with highly sexual words or phrases.

Psychotic symptoms, such as delusions (fixed irrational beliefs), and hallucinations (hearing voices, seeing things that others don't see) are not uncommon. Sometimes the voices and visions are compelling; often they are threatening, critical, or instruct the child to act on aggressive impulses towards others or self.

http://bipolarchild.com/newsletters/0611.html
A Closer Look at Problematic Boundary Issues: ADHD and Bipolar Disorder

At least seven of the DSM-IV criteria used to diagnose ADHD are commonly shared with bipolar disorder as it presents in childhood. A study of 1200 cases diagnosed with pediatric bipolar disorder performed by researchers of the Juvenile Bipolar Research Foundation found exceedingly high rates of endorsement of these "ADHD" symptoms:

Easily distracted by extraneous stimuli 96%
Difficulty sustaining attention in tasks or play 96%
Restlessness as if driven by a motor 71%
Often talks excessively 80%
Difficulty waiting turn 96%
Blurts thoughts out 96%
Often has difficulty organizing tasks 91%
Many of the most commonly used diagnostic inventories employed by mental health professionals to diagnose ADHD include symptoms that would be indistinguishable from the most common symptomatic profiles observed in children with bipolar disorder. Therefore, since attentional problems, motor disinhibition, and organizational deficits are part and parcel of both conditions, it is difficult to make a clear diagnosis.

If a clinician diagnoses according to strict DSM-IV criteria, and there are symptoms of mania present also, than, as we mentioned earlier, both bipolar disorder and ADHD must be diagnosed as co-occurring disorders

http://bipolarchild.com/newsletters/0611.html

The Bipolar Child Newsletter
November, 2006 Vol. 23

The Child Bipolar Questionnaire

Until very recently, newly-proposed diagnostic criteria for juvenile-onset bipolar disorder have been based on information from very small clinical samples, or from expert consensus. Diagnostic rating scales used in clinical studies have all been modified from adult versions that are derived from DSM-IV diagnostic concepts, and focus almost exclusively on symptoms of mania and/or depression.

This focus limits the capacity to encompass a broader view afforded by a dimensional analysis of the primary features of the illness.

In order to avoid imposing such artificial distinctions that carve out symptoms into pre-established diagnostic categories, and to address the fact that psychiatric rating scale instruments do not represent a finer grained dimensional view of the condition, the Child Bipolar Parent Questionnaire (CBQ) was developed.

This is a 65-item questionnaire completed by a parent or parent surrogate that is based upon a Likert Scale. The questionnaire requires a rating for frequency of occurrence for each of the 65 symptoms or behaviors. For instance, a rating of 1 signifies that a symptom or behavior never occurs, or occurs only rarely; a rating of 4 signifies that a symptom or behavior occurs very frequently, or almost constantly. It was developed to serve as a rapid screening inventory of common behavioral symptoms and temperamental features associated with pediatric bipolar disorder.

(To read about the development of the CBQ, or to complete the screening inventory, visit
http://www.jbrf.org/cbq/index.html ).

The ability of CBQ screening diagnoses and of the CBQ Core Index subscale to effectively predict diagnostic classification by structured interview was assessed using the well-validated Kiddie-SADS P/L. The validation study of the CBQ is published in the Journal of Affective Disorders (see bibliography below).

www.conductdisorders.com