Info on pediatric Bi-polar
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What are the symptoms of bipolar disorder in children?
Bipolar disorder involves marked changes in mood and energy. Persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.
However, the illness may look different in children than it does in adults. Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.
Diagnosis is made using the DSM-IV criteria, for which there is no lower age limit. See section below for DSM-IV criteria. However, it becomes more difficult to apply the DSM-IV criteria to very young children.
Behaviors reported by parents in children diagnosed with bipolar disorder may include:
an expansive or irritable mood (Mary often becomes irritable right b4 a mania)
extreme sadness or lack of interest in play
rapidly changing moods lasting a few hours to a few days(Mary can do both rapid cycling and then slow down into a steady state)
explosive, lengthy, and often destructive rages(Mary can pick up huge objescts such as chairs big tables and anything else she finds,she throws things tears up her favorite things and even has been known to rip her clothes)
separation anxiety
defiance of authority (Mary hates to be Told to do anything by a authority figure we find it easier to give her a choice)
hyperactivity, agitation, and distractibility (Mary suffers from sever A.D.H.D)
sleeping little or, alternatively, sleeping too much(Mary as a baby went days on end with no sleep and screaming and when i say no sleep i mean it even at 4 weeks she refused sleep)
bed wetting and night terrors
strong and frequent cravings, often for carbohydrates and sweets
excessive involvement in multiple projects and activities
impaired judgment, impulsivity, racing thoughts, and pressure to keep talking (Mary has a hard time thinking b4 she acts on a thought and is not able to stop talking if you cant talk to her she feels the need to repeat her self over and over again untill she is finnaly noticed then its a new question)
dare-devil behaviors (such as jumping out of moving cars or off roofs)
inappropriate or precocious sexual behavior
delusions and hallucinations
grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)
Symptoms of bipolar disorder can emerge as early as infancy (Mary always showed signs of being diffrent from the day she came home). Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word "no" often triggered these rages.(haha how true it is just try to tell mary no and see hoe far she goes to prove you wrong)
Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children. CABF will report all new findings on early-onset bipolar disorder and will include the more important articles in our Learning Center whenever possible
Diagnosing Bipolar Disorder in Children
Healthy children often have moments when they have difficulty staying still, controlling their impulses, or dealing with frustration. The Diagnostic and Statistical Manual IV (DSM-IV) still requires that, for a diagnosis of bipolar disorder, adult criteria must be met. There are as yet no separate criteria for diagnosing children.
Some behaviors by a child, however, should raise a red flag:
destructive rages that continue past the age of four
talk of wanting to die or kill themselves
trying to jump out of a moving car
To illustrate how difficult it is to use the DSM-IV to diagnose children, the manual says that a hypomanic episode requires a "distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days." Yet upwards of 70 percent of children with the illness have mood and energy shifts several times a day.
Since the DSM-IV is not scheduled for revision in the immediate future, experts often use some DSM-IV criteria as well as other measures. For example, a Washington University team of researchers uses a structured diagnostic interview called Wash U KIDDE-SADS, which is more sensitive to the rapid-cycling periods commonly observed in children with bipolar disorder.
How does bipolar disorder differ from other conditions?
Even when a child's behavior is unquestionably not normal, correct diagnosis remains challenging. Bipolar disorder is often accompanied by symptoms of other psychiatric disorders. In some children, proper treatment for the bipolar disorder clears up the troublesome symptoms thought to indicate another diagnosis. In other children, bipolar disorder may explain only part of a more complicated case that includes neurological, developmental, and other components.
Diagnoses that mask or sometimes occur along with bipolar disorder include:
depression
conduct disorder (CD)
oppositional-defiant disorder (ODD) (this is also one of Marys Diagonis)
attention-deficit disorder with hyperactivity (ADHD) (this is another one)
panic disorder
generalized anxiety disorder (GAD)
obsessive-compulsive disorder (OCD)(Mary as suffred for this since she was 11 months old she even cried when sand touched her at the park because she got dirty)
Tourette's syndrome (TS)
intermittent explosive disorder (Another one of Marys diagnois)
reactive attachment disorder (RAD)
Therapeutic ParentingTM
Parents of children with bipolar disorder have discovered numerous techniques that the CABF refers to as therapeutic parenting. These techniques help calm their children when they are symptomatic and can help prevent and contain relapses. Such techniques include:
practicing and teaching their child relaxation techniques(Mary knows how to count to 10 or to say a prayer)
using firm restraint holds to contain rages (we use this with Mary alot during rages)
prioritizing battles and letting go of less important matters (if it doesnt hurt anyone and it wont matter next year next month next week or even tomorrow I say go for it)
reducing stress in the home, including learning and using good listening and communication skills
using music and sound, lighting, water, and massage to assist the child with waking, falling asleep, and relaxation
becoming an advocate for stress reduction and other accommodations at school
helping the child anticipate and avoid, or prepare for stressful situations by developing coping strategies beforehand
engaging the child's creativity through activities that express and channel their gifts and strengths (Mary is a wonderful artist and loves to color draw or paint)
providing routine structure and a great deal of freedom within limits
removing objects from the home (or locking them in a safe place) that could be used to harm self or others during a rage, especially guns; keeping medications in a locked cabinet or box. (our Medication are in a cabinet with a pad lock)
What are the educational needs of a child with bipolar disorder?
A diagnosis of bipolar disorder means the child has a significant health impairment (such as diabetes, epilepsy, or leukemia) that requires ongoing medical management. The child needs and is entitled to accommodations in school to benefit from his or her education. Bipolar disorder and the medications used to treat it can affect a child's school attendance, alertness and concentration, sensitivity to light, noise and stress, motivation, and energy available for learning. The child's functioning can vary greatly at different times throughout the day, season, and school year.
The special education staff, parents and professionals should meet as a team to determine the child's educational needs. An evaluation including psychoeducational testing will be done by the school (some families arrange for more extensive private testing). The educational needs of a particular child with bipolar disorder vary depending on the frequency, severity and duration of episodes of illness. These factors are difficult to predict in an individual case. Transitions to new teachers and new schools, return to school from vacations and absences, and changing to new medications are common times of increased symptoms for children with bipolar disorder. Medication side effects that can be troublesome at school include increased thirst and urination, excessive sleepiness or agitation, and interference with concentration. Weight gain, fatigue, and a tendency to become easily overheated and dehydrated impact a child's participation in gym and regular classes.
These factors and any others that affect the child's education must be identified. A plan (called an IEP) will be written to accommodate the child's needs. The IEP should include accommodations for periods when the child is relatively well (when a less intense level of services may suffice), and accommodations available to the child in the event of relapse. Specific accommodations should be backed up by a letter or phone call from the child's doctor to the director of special education in the school district. Some parents find it necessary to hire a lawyer to obtain the accommodations and services that federal law requires public schools to provide for children with similar health impairments.
Examples of accommodations helpful to children and adolescents with bipolar disorder include:
preschool special education testing and services
small class size (with children of similar intelligence) or self-contained classroom with other emotionally fragile (not "behavior disorder") children for part or all of the day (Mary goes to the special education room 2xs a day for 30 mins at a time)
one-on-one or shared special education aide to assist child in class
back-and-forth notebook between home and school to assist communication (Marys teacher and I use this method)
homework reduced or excused and deadlines extended when energy is low (we do not allow this as we believe in encourages Mary to use her condition as a means of getting out of work)
late start to school day if fatigued in morning (Mary must go to school on time however she may have a nap in the office)
recorded books as alternative to self-reading when concentration is low
designation of a "safe place" at school where child can retreat when overwhelmed (Mary is allowed to go to the office and sit with her friend Mrs.Snyder)
designation of a staff member to whom the child can go as needed(Mary has two people her special ed teacher and Mrs.snyder)
unlimited access to bathroom (Mary has a pass that hangs on the classroom door)
unlimited access to drinking water
art therapy and music therapy (Mary has both)
extended time on tests
use of calculator for math
extra set of books at home
use of keyboard or dictation for writing assignments
regular sessions with a social worker or school psychologist(mary sees the school psy. 3 times a week)
social skills groups and peer support groups
annual in-service training for teachers by child's treatment professionals (sponsored by school)
enriched art, music, or other areas of particular strength
curriculum that engages creativity and reduces boredom (for highly creative children)
tutoring during extended absences
goals set each week with rewards for achievement (mary gets to ride and see the horses for 5 days good behavior at school)
summer services such as day camps and special education summer school
placement in a day hospital treatment program for periods of acute illness that can be managed without inpatient hospitalization
placement in a therapeutic day school during extended relapses or to provide a period of extra support after hospitalization and before returning to regular school
placement in a residential treatment center during extended periods of illness if a therapeutic day school near the family's home is not available or is unable to meet the child's needs
thanks and i will add more as i come accross it
Bipolar disorder involves marked changes in mood and energy. Persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.
However, the illness may look different in children than it does in adults. Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.
Diagnosis is made using the DSM-IV criteria, for which there is no lower age limit. See section below for DSM-IV criteria. However, it becomes more difficult to apply the DSM-IV criteria to very young children.
Behaviors reported by parents in children diagnosed with bipolar disorder may include:
an expansive or irritable mood (Mary often becomes irritable right b4 a mania)
extreme sadness or lack of interest in play
rapidly changing moods lasting a few hours to a few days(Mary can do both rapid cycling and then slow down into a steady state)
explosive, lengthy, and often destructive rages(Mary can pick up huge objescts such as chairs big tables and anything else she finds,she throws things tears up her favorite things and even has been known to rip her clothes)
separation anxiety
defiance of authority (Mary hates to be Told to do anything by a authority figure we find it easier to give her a choice)
hyperactivity, agitation, and distractibility (Mary suffers from sever A.D.H.D)
sleeping little or, alternatively, sleeping too much(Mary as a baby went days on end with no sleep and screaming and when i say no sleep i mean it even at 4 weeks she refused sleep)
bed wetting and night terrors
strong and frequent cravings, often for carbohydrates and sweets
excessive involvement in multiple projects and activities
impaired judgment, impulsivity, racing thoughts, and pressure to keep talking (Mary has a hard time thinking b4 she acts on a thought and is not able to stop talking if you cant talk to her she feels the need to repeat her self over and over again untill she is finnaly noticed then its a new question)
dare-devil behaviors (such as jumping out of moving cars or off roofs)
inappropriate or precocious sexual behavior
delusions and hallucinations
grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)
Symptoms of bipolar disorder can emerge as early as infancy (Mary always showed signs of being diffrent from the day she came home). Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word "no" often triggered these rages.(haha how true it is just try to tell mary no and see hoe far she goes to prove you wrong)
Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children. CABF will report all new findings on early-onset bipolar disorder and will include the more important articles in our Learning Center whenever possible
Diagnosing Bipolar Disorder in Children
Healthy children often have moments when they have difficulty staying still, controlling their impulses, or dealing with frustration. The Diagnostic and Statistical Manual IV (DSM-IV) still requires that, for a diagnosis of bipolar disorder, adult criteria must be met. There are as yet no separate criteria for diagnosing children.
Some behaviors by a child, however, should raise a red flag:
destructive rages that continue past the age of four
talk of wanting to die or kill themselves
trying to jump out of a moving car
To illustrate how difficult it is to use the DSM-IV to diagnose children, the manual says that a hypomanic episode requires a "distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days." Yet upwards of 70 percent of children with the illness have mood and energy shifts several times a day.
Since the DSM-IV is not scheduled for revision in the immediate future, experts often use some DSM-IV criteria as well as other measures. For example, a Washington University team of researchers uses a structured diagnostic interview called Wash U KIDDE-SADS, which is more sensitive to the rapid-cycling periods commonly observed in children with bipolar disorder.
How does bipolar disorder differ from other conditions?
Even when a child's behavior is unquestionably not normal, correct diagnosis remains challenging. Bipolar disorder is often accompanied by symptoms of other psychiatric disorders. In some children, proper treatment for the bipolar disorder clears up the troublesome symptoms thought to indicate another diagnosis. In other children, bipolar disorder may explain only part of a more complicated case that includes neurological, developmental, and other components.
Diagnoses that mask or sometimes occur along with bipolar disorder include:
depression
conduct disorder (CD)
oppositional-defiant disorder (ODD) (this is also one of Marys Diagonis)
attention-deficit disorder with hyperactivity (ADHD) (this is another one)
panic disorder
generalized anxiety disorder (GAD)
obsessive-compulsive disorder (OCD)(Mary as suffred for this since she was 11 months old she even cried when sand touched her at the park because she got dirty)
Tourette's syndrome (TS)
intermittent explosive disorder (Another one of Marys diagnois)
reactive attachment disorder (RAD)
Therapeutic ParentingTM
Parents of children with bipolar disorder have discovered numerous techniques that the CABF refers to as therapeutic parenting. These techniques help calm their children when they are symptomatic and can help prevent and contain relapses. Such techniques include:
practicing and teaching their child relaxation techniques(Mary knows how to count to 10 or to say a prayer)
using firm restraint holds to contain rages (we use this with Mary alot during rages)
prioritizing battles and letting go of less important matters (if it doesnt hurt anyone and it wont matter next year next month next week or even tomorrow I say go for it)
reducing stress in the home, including learning and using good listening and communication skills
using music and sound, lighting, water, and massage to assist the child with waking, falling asleep, and relaxation
becoming an advocate for stress reduction and other accommodations at school
helping the child anticipate and avoid, or prepare for stressful situations by developing coping strategies beforehand
engaging the child's creativity through activities that express and channel their gifts and strengths (Mary is a wonderful artist and loves to color draw or paint)
providing routine structure and a great deal of freedom within limits
removing objects from the home (or locking them in a safe place) that could be used to harm self or others during a rage, especially guns; keeping medications in a locked cabinet or box. (our Medication are in a cabinet with a pad lock)
What are the educational needs of a child with bipolar disorder?
A diagnosis of bipolar disorder means the child has a significant health impairment (such as diabetes, epilepsy, or leukemia) that requires ongoing medical management. The child needs and is entitled to accommodations in school to benefit from his or her education. Bipolar disorder and the medications used to treat it can affect a child's school attendance, alertness and concentration, sensitivity to light, noise and stress, motivation, and energy available for learning. The child's functioning can vary greatly at different times throughout the day, season, and school year.
The special education staff, parents and professionals should meet as a team to determine the child's educational needs. An evaluation including psychoeducational testing will be done by the school (some families arrange for more extensive private testing). The educational needs of a particular child with bipolar disorder vary depending on the frequency, severity and duration of episodes of illness. These factors are difficult to predict in an individual case. Transitions to new teachers and new schools, return to school from vacations and absences, and changing to new medications are common times of increased symptoms for children with bipolar disorder. Medication side effects that can be troublesome at school include increased thirst and urination, excessive sleepiness or agitation, and interference with concentration. Weight gain, fatigue, and a tendency to become easily overheated and dehydrated impact a child's participation in gym and regular classes.
These factors and any others that affect the child's education must be identified. A plan (called an IEP) will be written to accommodate the child's needs. The IEP should include accommodations for periods when the child is relatively well (when a less intense level of services may suffice), and accommodations available to the child in the event of relapse. Specific accommodations should be backed up by a letter or phone call from the child's doctor to the director of special education in the school district. Some parents find it necessary to hire a lawyer to obtain the accommodations and services that federal law requires public schools to provide for children with similar health impairments.
Examples of accommodations helpful to children and adolescents with bipolar disorder include:
preschool special education testing and services
small class size (with children of similar intelligence) or self-contained classroom with other emotionally fragile (not "behavior disorder") children for part or all of the day (Mary goes to the special education room 2xs a day for 30 mins at a time)
one-on-one or shared special education aide to assist child in class
back-and-forth notebook between home and school to assist communication (Marys teacher and I use this method)
homework reduced or excused and deadlines extended when energy is low (we do not allow this as we believe in encourages Mary to use her condition as a means of getting out of work)
late start to school day if fatigued in morning (Mary must go to school on time however she may have a nap in the office)
recorded books as alternative to self-reading when concentration is low
designation of a "safe place" at school where child can retreat when overwhelmed (Mary is allowed to go to the office and sit with her friend Mrs.Snyder)
designation of a staff member to whom the child can go as needed(Mary has two people her special ed teacher and Mrs.snyder)
unlimited access to bathroom (Mary has a pass that hangs on the classroom door)
unlimited access to drinking water
art therapy and music therapy (Mary has both)
extended time on tests
use of calculator for math
extra set of books at home
use of keyboard or dictation for writing assignments
regular sessions with a social worker or school psychologist(mary sees the school psy. 3 times a week)
social skills groups and peer support groups
annual in-service training for teachers by child's treatment professionals (sponsored by school)
enriched art, music, or other areas of particular strength
curriculum that engages creativity and reduces boredom (for highly creative children)
tutoring during extended absences
goals set each week with rewards for achievement (mary gets to ride and see the horses for 5 days good behavior at school)
summer services such as day camps and special education summer school
placement in a day hospital treatment program for periods of acute illness that can be managed without inpatient hospitalization
placement in a therapeutic day school during extended relapses or to provide a period of extra support after hospitalization and before returning to regular school
placement in a residential treatment center during extended periods of illness if a therapeutic day school near the family's home is not available or is unable to meet the child's needs
thanks and i will add more as i come accross it