Transcript Pediatric Bipolar Presentation

“The Storm in my Brain:”
A Teacher’s Guide to
Pediatric Bipolar Disorder
Pediatric Bipolar Disorder (PBPD) is a
neurologically based mood disorder found
in children 12 years and under. A serious,
but treatable mental illness, it causes rapid
shifts of mood that commonly cycle many
times within a single day.
PBPD affects all aspects of a child’s life:
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Emotion
Behavior
Cognitive skills
Social interactions
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The Child & Adolescent Bipolar
Foundation (CABF) estimates
that at least three quarters of a million
American children and teenagers, mostly
undiagnosed, may currently suffer from
this illness.
Children as young as three-years-old have been
diagnosed with PBPD;
preschool students may talk of wanting to
”make myself dead.”
Also known as “manic-depression,”
this disorder manifests itself
differently in kids; abrupt swings of
mood and energy occur much more
frequently than they do in bipolar adults.
Characteristics of PBPD include:
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Crying for no reason
Extreme irritability
Depression
Explosive, lengthy rages
Separation anxiety
Defiance of authority
Hyperactivity
Sleeping too little or too
much & night terrors
 Hallucinations
 Elation
 Excessive involvement in
multiple projects
 Impaired judgment,
impulsivity, racing thoughts
 Inappropriate sexual
behavior
 Grandiosity
 Strong, frequent cravings
for carbs & sweets
 Suicidal thoughts
Diagnosing PBPD
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Family history is an important consideration.
The illness has a strong genetic component, although it can
skip a generation; the risk of a parent with bipolar disorder
passing it on to a child is 13%.
A family history of BPD is found in 95% of PBPD patients.
A family history of alcohol abuse is often related to PBPD.
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The symptoms of this disorder resemble symptoms of
Attention Deficit Hyperactivity Disorder (ADHD).
Over 80% of children with early-onset BPD will meet the full
criteria of ADHD.
Treatment with a stimulant typically prescribed for ADHD can
aggravate symptoms in children with bipolar disorder or trigger
mania in a child with a family history of the illness.
There are significant differences
between PBPD and ADHD.
Bipolar children:
1.) are much more irritable;
2.) have more violent, destructive
and lengthy outbursts;
3.) are more grandiose
(“I am the best”);
4.) have more frequent and
intense mood changes (i.e.
“rapid cycling”)
5.) exhibit an early interest in
sexual activity.
Treatment for PBPD includes:
A few important notes
about medication: No single
medication works in all
children. Since symptoms
wax and wane, and children’s
bodies change as they grow,
managing medication to
ensure continued stability is
an ongoing challenge. Also,
controlled long-term studies
of the effects of lithium and
other mood stabilizers in
bipolar children is nearly nonexistent.
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Medication
 Mood stabilizers (Lithium, Depakote,
Tegratol)
 Antipsychotic medications (Risperdal,
Zyprexa)
 Benzodiazepines for sleep disturbances
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Close monitoring of symptoms
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Education for child and family about the
symptoms, course and treatment of the disorder
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Psychotherapy for the child and family
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Stress reduction
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Good nutrition, regular sleep and exercise
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Participation in a network of support
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Accommodations at school
How PBPD Affects Learning
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Disorder can cause cognitive deficits including the ability to:
– pay attention
– remember and recall information
– think critically
– categorize and organize information
– employ problem-solving skills
– quickly coordinate eye-hand movements
Disorder can cause child to be
– talkative
– impulsive
– distractible
– withdrawn
– unmotivated
– difficult to engage
Medication can cause
– cognitive dulling
– sleepiness
– slurring of speech, memory recall difficulties
– physical discomfort such as nausea or thirst
Suggested Guidelines for Teachers
 Be informed
 Learn about PBPD; request additional in-service training.
 Work closely with the student’s family to understand the
symptoms & course of the illness, changes in medication, etc.
 Demonstrate good conflict management skills; strive to be
flexible, calm, patient, firm, loving and consistent.
 Focus on quality not quantity of the student’s work
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Provide
 Structure and predictability since change is so difficult
 Seating with few distractions (with buffer space & model children)
 Praise and encouragement at least once every 5 minutes
 Sufficient supervision
1) Designate a “safe” person – an adult to go to when the student is feeling
overwhelmed and a safe place to regain composure
2) Assign one-on-one adult supervision if needed outside the classroom
during times of transition, lunch, recess, etc.
3) Request an aide within the classroom to help manage & support student,
if necessary.
Suggested Accommodations
• Scheduling
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Permission to arrive later when necessary
Shorter school day
Scheduling difficult tasks for a time of day when student is best able to perform
Scheduling stimulating courses early in day to get interest going
Warnings before changes in activities; minimize surprises
More time for turning in homework of large projects
Break up assignments into shorter segments & allow more time for completion
Plan for breaks; lulls in the day
Periodic checks on progress during an assignment to make sure student is on
schedule
• Testing Situations
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Modified time constraints
Altered or simpler instructions
Oral testing or use of a scribe
Altered environment with less distractions
Tools such as a calculator or word bank
Offering alternative assignments to reduce
stress of testing
When developing an IEP, the
classification Other Health
Impaired (OHI) is advised to
acknowledge the biological
nature of this illness. To see a
draft IEP for a bipolar student:
http://www.bipolarchild.com/iep
_print.html
Living with Bipolar Disorder:
Prognosis & Long Term Options
 Chronic, lifetime condition that can be managed but not cured with
medication and lifestyle changes.
 Children with bipolar disorder are at risk for school failure, addiction,
and suicide. The lifetime mortality rate from bipolar disorder from
suicide is higher than that for some childhood cancers.
 Many students with PBPD are successful in a regular classroom
setting. Depending on the child, there are other options available:
 Self-contained classroom within the public school setting
 Therapeutic day school with small class size (6 to 8) students and a
trained special education teacher and a trained aide.
 With the right support and treatment plan, a student with PBPD can
thrive in school and develop satisfying peer relationships.
References
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Baldessarini, R., Faedda, G., Suppes, T. et al (1995). Pediatric-Onset Bipolar Disorder: A
Neglected Clinical and Public Health Problem. Harvard Rev Psychiatry, 3 (4), 171-195.
Birmaher, B., Naylor, M. & Pavuluri, M. (2005). Pediatric Bipolar Disorder: A Review of the Past 10 Years.
Journal of the American Academy of Child and Adolescent Psychiatry, 44 (9), 846-871.
Forness, S., Kavale, K. & Walker, H. (2003). Psychiatric Disorders and Treatments: A Primer for
Teachers. Teaching Exceptional Children, 36 (2), 42-49.
Kowatch, R., Fristad, M., Birmaher, B. et al (2005). Treatment Guidelines for Children and Adolescents
with Bipolar Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44
(3), 213 - 235.
McClure, E., Treland, J., Snow, J. et al (2005). Memory and Learning in Pediatric Bipolar
Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44 (5), 461-469.
Naparstek, N. (2002). Successful educators: a practical guide for understanding children’s
learning problems and mental health issues. Westport, CN: Bergin & Garvey.
Papolos, D. & Papolos, J. (1999). The bipolar child: the definitive and reassuring guide to
childhood’s most misunderstood disorder. New York: Broadway Books.
Child and Adolescent Bipolar Foundation. (2004). Educating the child with bipolar disorder
(Brochure).Wilmette, Ill.: Child and Adolescent Bipolar Foundation.
Child & Adolescent Bipolar Foundation, Depression & Bipolar Support Alliance (2003). The Storm in my
Brain: Kids and Mood Disorders (Bipolar Disorder and Depression).
Internet Resources
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Child & Adolescent Bipolar Foundation (copies of The Storm in my Brain available)
http://www.bpkids.org/site/PageServer
Depression & Bipolar Support Alliance
http://www.DBSAlliance.org
Juvenile Bipolar Research Foundation
Listen to National Public Radio programs on PBPD
http://www.bpchildresearch.org
http://www.npr.org/templates/story/story.php?storyId=4457271
http://www.npr.org/templates/story/story.php?storyId=1439204
http://www.npr.org/templates/story/story.php?storyId=1444271
http://www.npr.org/templates/story/story.php?storyId=1151407