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Study Notes on Bipolar Disorder in School-Age Children

A Closer Examination of Bipolar Disorder in School-Age Children

Authors and Publication

  • Authors: Angela D. Bardick and Kerry B. Bernes

  • Institution: University of Lethbridge, Alberta, Canada

  • Published in: Professional School Counseling, October 2005, Vol. 9, No. 1, pp. 72-77

  • Stable URL: JSTOR Link

Overview

  • Bipolar disorder in school-age children often presents symptoms that overlap with other common childhood disorders, including:

    • Attention Deficit Hyperactivity Disorder (ADHD)

    • Oppositional Defiant Disorder (ODD)

    • Conduct Disorder (CD)

  • Awareness of early-onset bipolar disorder symptoms is crucial for accurate diagnosis and referral for treatment.

  • This article discusses:

    • Difficulties in diagnosis

    • Differences in presentations between adults and children

    • A case study

    • Assessment, treatment, program planning

    • Implications for school counselors

Challenges in Diagnosis

  • Misdiagnosis Commonality: Children with severe behavioral concerns may be improperly diagnosed due to symptom overlap.

  • Complexity of Child Behaviors: Distinguishing between normal childhood behavior and pathological behavior is often challenging.

  • Symptoms Mimicking Other Disorders: Symptoms can co-occur with other childhood mental disorders, complicating diagnosis further (Bowring & Kovacs, 1992; NIMH, 2000).

  • NIMH (2000) Position: Emphasizes the need for improved understanding of diagnosis and treatment of bipolar disorder in youth.

Theoretical Background

Bipolar Disorder in Adults

  • DSM-IV-TR Description:

    • Mood swings from hypomania or mania (hyperactivity, increased energy, creativity, decreased need for sleep) to depression (low energy, sleep disturbances, lack of interest).

    • Bipolar I: Involves depression alternating with psychotic mania.

    • Bipolar II: Involves hypomanic episodes without full-blown mania.

    • Rapid Cycling: Defined as four or more episodes within a year.

Bipolar Disorder in Children

  • Differences in symptomatology from adults make diagnosis particularly challenging.

  • Typical symptoms may range from:

    • Irritability and unpredictability

    • Hyperactivity and attention problems

    • Conduct problems (defiance, aggression)

    • Childhood depression (e.g., crying, social withdrawal)

  • Behavior Indicators of Mania:

    • Increased silliness, grandiosity, racing thoughts, impulsivity.

    • Symptoms of mixed states and rapid cycling reported in over 70% of diagnosed children.

  • Ultra-Rapid Cycling: Manic and depressive phases can occur multiple times within a day.

Co-Morbid Conditions

  • Many children with early-onset bipolar disorder may also demonstrate:

    • Symptoms of ADHD (90% co-morbidity with children and 30% with adolescents).

    • ODD and CD symptoms (defiance, manipulation).

  • Substance abuse is a risk during adolescence.

  • Increased risk of eating disorders, specifically among females (e.g., anorexia, bulimia).

Behavioral Presentation

  • Symptoms can be setting-specific; behavior may vary at home vs. school.

  • Difficulty with Social Interactions: Children may not recognize social cues, potentially described by parents as bossy or intrusive.

  • Self-Mutilation: Some children may engage in self-harming behaviors or experience suicidal ideation, even at a very young age.

Diagnosis Considerations

  • Assessment Challenges: There are no definitive diagnostic tests, and behaviors may overlap with typical childhood development.

  • Medical conditions (e.g., diabetes, thyroid issues) need to be ruled out through comprehensive exams.

  • The diagnostic process includes gathering a family history, social history, and self-reports coupled with observations.

Importance of Early Intervention

  • Early detection and intervention can greatly impact mood stabilization and future behavior management.

  • Effective early intervention strategies can prevent risk-taking behaviors associated with adolescent bipolar disorder.

Case Study: 9-Year-Old Male

  • Background:

    • Born after a full-term vacuum delivery; normal developmental milestones.

    • Early behavior issues noted at 2-3 years old (tantrums, aggression).

  • Clinical Assessment:

    • Diagnosed initially with ADHD and ODD.

    • Behavioral difficulties persisted, leading to referral to psychological testing which revealed average intelligence and math giftedness.

  • Treatment Route:

    • Initially no pharmacological intervention taken by parents; Individual Program Plans (IPP) implemented for behavioral support.

    • Notable improvement with focus on anger management and reduced expectations in timed activities.

Role of School Counselors

  • School counselors must operate under the ASCA's National Standards.

    • Recommendations include:

    • Referrals for comprehensive assessment and treatment.

    • Collaboration with parents and teachers to form a cohesive support system.

    • Development of individualized programs promoting social skills and self-management.

    • Monitoring and documenting behavioral incidents for professional use during diagnosis and treatment.

  • Maintenance of Communication:

    • Daily logs and communication strategies aid in managing the child's educational experience and emotional response.

Management of Crisis Situations

  • Children showing severe behaviors should be taken seriously and managed safely, including possible removal from overstimulating environments.

  • Establishing communication protocols is essential for recognizing triggers and implementing preemptive strategies.

Conclusion

  • Many children face misdiagnosis related to bipolar disorder due to overlapping symptoms with other conditions. Recognition of unique behavioral presentations and early intervention is vital to accurately support children and enable educators and parents to provide better care and resources.