Bipolar diagnosis has increased in children over the years. Understand the bipolar diagnosis and find options for support, including treatment.
Does your child go through intense mood changes? Most children do, however, if your child go through these moods to the point where they are unable to function normally at school and at home, then they may have bipolar disorder.
Bipolar disorder is a serious condition where a persons mood can swing from feeling very happy or “up” to very sad or “down.” The “up” mood is known as manic episode and the “down” mood is called a depressive episode. The fluctuation between the two of these moods can cause a child to be hyper productive one moment and show signs of depression the next. While Bipolar disorder can be diagnosed in children, it is usually developed during the teen years or early adulthood. Bipolar symptoms usually lasts a lifetime. There is no known cause for Bipolar disorder.
Children with bipolar disorder can have other problems including: substance abuse problems, ADHD, Anxiety disorders. Suicidal thoughts can also be a problem.
Here is the criteria for diagnosis from the DSM-5 (Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition).
Includes at least 5 of the following symptoms occurring over the same 2-week period and must include either #1 or #2:
The DSM defines mania as a “distinct period of abnormally and persistently elevated, expansive, or irritable mood.” The episode must last at least a week. The mood must have at least three of the following symptoms. A Hypomanic Episode is very similar to a manic one, but less intense, requiring to persist for 4 days. Symptoms should be observable by others that the person is noticeably different from his or her regular, non-depressed mood and the change has an impact on his or her functioning.
Would fulfill the symptom requirements for both a Major Depressive Episode and a Manic Episode where the person is experiencing symptoms nearly every day. Mixed symptoms only need to last for a 1-week period.
For all four of these episodes, the symptoms must have an impact on the person’s ability to function and can’t derive from some other circumstance or illness that would logically, or better, account for its expression.
The main difference between BP I and BP II is full mania (7 days) v. hypomania (4 days). Once a person experiences a full manic episode, they will receive a BP I diagnosis.
The Bipolar I diagnosis, (with Manic Episode), gets broken down into six different sub-diagnoses which are not important to detail here. Broadly, they are defined by which type of episode the patient is currently in or has most recently experienced and which types of episodes (if any) they have experienced in the past. Two of the six diagnoses do not require the experience of any Major Depressive Episodes.
For a Bipolar II diagnosis, (no Manic Episode) the person must have experienced at least one Major Depressive Episode and at least one Hypomanic Episode.
Once the diagnosis is confirmed it will be important to begin treatment as soon as possible. The earlier the treatment starts the better it is for your child. It is documented that children, with early treatment, are better able to function over time. Begin by working with your physician to determine what treatment option will work best for your child. Bipolar, like other mental health diagnosis, manifest themselves differently in each child. The length of manic and depressive episodes will vary as will the intensity. You will need to do a lot of monitoring of your child before an episode and during treatment. It is helpful for parents to document things by keeping a daily journal of your child’s moods and behaviors. This information will help determine if your child exhibits more manic or depressive features and how best to address them. Parents are the first line of treatment and can provide a foundation for treatment that is successful for the child. Be aware. Be informed. Be active.
Different kinds of psychotherapy can help children with Bipolar disorder. The following approaches are the most effective when treating Bipolar disorder:
This focuses on behaviors that decrease stress as learning how to manage stress will be helpful in dealing with symptoms.
This type of approach involves learning to identify problem thinking and to modify behaviors to correct that thinking pattern.
This focuses on relationships with the goal of reducing strain the illness may place on the individual.
This approach is focused on helping maintain a normal routine sleep schedule. Predictability is helpful for children with mental disorders.
Parents should be prepared to accept that the therapy approaches will change over time. Parents should engage in treatment when necessary and provide feedback to the therapist about progress. Parents should evaluate if therapy is working and make changes if they do not see progress within a reasonable amount of time. Effective therapy will help a child learn coping skills and strategies that will help decrease the severity of the mood swings. Being able to manage the severity of the mood swings may make it possible for a decrease in medication over time. This is, of course, under the direction of the physician managing treatment. Do not change dosage of your child without a doctor’s approval.
There are several types of medications that can help children with Bioplar. All children respond differently to medication so the right medication and dosage will vary. Children should take the least amount of medication necessary to address issues. Physicians will help determine what dosage that is. As mentioned before, parents can play a key role in treatment by keeping a daily journal. The daily journal can should list the date, behaviors, responses and medication intake. This information will be helpful for the physician when deciding on medication treatment.
The role of parents is very important in treatment of Bipolar disorder. Parents will be able to gauge both the progress of the child with treatment and the effectiveness of treatment for the child. Parents should be actively seeking for new information on treatment and, if necessary, move treatment in a different direction if things are not going well.
Parents can implement some parenting skills to help at home. The recommended skills for parents to master with children who have been diagnosed with Bipolar Disorder are the ABC’s of Behavior and Preventive Teaching.
This concept is especially helpful for children to connect their feelings with their behaviors and the ultimate consequences of those behaviors.
Teaching a child how to handle the stress of situations allows a child to better manage the triggers that may set off an episode.
There are additional tips, ideas, games and activities associate with these behavior skills to help children of all ages learn these lessons. Feel free to explore the Smarter Parenting lessons page for more information on these and other skills. Once you and your child have mastered these skills, feel free to implement another lesson until you have learned them all.
The National Institute of Mental Health provides further insight into Bipolar Disorder with videos, testimonials, and where to find help in your area.
The Depression and Bipolar Support Alliance provides an online community for parents and children with Bioplar Disorder.
Help Guide provides tips for how to support someone who is suffering/taking care of someone with Bipolar Disorder.
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