About Pediatric Bipolar Disorder

A Guide for Families by the 
The Balanced Mind Parent Network

 

Table of Contents

 

 “There's a tremendous amount 
  of progress in understanding bipolar
  disorder. It's a bad illness to have, 
  but a good time to have it.” 


  Kay Redfield Jamison, Ph.D.



 

 

Introduction  
Diagnosis
Prognosis
First Steps
Finding a Doctor
Goals of Treatment     
Medication
Psychotherapy
Sleep & Exercise
Parenting
Genetics
Prevalence
Education
Support for Parents

 

 

Bipolar disorder (also known as manic-depression) is a chronic brain disorder marked by bouts of extreme and impairing changes in mood, energy, thinking, and behavior. The most outwardly apparent symptoms are behavioral; however, the illness often has less visible, but serious, cognitive, cardiac, and metabolic effects. Symptoms may emerge gradually or suddenly during childhood, adolescence, or adulthood. Researchers have identified cases of bipolar disorder in every age group studied, including preschoolers.1    
Here, The Balanced Mind Parent Network examines bipolar disorder that emerges in childhood or adolescence.

Bipolar disorder does not affect every child in the same way. The frequency, intensity, and duration of a child’s symptoms and the child’s response to treatment vary dramatically. As the child grows up, bipolar disorder may affect the size, shape, and function of brain regions and networks. Recent research suggests that pediatric bipolar disorder is a neurodevelopmental disorder. Parts of the brain mature (or come online) at different rates and times; brain maturation is not complete until an individual is 25 or so. Consequently, the symptoms and diagnosis of a psychiatric illness may change as the child grows.   

There is presently no cure for bipolar disorder. Yet, there are reasons for optimism. Research to help children and adults with this illness is ongoing. Genetic discoveries are expected to lead to more accurate diagnosing, better treatments, and perhaps a cure. As always, it is wise to expect the best but prepare for the worst. Learn where the road ahead may lead. Develop strategies and contingency plans while staying flexible and confident in the present. Network with other parents. Be involved in The Balanced Mind Parent Network. Most importantly, take care of yourself. 

Diagnosis

Pediatric Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders, the formal psychatric diagnostic manual referred to as the "DSM-IV", is the standard reference for diagnosing psychiatric disorders. However, when the DSM-IV was first published in 1994, the entire focus was on adult-onset bipolar disorder. In the decade plus since then, rapid research developments in every area of science, especially the brain, have answered many old questions and opened the door to new questions we couldn't even articulate then.

We now understand that children and adolescents can have bipolar disorder. Some of our ill children meet the textbook definition of bipolar disorder. Some of our ill children with severe mood dysregulation might not meet the textbook definition because they don't have distinct episodes of a certain duration or have few clear periods of wellness between episodes. They might have rapid and severe cycling between moods or they might present in a mixed state that produces chronic irritability. Experts have not yet reached consensus as to whether children with chronic irritability and clear mood swings, but without mania, should be classified as having bipolar disorder.  The Balanced Mind Parent Network urges the research community to agree on a common terminology and a way to communicate with each other and with families about the full spectrum of the severe illness(es) impairing our children. It is imperative that we work together to alleviate the terrible suffering that this disorder wreaks.

The DSM-IV Diagnosis

The DSM-IV describes four types of bipolar disorder.2 

Bipolar I. In this form of the disorder, the individual experiences one or more episodes of mania. Episodes of depression may also occur, but are not required to diagnose bipolar disorder. 

Symptoms of mania include:

  • euphoria (elevated mood)—silliness or elation that is inappropriate and impairing
  • grandiosity
  • flight of ideas or racing thoughts
  • more talkative than usual or pressure to keep talking
  • irritability or hostility when demands are not met
  • excessive distractibility
  • decreased need for sleep without daytime fatigue
  • excessive involvement in pleasurable but risky activities (daredevil acts, hypersexuality)
  • poor judgment
  • hallucinations and psychosis

For an episode to qualify as mania, there must be elevated mood plus at least three other symptoms, or irritable mood plus at least four other symptoms.

Symptoms of depression include:

  •  lack of joy and pleasure in life
  • withdrawal from activities formerly enjoyed 
  • agitation and irritability
  • pervasive sadness and/or crying spells
  • sleeping too much or inability to sleep
  • drop in grades or inability to concentrate
  • thoughts of death and suicide
  • fatigue or loss of energy
  • feelings of worthlessness
  • significant weight loss, weight gain or change in appetite

Stable periods occur between episodes of mania and depression. An episode must last at least one week, or, if hospitalization is necessary, may be of any duration.

Bipolar II. In this form of the disorder, the individual experiences recurrent periods of depression with episodes of normal mood (euthymia) or hypomania between episodes. Hypomania is a markedly elevated or irritable mood accompanied by increased physical and mental energy. Hypomania can be a time of great creativity and energy and may, but not always, progress into full-blown mania if not treated. Some people with bipolar disorder never develop full-blown mania. 

Bipolar Disorder NOS (Not Otherwise Specified).Doctors may make this diagnosis when there is severe mood dysregulation with serious impairment, but it is not clear which type of bipolar disorder, if any, is emerging.  Perhaps the individual has always been impaired, with cycling apparent since infancy. Maybe there have been no discernable periods of wellness. Perhaps the child is experiencing the emergence of another neurodevelopmental illness and the symptoms of that disorder have not yet been fully expressed. The inability to pinpoint a diagnosis should not be taken as a dismissal of the severity of the child’s symptoms.  

Cyclothymia. This form of the disorder produces recurrent periods of less severe, but definite, mood swings that seriously impair the individual's life. Cyclothymia may progress into full bipolar disorder.

A Child's Behavior

Since its founding in 1999, The Balanced Mind Parent Network has reviewed numerous family accounts that repeatedly report similar behaviors. If your child exhibits more than a few of these behaviors and you know something is wrong, follow through with our First Steps plan. This is especially crucial if there is a history of mood disorders or substance abuse in your child's family.

  Severe and recurring depression
  Explosive, destructive or lengthy rages, especially after the age of four
  Extreme sadness or lack of interest in play
  Severe separation anxiety
  Talk of wanting to die or kill themselves or others
  Dangerous behaviors, such as trying to jump from a fast moving car or a roof
  Grandiose belief in own abilities that defy the laws of logic (possessing ability to
       fly)
  Sexualized behavior unusual for the child’s age
  Impulsive aggression
  Delusional beliefs and hallucinations
  Extreme hostility 
  Extreme or persistent irritability
  Telling teachers how to teach the class, bossing adults around
  Creativity that seems driven or compulsive
  Excessive involvement in multiple projects and activities
  Compulsive craving for certain objects or foods
  Hearing voices telling them to take harmful action
  Racing thoughts, pressure to keep talking
  Sleep disturbances, including gory nightmares or not sleeping very much
 Drawings or stories with extremely graphic violence

 Is it Bipolar Disorder, Something Else, or a Mixed Bag?

Bipolar disorder is often accompanied by symptoms of other psychiatric disorders (those other disorders are said to be "comorbid" with the bipolar disorder). In some children, proper treatment for bipolar disorder clears up the 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. An accurate diagnosis of a child or teen presenting with severely troubled behavior is perhaps the most problematic issue facing families.

Diagnoses that mimic, mask, or co-occur with pediatric bipolar disorder include:  

  • Attention-deficit hyperactivity disorder (ADHD)* 
  • Depression** 
  • Oppositional-defiant disorder (ODD) 
  • Conduct disorder (CD) 
  • Pervasive developmental disorder (PDD) 
  • Generalized anxiety disorder (GAD) 
  • Panic disorder 
  • Obsessive-compulsive disorder (OCD) 
  • Tourette's syndrome (TS) 
  • Seizure disorders 
  • Reactive attachment disorder (RAD)

* It is estimated that 85% of children with bipolar disorder also have ADHD and up to 22% of children with ADHD have bipolar disorder.3  

**Depression in children and teens is often chronic and cyclical. A significant proportion of the millions of children and adolescents with depression may actually be experiencing the early onset of bipolar disorder, but have not yet experienced the manic phase of the illness.

Bipolar disorder is often misdiagnosed as:

  • ADHD or ADHD with depression
  • Depression
  • Borderline personality disorder
  • Post-traumatic stress disorder (PTSD)
  • Substance abuse


 
Just, as juvenile diabetes is generally a more severe disorder than adult-onset diabetes, pediatric bipolar disorder appears to be more perilous than adult-onset bipolar disorder. The rationale for early intervention is compelling. 

Common outcomes of pediatric bipolar disorder are school refusal, suspension, and dropping-out; impulsive acts of aggression; self-injury; substance abuse; and suicide attempts and completions. Teens with symptoms of untreated bipolar disorder are arrested and incarcerated. Suicide is the third leading cause of death among teens. Children as young as six have attempted to hang, shoot, stab or overdose themselves. Suicide Prevention Tips.   

The longest study on pediatric bipolar disorder is ongoing under the direction of Barbara Geller, M.D., a child psychiatrist at Washington University in St. Louis. In the mid-1990s, Dr. Geller began observing 93 children whose average age was 10.8 years. All of the children had mania (Bipolar I) which had begun to onset at an average age of 6.8 years. Assessing the children after four years, Geller and colleagues found that children with mania were sicker than adults, less likely than adults to recover, and relapsed sooner than adults with mania.4   Differences in symptom severity and frequency of cycling between manic and depressive episodes have presented questions as to whether bipolar disorder in youth is the same illness as in adults. A study published in 2006 by Dr. Geller and colleagues showed that early-onset Bipolar I disorder does appear to be the same illness as adult-onset Bipolar I disorder.5

Another study of three major subtypes of bipolar disorder that affect children and adolescents is ongoing under the direction of David Axelson, M.D., a child psychiatrist at Western Psychiatric Institutes and Clinics in Pittsburgh. A report on the 263 children and adolescents, ages 7-17 years, confirmed that bipolar disorder affects children and adolescents more severely than adults.6 “Study participants had comparatively longer symptomatic stages and more frequent cycling (changing from one mood to another) or mixed episodes. Children and adolescents also converted from a less severe form of bipolar disorder to a more severe form at a much higher rate than seen in adults.”7


First Steps

Parents with concerns about their child’s extreme behaviors should consider the following steps:

  •  If your child is psychotic, suicidal, or menacing others: take him or her to the emergency room or call 911 for an ambulance (stress that the child needs medical care and an ambulance should be sent). If you are alone, also call a friend or relative to help you immediately.
  •  Ensure the safety of your family. Find safe havens for siblings. Remove all firearms from the home (this is a matter of life and death, not a political statement). Lock up sharps (knives, razors, whatever). Lock up all prescription and over-the-counter medications. Childproof your home, no matter the physical age of your child.
  • Request an urgent appointment to have your child evaluated by a psychiatrist familiar with pediatric bipolar disorder. Start the process now. Your insurance plan might require a referral from your primary care provider. You might also be required to see a social worker or therapist for evaluation before you are permitted to access a psychiatrist.  If your child is suspected of abusing substances, a substance abuse evaluation will be needed.  Prepare for the initial meeting
    • Start a mood chart for your child today.  Make daily notes of your child's mood, behavior, sleep patterns, events, medications. Include statements by the child that seem odd or concern you. Share your notes with the professional who evaluates your child and with the doctor who eventually treats your child. 
    •  Compile a brief family history on both sides. Include family members who have abused alcohol or drugs. Include family members who have been diagnosed with mood disorders, bipolar disorder, or other psychiatric diagnoses. Remember that even if a family member was not diagnosed, it may be a critical link if that person was hospitalized, attempted or completed suicide, or has a history of numerous marriages, fighting, or reckless behavior. 
  •  Keep a notebook or file in which you keep records of each doctor visit and results of lab tests. This notebook will be a good place to keep a list of all medications your child has trialed, the dates, the doses, and the effects. You can keep your mood charts in here too. And your family history.
  • Educate yourself about bipolar disorder. Join The Balanced Mind Parent Network and connect with others on The Balanced Mind Parent Network’s message boards and online support networks. We’re here to help you. Later on, you can volunteer to help others!
  • Take care of yourself! Remember the flight attendant's safety talk on the airplane: put on your oxygen mask first so that you are in a position to put your children's masks on. Reduce stress, address your own mental health issues, exercise.


Finding a Doctor

Child psychiatrists are scarce. And few have extensive experience treating pediatric bipolar disorder. Teaching hospitals affiliated with medical schools are often a good place to start looking for an experienced child psychiatrist. Call the hospital’s child psychiatry outpatient clinic for an appointment. Perhaps your pediatrician can refer you to a child psychiatrist. An alternative to a child psychiatrist with expertise in mood disorders, is an adult psychiatrist who has a comprehensive background in mood disorders and experience in treating children and adolescents. Check the The Balanced Mind Parent Network Directory of Professional Members for doctors and other professionals who list themselves as treating pediatric bipolar disorder in your area. The American Academy of Child and Adolescent Psychiatrists also has an online doctor finder.

Other specialists who may be able to help, at least with an initial evaluation, include psychotherapists and  pediatric neurologists. Psychotherapists may recognize symptoms and refer your child to a psychiatrist for evaluation. Neurologists have experience with the anti-convulsant medications often used for treating bipolar disorders

Some families travel to take their child to nationally-known doctors at teaching hospitals for the initial evaluation, diagnosis, and treatment recommendations. They then turn to local professionals for ongoing medical management of their child's treatment and psychotherapy. The local professionals consult with the expert as needed.

Some families enroll their children in research studies run by recognized experts, often providing an in-depth evaluation. The National Institute of Mental Health in Bethesda, Maryland, sometimes has spaces available in approved studies for children with mood symptoms. You can also try consulting other parents through The Balanced Mind Parent Network’s online forums or seeking information from a member of the The Balanced Mind Parent Network Family Helpine.


Goals of Treatment

The initial goals of treatment are to relieve the child’s suffering and to stop dangerous behavior. This is accomplished by alleviating the severest symptoms, such as suicidal thoughts and actions, aggression, destructive behavior, psychosis, and sleep disturbances.  The long-range goals of treatment are to stabilize mood and extend the period of wellness so that the child is less impaired and may resume developing on a more typical path. Additionally, a successful treatment plan will minimize the side effects of medication.

There are many components to a good treatment plan. Ideally, your menu will include:

  • Medication and monitoring of side effects. 
  • Close monitoring of symptoms. 
  • Education about the illness for your child and you. 
  • Psychotherapy for your child and family. 
  • Treatment of coexisting disorders. 
  • Accommodations at school. 
  • Stress reduction. 
  • Good nutrition and steady exercise. 
  • Adherence to a regular sleeping schedule and a consistent routine.

Responses to a good treatment plan vary greatly. With appropriate treatment and support at home and at school, many children with bipolar disorder achieve a marked reduction in the severity, frequency, and duration of their episodes. Just as with other chronic illnesses such as diabetes and epilepsy, children who are educated about bipolar disorder can learn how to manage and monitor their symptoms as they grow older, and some experience long periods of wellness.  More than a few longtime The Balanced Mind Parent Network members report that their children have achieved lengthy remissions, graduated from high school, and are attending college successfully or living and working independently. 

Factors that contribute to a better outcome are:

  • Early diagnosis and treatment. 
  • Access to competent medical care.   
  • Adherence to medication and treatment plan. 
  • A flexible but consistent low-stress home and school environment 
  • A supportive network of family and friends 
  • Family members who are effective advocates for the child’s medical, educational, and therapeutic needs

Factors that hinder treatment effectiveness are:

  • Time lag between onset of illness and treatment. 
  • Limited access to competent medical care.
  • Not taking medication as prescribed.
  • Not having a regular sleep/wake cycle.
  • Co-occurrence of other disorders including any use of alcohol or unprescribed drugs.
  • Stressful, inflexible, or negative home or school environment. 
  • Traumatic life events. 
  • Lack of insight.

In most cases, symptoms can be managed at home with outpatient treatment. Sometimes though, severe episodes require rapid medication adjustments that are best done in an inpatient unit. And some children’s illnesses cannot be successfully managed at home. These children and their families may benefit from longer stays in residential treatment centers or therapeutic boarding schools that can provide treatment and education in a safe and highly-supervised setting.

Unfortunately, relapses are common even with the best treatment; in fact, relapse is a hallmark of bipolar disorder. Even with treatment by professionals, children may need hospitalization or residential treatment. Upon reaching 18, many young adults with bipolar disorder still require significant support. In fact, The Balanced Mind Parent Network advocates that you keep in mind that the adult brain of a typical individual does not fully mature until age 25.

A symptomatic child should not be untreated. If parental disagreement makes treatment impossible, illness education (psychoeducational therapy) is recommended. As a last resort, a court order regarding treatment may become necessary.

Medication

Medication is the first line of treatment for any patient with bipolar disorder. The Balanced Mind Parent Network recommends that parents and clinicians consult the Treatment Guidelines for Children and Adolescents with Bipolar Disorder. The Guidelines contain specifics of medications currently used to treat children and teenagers with bipolar disorder. 

No one medication works in all children. Expect a lengthy trial-and-error process as your doctor may have to prescribe several medications, alone or in combination. The Balanced Mind Parent Network advises generally: "Start Low. Go Slow." Two or more mood stabilizers or other medications may be necessary to achieve and maintain the best response.  And it is very common that a medication regimen that works might have to be changed as the child grows and the disorder presents differently.

Because of the lack of controlled studies, the Food and Drug Administration has approved only a few psychiatric medications specifically for pediatric use. You might want to keep in mind, however, that few medications used to treat any illnesses— including cancer— have been FDA-approved for children. In many cases, neither pharmaceutical companies nor the government opts to invest in drug trials in children because of the difficulty of finding child subjects or because of the costs or for various other reasons. (Some parents try vitamins or other alternative treatments; research studies have, likewise, not found these effective in reducing the symptoms of bipolar disorder). 

Psychiatrists must adapt what they know about treating adults to children and adolescents. The use of FDA-approved psychiatric medications in children is legal and relatively common in the United States.  If a medication is FDA-approved for some age or some condition, a doctor may— in his or her professional judgment— prescribe its use for any age or for any condition. Doctors often treat illnesses in children with medications found safe and effective and approved for use in adults with the same illness. 

However, more research is needed not only on the effectiveness of these medications on children but also on side effects and dosing strategies. One side effect clearly of concern is metabolic syndrome. As for dosing strategies, children’s bodies process drugs differently from adults (they sometimes need more of a medication eliminated by the kidneys or less if the drug is metabolized by the liver). A blood test, theCytochrome P-450, is available to determine how a child’s liver processes drugs. The results might be useful to evaluate which drugs may result in adverse effects and to calculate dosing schedules. 
 
The use of psychiatric medications with any child requires close supervision by medical personnel and by caregivers who are knowledgeable, mentally healthy, and organized. Some caregivers may themselves need close supervision and in-home assistance to manage the complex treatment regimens for a child with bipolar disorder.

The Balanced Mind Parent Network has heard from many parents that medications used to treat their children have proven effective.  Yet it is often hard to accept that your child has a chronic condition that requires long-term treatment with several medications. Remember bipolar disorder has a high mortality rate. Estimates vary but the suicide rate in untreated bipolar disorder is 30 to 60 times higher than that of the general population. The untreated disorder also carries the risk of drug and alcohol addiction, damaged relationships, school failure, difficulty finding and holding jobs, tragic encounters with law enforcement, and even violence. The risks of not treating the illness are known and substantial.  These risks must be measured against the risks of using medications whose safety and efficacy have been established in adults but perhaps not in children. The Balanced Mind Parent Network advocates for families to have full access to medications to treat bipolar illness— and competent professionals to prescribe and monitor them— because they are life-saving.  

 

In addition to seeing a psychiatrist, the treatment plan for a child with bipolar disorder usually includes regular therapy sessions with a licensed clinical social worker, a licensed psychologist, or a psychiatrist who provides psychotherapy. It is important that the child like the therapist. Cognitive behavioral therapy, interpersonal therapy, and multi-family support networks are an essential part of treatment for children and adolescents with bipolar disorder. These may be offered by a teaching hospital in a large city. Dialectical behavioral therapy, which teaches skills to help the patient learn to tolerate and manage extreme mood states, appears promising.  
 
Therapy might not be effective until mood stabilization occurs. An unstable child is unlikely to be able to absorb the concepts of therapy. While the child is wracked by the turmoil of extreme lows or highs or sudden shifts in mood, cognitive skills are impaired and learning often comes to a standstill until he or she reaches a stable plateau.

Sleep and Exercise

Regular sleep patterns help tackle the fact that your child with bipolar disorder has an out-of-whack biological clock; regular sleep patterns can reduce cycling and mood fluctuations. Provide a child with the necessary routine and deviate only when absolutely necessary. Tell your child (especially your teenager!) to see himself or herself as a farmer: go to bed with the sun and wake up with the sun. Enforce consistent bedtimes and awake times all week long; teens who fall into a weekend pattern of staying up late and sleeping late find that by Monday morning their biological rhythms are out of kilter. Keep to a sleep routine even in the summer. Maybe you can schedule a fun morning activity to motivate your child to get up. Even a few missed wake/sleep cycles can have unfortunate consequences.

Exercise combats depression and can serve as an important tool in stress reduction. Exercise helps your child let go of anger, anxiety and tension. The naturally-occurring beta endorphins that the brain releases during exercise have a calming effect on the body. Trampolines, punching bags, jump ropes, electronic dance mats and treadmills in front of the TV are some ways to provide an exercise outlet at home. 
 

Here are some ideas for you:  

  • Learn and use good listening and communication skills.
  • Prioritize issues (battles) and let go of less important matters.
  • Practice and teach relaxation techniques to your child. Use music, sound, lighting, water, massage to help your child with falling asleep, waking up, and relaxing.
  • Help your child anticipate, and avoid or prepare for, stressful situations by developing strategies in advance.
  • Learn safe but firm restraint holds to contain rages.
  • Advocate at school for stress reduction and other accommodations.
  • Engage your child's creativity through activities that express their gifts and strengths.
  • Provide routine structure while allowing freedom within express limits.

Genetics

Bipolar disorder is a complex genetic illness.  The illness is highly inheritable. Researchers have uncovered a handful of genes that may elevate the risk of bipolar disorder and are searching for dozens more genes that may be involved. The following statistics support the search for the genetic origins of bipolar disorder:

  • For the general population, a conservative estimate of an individual's risk of having Bipolar I disorder is 1% to 3%. Disorders in the bipolar spectrum are thought to affect at least 4% to 6 % of the general population.
  • When one parent has bipolar disorder, the risk that his or her child will have bipolar disorder is 15% to 30%.
  • When both parents have bipolar disorder, the risk increases to 50% to 75%.
  • If a sibling (including a fraternal twin) has bipolar disorder, the child's risk is 15% to 25%.
  • The risk in identical twins is approximately 85%.8

The family trees of many children who develop pediatric bipolar disorder include individuals who suffered from substance abuse or mood disorders (perhaps undiagnosed) or both. Because previous generations were less likely to diagnose bipolar disorder, affected family members may have been written off as “crazy Auntie” or simply as prone to troubling behaviors, such as alcoholism, frequent periods of unemployment, dysfunctional personal relationships, bankruptcies, or incarceration. Interestingly, the family tree might also have many members who are highly-accomplished, creative, charismatic and extremely successful in business, politics, and the arts. 

Prevalence

Currently, there are very few studies, and none in the US, that establish theprevalence of bipolar disorder in children. In a review of data in the Netherlands Twin Registry, 4% to 5% of more than 6,000 ten-year-olds were deemed likely to meet criteria for pediatric bipolar disorder.

A recent study showed a 40-fold increase in the diagnosis of bipolar disorder in the US in the past ten years. The study reveals that in 1994, very few doctors wished to label children as bipolar (25 bipolar diagnoses per 100,000 people). Yet even the 40-fold increase rate in 2003 (1,003 bipolar diagnoses per 100,000 people) is still well below the rate of bipolar disorder for adults (1,679 bipolar diagnoses per 100,000 people).9  Further, a long-term NIMH study of adults shows at least 65% felt their illness onset in childhood or adolescence and acknowledges a lag between onset and diagnosis in adults.

As with autism, some of the increase in diagnosis is due to greater awareness in the medical community and the public leading to earlier diagnosis. The Balanced Mind Parent Network believes that children have been suffering from bipolar disorder all along but in the past were dismissed as 'bad seeds' or the product of poor parenting.  On the other hand, further research is absolutely necessary to establish the prevalence of bipolar disorder in children and the reasons for it. 

Education

Your child with bipolar disorder has a significant health impairment that requires ongoing medical management. Bipolar disorder and the medications used to treat it often have a significant impact on a child's education. The child's functioning may fluctuate throughout the day, the season, and the school year.

The educational needs of a child with bipolar disorder vary immensely. Bipolar disorder can affect a child's school attendance, alertness and concentration, sensitivity to light, noise and stress, motivation, and energy available for learning. Transitions to new teachers and new schools, return to school from vacations and absences, and changing to new medications commonly increase symptoms. 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. 
 
A child needs and is entitled to the school accommodations necessary to ensure his or her education. The special education staff, parents, and professionals should form a team to determine the child's educational needs. Some families pay for extensive private testing but your public school must provide an evaluation including specialized testing. Specifically request an Individual Education Program (IEP) that identifies the factors that affect the child's education and how they will be accommodated. 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. A letter from the child's doctor to the director of special education in the school district may be persuasive. Some parents find it helpful to hire an education advocate or necessary to hire a lawyer or to obtain the services that federal law requires public schools to provide for children with health impairments.

The Balanced Mind Parent Network's online pamphlet, Educating the Child with Bipolar Disorder, describes accommodations and strategies that may be helpful.

Support for Parents

Learn all you can about bipolar disorder. Read, join support networks, and network. Not surprisingly, other parents are often a good source of ideas and strategies for parenting a bipolar child.

Childhood is a window of opportunity in which parents have the chance to provide treatment that may profoundly benefit their children’s development and save their children’s lives. When your child becomes a legal adult, state laws on privacy and individual rights may exclude you from participating in treatment decisions and from talking with the professionals who treat your child. Help establish now as firm a foundation as possible for your child to reach adulthood and be able to make sound independent judgments.

We know that learning and confronting that one's child has bipolar disorder is traumatic and often follows an extended period of instability, school difficulties, and damaged relationships with family and friends. More positively, however, diagnosis can and should be a turning point for everyone concerned. Once the illness is identified, energies can be directed toward treatment, education, and developing coping strategies. Proper treatment can minimize the adverse effects of the illness on your child and the lives of those who love your child.

We hope this article, and the rest of the The Balanced Mind Parent Network Web site, will save you precious time and help you make the many decisions you face as parents so that your children achieve stability, gain the best possible level of wellness, and grow up to enjoy their gifts and build upon their strengths.

© The Balanced Mind Parent Network, 2007, 2010
www.thebalancedmind.org

About BP was produced by Martha Hellander (J.D.), Sheila McDonald (J.D.), Lisa Pedersen (M.A.), and Susan Resko (M.M.) all of whom have been there.

_________________________________
1 Luby J, Belden A. Defining and validating bipolar disorder in the preschool period.  Dev Psychopathol. 2006 Fall;18(4):971-88.
2 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.Washington, DC, American Psychiatric Association, 2000.
Singh MK, Delbello MP, Kowatch RA, Strakowski SM.  Co-occurrence of bipolar and attention-deficit hyperactivity disorders in children.  Bipolar Disord. 2006 Dec;8(6):710-20
4 Geller B, Tillman R, Craney JL, Bolhofner K.  Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry.  2004 May;61(5):459-67
5 Geller B, Tillman R, Bolhofner K, Zimerman B, Strauss NA, Kaufmann P. Controlled, blindly rated, direct-interview family study of a prepubertal and early-adolescent bipolar I disorder phenotype: morbid risk, age at onset, and comorbidity. Arch Gen Psychiatry. 2006 Oct;63(10):1130-8.
6 Birmaher B, Axelson D, Strober M, Gill MK, Valeri S, Chiappetta L, Ryan N, Leonard H, Hunt J, Iyengar S, Keller M. Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry. 2006 Feb;63(2):175-83.
7 National Institute of Mental Health, Web site accessed July 3, 2007:http://www.nimh.nih.gov/science-news/2006/largest-study-to-date-on-pediatric-bipolar-disorder-describes-disease-characteristics-and-short-term-outcomes.shtml
8 McGuffin P, Rijsdijk F, Andrew M, et al.  The heritability of bipolar affective disorder and the genetic relationship to unipolar depression.  Arch Gen Psychiatry. 2003 May;60(5):497-502.
Carmen Moreno; Gonzalo Laje; Carlos Blanco; Huiping Jiang; Andrew B. Schmidt; Mark Olfson Arch Gen Psychiatry. 2007;64:1032-1039

Last updated: March 24, 2014

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