BEYOND ADHD AND ODD: BIPOLAR SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS - PowerPoint PPT Presentation

1 / 42
About This Presentation
Title:

BEYOND ADHD AND ODD: BIPOLAR SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS

Description:

ASPERGER'S SYNDROME. MOOD DISORDERS. Common Symptoms of Early-Onset Bipolar Disorder ... Firstad, M.A., & Goldberg Arnold, J.S. (2004) ... – PowerPoint PPT presentation

Number of Views:358
Avg rating:3.0/5.0
Slides: 43
Provided by: julie64
Category:

less

Transcript and Presenter's Notes

Title: BEYOND ADHD AND ODD: BIPOLAR SPECTRUM DISORDERS IN CHILDREN AND ADOLESCENTS


1
BEYOND ADHD AND ODD BIPOLAR SPECTRUMDISORDERS
IN CHILDREN AND ADOLESCENTS
  • Prepared for
  • Indiana Deaf Educators Conference
  • August 2 3, 2005
  • Julie T. Steck, Ph.D., HSPP
  • Childrens Resource Group

2
CASE STUDIES
  • TEDDY
  • Diagnosed with ADHD at age 4
  • Early speech and language difficulties
  • Behavior manageable in kindergarten
  • Behavior very problematic in grade one
  • Superior non-verbal IQ
  • Struggles with reading and paper-pencil
  • tasks
  • Difficulty with sleep, eating, anger

3
CASE STUDIES
  • SUZANNE
  • Eighth grade
  • Extreme separation anxiety and school phobia
  • Four previous hospitalizations
  • Tried on numerous medications for anxiety and
    depression with no change or worsened symptoms
  • Numerous somatic symptoms
  • Does well in English, struggles in math

4
CASE STUDIES
  • DAVID
  • Senior in high school
  • Difficulty with sleep and attention
  • History of substance abuse
  • Family history of suicide
  • No school problems of note
  • Introspective, creative
  • Unrealistic goals (be a model in LA)

5
EDUCATIONAL ISSUES
  • Excessive anxiety
  • School phobia/refusal
  • Runs out of classroom
  • Refuses to talk in class/do presentations
  • Frequent absences or trips to nurses office
  • Aggression
  • Intense hyperactivity

6
Autism Spectrum/Pervasive DevelopmentalDisorders

AUTISM/ ASPERGERS
PDD/NOS
7
Bipolar Spectrum/Mood Disorder Spectrum
Mood Disorder/NOS Bipolar II Bipolar
I
8
Primary Symptom isMood Dysregulation
9
Mania
Hypomania
Mood Disorder, NOS Bipolar II
Bipolar I
10
Secondary Symptom of Bipolar Spectrum
Disordersis Cognitive Dysregulation
  • Working memory
  • Visual-spatial reasoning
  • Planning/organization
  • Attention
  • Most noticeable in math and written language

11
Bipolar Spectrum DisordersCause Family
Dysregulation
  • Marital conflict
  • Financial strain
  • Difficulty with parents work schedules
  • Significant impact on siblings
  • Isolation from friends and extended family
  • Shame/fear/reliving old memories

12
Bipolar Disorder
  • Primary symptom is "mood dysregulation"
  • One of the most complicated severe of all
    psychiatric disorders
  • Also one of the most treatable
  • Underrecognized undertreated

13
Bipolar Disorder
  • Early, accurate diagnosis is a rarity
  • DMDA survey 48 did not receive accurate
    diagnosis until they had seen 3 or more
    professionals
  • 34 suffered with bipolar disorder for 10 years
    or more before correct diagnosis treatment

14
Bipolar Disorder
  • High level of morbidity major public health
    problem
  • Mortality suicide rate estimated between 23
    41.
  • Mortality can be reduced by 80 with appropriate
    treatment

15
Bipolar Disorder
  • Prevalence estimate 5.7 of adolescents have
    bipolar spectrum disorder
  • Lifelong condition with early onset
  • DMDA survey 31 experienced first bipolar
    symptoms before age 14 28 between 15-19 years
    of age.

16
Bipolar Disorder
  • Strong genetic basis
  • Underlying biological basis not fully understood
  • Dysregulation of neurochemical and neuroendocrine
    pathways
  • Oversensitivity of limbic brain

17
Cingulate Cortex
Cerebral Cortex
HIGHER BRAIN
Frontal Cortex
Corpus Callosum
Hippocampus
Thalamus
MIDDLE BRAIN
Cerebellum
Hypothalamus
Pons
Amygdala
LOWER BRAIN
Medulla
18
Speaking
Smell
Hearing
Taste
Conscious decision making
Generating Speech
Reading
AUTISM/ ASPERGERS SYNDROME
Vision
MOOD DISORDERS
FUNCTIONAL ANATOMY
19
Common Symptoms of Early-Onset Bipolar
Disorder(Papolos Papolos, 1999)
  • Separation-anxiety
  • Rages and explosive temper tantrums
  • lasting up to several hours
  • Marked irritability
  • Oppositional behavior
  • Rapid cycling or mood lability
  • Distractibility
  • Hyperactivity
  • Impulsivity

20
Diagnostic Challenges in Bipolar Disorder
  • Overlaps with many other disorders ADHD, panic,
    generalized anxiety, OCD, Tourettes
  • Estimated that 1/3 children diagnosed with ADHD
    actually have bipolar disorder
  • 1/3 of children diagnosed with depression will
    eventually manifest bipolar disorder


21
Differences between adult childhood bipolar
disorder
  • Adults typically have episodes of either mania or
    depression with relatively normal functioning
    between episodes
  • Children with bipolar disorder often both manic
    depressed at the same time
  • Younger children tend to be irritable, excitable
    explosive
  • Children frequently have multiple daily cycles of
    highs lows
  • Children often show a more severe, chronic course
    of illness

22
Bipolar disorder in adolescents
  • May resemble classical adult presentation with
    periods of wellness between episodes
  • Puberty is a time of risk for onset
  • In girls, onset of menses may trigger the illness
  • Alcohol and drug abuse common

23
The Many Moods of Bipolar Disorder
  • Manic episode
  • Hypomanic episode
  • Major depressive episode
  • Mixed episode

24
(No Transcript)
25
Symptoms of Mania
  • Euphoria or irritability
  • Needing little sleep yet having great amounts of
    energy
  • Racing thoughts and rapid speech
  • Easily distracted
  • Grandiosity inflated feeling of power,
  • greatness or importance
  • Reckless behaviors spending, promiscuity

26
Symptoms of Hypomania
  • Symptoms similar to mania, but less severe
  • No marked impairment in functioning
  • Psychotic features never present
  • Pleasurable
  • Seldom recognized by the patient as problematic

27
(No Transcript)
28
Symptoms of depression
  • Criteria same for childhood adult depression
  • Physical symptoms disturbances in sleep,
    appetite, energy, somatic complaints
  • Mental symptoms problems with concentration,
    memory
  • Emotional symptoms tearfulness, sadness,
    irritability, suicidal thoughts, hopelessness,
    pessimism

29
Symptoms of a mixed episode
  • Criteria for both mania and depression
    experienced nearly every day for at least one
    week
  • Mood alternates rapidly between euphoria,
    sadness, and irritability
  • Agitation, appetite disturbance, insomnia,
    psychosis, suicidal ideation are common

30
Subtypes of Bipolar Disorder
  • Bipolar I at least one manic or mixed episode
  • Bipolar II one or more episodes of both major
    depression and hypomania, but no manic or mixed
    episodes
  • Bipolar NOS partial criteria
  • Cyclothymia numerous episodes of hypomania and
    depression that do not meet criteria for mania
    or major depression

31
Bipolar Disorder Summary
  • Mood dysregulation disorder
  • Early onset, but challenging to diagnose given
    comorbidities developmental issues
  • Illness causes significant impairment in
    interpersonal, academic, and emotional
    functioning
  • Very treatable

32
INTERVENTIONS
  • Intervention starts with diagnosis
  • Education about the disorder for the
    parent/child/educators
  • Appropriate and closely monitored medication
    management
  • Therapy (Diagnositic, educational, family,
    cognitive-behavioral, supportive)
  • School programming

33
Treatment Planning
34
SCHOOL CONSIDERATIONS
  • Little learning will take place until mood is
    stabilized
  • Goals should proceed from attendance to
    participation to production
  • Reading comprehension, speed and accuracy of math
    and written expression most affected

35
SCHOOL CONSIDERATIONS
  • Student cannot complete as much work in same
    amount of time as other students with same
    ability
  • Student has difficulty with flexibility so
    teachers/staff must be flexible
  • Performance will be variable
  • Fatigue, hunger, illness, mild life issues will
    have major impact on functioning

36
SCHOOL CONSIDERATIONS
  • Environmental issues are important
  • (lighting, seating, noise/distractions)
  • Periods of transition are taxing
  • Communication among those involved with the
    student is critical
  • Student needs a safe place and a
  • confidante at school

37
SCHOOL CONSIDERATIONS
  • Behavior should not be interpreted at face
    valueimportant to look at the underlying
    emotions
  • Writing assignments and math will be the most
    threatening for these students
  • Students may need more than the
  • four year plan for high school

38
PEARLS . . .
  • Treat a Bipolar Spectrum Disorder as a chronic
    illness . . . it will wax and wane but not be
    cured.
  • Children do well if they can.
  • Ross Greene, 2001.

39
Reading List
  • The Bipolar Child, Papolos and Papolos, Broadway
    Books, 2002.
  • The Bipolar Disorder Survival Guide, Miklowitz
    DJ., The Guilford Press, 2002.
  • An Unquiet Mind, Jamison KR, Knopf, 1995.
  • Touched with Fire Manic-depressive Illness and
    the Artistic Temperament, Jamison KR, Maxwell
    Macmilllan International
  • The Explosive Child, Greene R, Harper Collins,
    2001.

40
Reading List
  • His Bright Light, Steel D, Delacorte Press, 1998.
  • Survival Strategies for Parenting Children with
    Bipolar Disorder, Lynn GT, Jessica Kingsley
    Publishing, 2000.
  • Straight Talk About Psychiatric Medication for
    Kids, Wilens TE, Guilford Press, 1998.
  • Geller, B. DelBello, M.P. (2003). Bipolar
    Disorder in Childhood and Early Adolescence. New
    York Guilford Press.

41
Reading List
  • Its Nobodys Fault New Hope for Difficult
    Children. Harold S. Koplewicz. Three Rivers
    Press, 1996.
  • When You Worry About the Child You Love
    Emotional and Learning Problems in Children.
    Edward Hallowell. DIANE Publishing, 1999.
  • Firstad, M.A., Goldberg Arnold, J.S. (2004).
    Raising a Moody Child how to cope with
    depression and bipolar disorder. New York
    Guilford Press.

42
  • Julie T. Steck, Ph.D., HSP
  • Childrens Resource Group
  • 9106 North Meridian, Suite 100
  • Indianapolis, IN 46260
  • 317/575-9111
  • www.childrensresourcegroup.com
Write a Comment
User Comments (0)
About PowerShow.com