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It is as if my life were magically run by two electric currents: joyous positive and despairing negative - whichever is running at the moment dominates my life, floods it. Delia Villasenor, Stephen Brock, & Beth Hopper Sylvia Plath (2000)The Unabridged Journals of Sylvia Plath, 1950-1962New York: Anchor Books „ Best Practices for School Psychologists „ Best Practices for School Psychologists One or more Manic Episode or Mixed Manic Numerous periods with hypomanic and depressive Minor or Major Depressive Episodes often present No full Manic, Major Depressive, or Mixed Bipolar features that do not meet criteria for any specific bipolar disorder.
A distinct period of abnormally and persistently elevated, expansive, or irritable mood.
Causes marked impairment in occupational functioning in usual social activities or relationships, or
Three or more (four if the mood is only irritable) of the following symptoms: Necessitates hospitalization to prevent harm to
self or others, or
Pressured speech or more talkative than usual Not due to substance use or abuse (e.g., drug abuse, medication, other treatment), or a Psychomotor agitation or increase in goal-directed Euphoria: Elevated (too happy, silly,
Decreased Need for Sleep:
inappropriate reaction to external events Irritability: Energized, angry, raging, or
intensely irritable mood, “out of the blue” Increased Speech: Dramatically A child suddenly begins to talk
or as an inappropriate reaction to external flies into a violent 20- amplified volume, uninterruptible extremely loudly, more rapidly, and events for an extended period of time.
Inflated Self-Esteem or Grandiosity:
Flight of Ideas or Racing
Believing, talking or acting as if he is Thoughts: Report or observation rambling speech that is out of
special powers or abilities despite clear From Lofthouse & Fristad (2006, p. 215) From Lofthouse & Fristad (2006, p. 215) Distractibility: Increased
Increase in Goal-Directed Activity
or Psychomotor Agitation: Hyper-
focused on making friends, engaging everyone’s desks, or plan to in multiple school projects or hobbies build an elaborate fort in the Excessive Involvement in
„ May not be viewed by the individual as pathological Pleasurable or Dangerous
‰ However, others may be troubled by erratic behavior Activities: Sudden unrestrained
participation in an action that is likely jump out of a moving school to lead to painful or very negative From Lofthouse & Fristad (2006, p. 215) „ Major Depressive Episode Criteria (cont.) A period of depressed mood or loss of interest or Causes marked impairment in occupational functioning or in usual social activities or In children and adolescents, the mood may be Not due to substance use or abuse, or a general Lasting consistently for at least 2 weeks.
Represents a significant change from previous After the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation Diagnosis: Major Depressive Symptoms at School „ Major Depressive Episode Criteria (cont.) Five or more of the following symptoms (at least one of Depressed Mood: Feels or looks
Markedly Diminished Interest or
Pleasure in All Activities:
Significant Weight Loss/Gain or
Appetite Increase/Decrease:
7) Feelings of worthlessness/inappropriate guilt 8) Diminished ability to think or concentrate/indecisiveness From Lofthouse & Fristad (2006, p. 216) Diagnosis: Major Depressive Symptoms at School Diagnosis: Major Depressive Symptoms at School Insomnia or Hypersomnia:
Low Self-Esteem, Feelings of
Worthlessness or Excessive
Guilt: Thinking and saying more no one likes me, I can’t do anything.”
Agitation/Retardation: Looks
Diminished Ability to Think or A child can’t seem to focus in class,
Concentrate, or
Fatigue or Loss of Energy:
Indecisiveness: Increase
baseline attentional capacity; difficulty stringing thoughts together or making choices.
From Lofthouse & Fristad (2006, p. 216) From Lofthouse & Fristad (2006, p. 216) Diagnosis: Major Depressive Symptoms at School Hopelessness: Negative
Both Manic and Major Depressive Episode criteria are met nearly every day for a least a 1 week period. Recurrent Thoughts of Death
Rapidly alternating moods (sadness, irritability, euphoria) accompanied by symptoms of a Manic and or Suicidality: Obsession with
Causes marked impairment in occupational functioning or in usual social activities or relationships, or
Necessitates hospitalization to prevent harm to self or others, or
possessions away or tries to kill self.
Not due to substance use or abuse, or a general medical condition From Lofthouse & Fristad (2006, p. 216) „ Terms used to define juvenile bipolar disorder.
Ultrarapid cycling = 5 to 364 episodes/year Four or more mood episodes (i.e., Major Depressive, Manic, Mixed, or Hypomanic) per 12 months Brief frequent manic episodes lasting hours to days, but less than the 4-days required under Hypomania a period of full remission, or
Ultradian cycling = >365 episodes/year a switch to an episode of the opposite polarity Repeated brief cycles lasting minutes to hours (77%).
‰ Manic, Hypomanic, and Mixed are on the same pole Chronic baseline mania (Wozniak et al., 1995).
Ultradian is Latin for “many times per day.” NOTE: This definition is different from that used in some literature, where in cycling refers to mood changes within an episode (Geller et al., 2004).
Mania includes marked euphoria, grandiosity, and irritability„ Racing thoughts, increased psychomotor activity, and mood lability.
‰ Discrete episodes of mania or depression lasting Mania is frequently associated with psychosis, mood lability, and depression.
Tends to be more chronic and difficult to treat than adult BPD.
‰ Significant departures from baseline functioning.
Prognosis similar to worse than adult BPD Mania involves markedly labile/erratic changes in mood, energy levels, and behavior. Predominant mood is VERY severe irritability (often associated with Irritability, anger, belligerence, depression, and mixed features are ‰ Lower rates of inter-episode recovery.
Mania is commonly mixed with depression.
AACAP (2007); NIMH (2001); Wozniak et al. (1995) „ Unique Features of Pediatric Bipolar Disorder „ Bipolar Disorder in childhood and adolescence appear to „ However, there are significant developmental variations ‰ Predominantly mixed episodes (20% to 84%) and/or ‰ High rate of comorbid ADHD (75% to 98%) and Increased thirst, increased urination, water retention Brain-Derived Neurotropic Factor (BDNF) & Apoptosis ‰ Electro-Convulsive Therapy (ECT) & Repeated ‰ Multifamily Psycho-education Groups (MFPG) Transcranial Magnetic Stimulation (r-TMS) ‰ Interpersonal and Social Rhythm Therapy (IPSRT) „ Best Practices for School Psychologists „ Adolescent onset = significant disruptions ‰ Develop the Psycho-Educational Assessment ‰ Understand the focus of the assessment‰ Eligibility Category? „ Special Education Eligibility Categories ‰ An inability to learn that cannot be explained by other ‰ An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.
‰ Inappropriate types of behavior or feelings under ‰ A general pervasive mood of unhappiness or ‰ A tendency to develop physical symptoms or fears associated with personal or school problems.
‰ Having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment that: is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit „ Represents the origin of the
hyperactivity disorder, diabetes, epilepsy, a heart presentation of the disorder.
condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, and sickle cell anemia; and adversely affects a child’s educational performance.
‰ Any medical conditions that may be impacting ‰ Child-Behavior Checklist (CBCL)‰ Behavior Assessment System for Children (BASC-II) ‰ Devereux Scales of Mental Disorders (DSMD) ‰ What type of information will you be collecting? Mania‰ Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U KSADS) ‰ Young Mania Rating Scale‰ General Behavior Inventory (GBI) ‰ Questionnaires, phone calls, or face-to-face? Depression‰ Beck Depression Inventory (BDI)‰ Hamilton Rating Scale for Depression‰ Reynolds Adolescent Depression Scale (RADS-2) „ Socio-Emotional Functioning, cont.
‰ Woodcock-Johnson Tests of Cognitive Abilities (WJ-III) Brown Attention-Deficit Disorder Scales for Children and ‰ Wechsler Intelligence Scale for Children (WISC-IV) ‰ Developmental Neuropsychological Assessment (NEPSY) Scale for Assessing Emotional Disturbance (SAED) ‰ Kaufman Assessment Battery for Children (KABC-2) ‰ Differential Ability Scales (DAS-2) Revised Children’s Manifest Anxiety Scale (RCMAS) Wide Range Assessment of Memory & Learning (WRAML-2) Behavior Rating Inventory of Executive Functions Comprehensive Test of Phonological Processing (CTOPP) Comprehensive Behavior Rating Scale for Children Tests of Auditory Processing (TAPS-3) Motor-Free Visual Perception Test (MVPT-3) Delis-Kaplan Executive Function Scale Beery Buktenica Developmental Test of Visual Motor-Integration (VMI) Conners Continuous Performance Test Bender Visual-Motor Gestalt Test (Bender-Gestalt II) Special Education & Programming Issues Background (e.g., developmental, health, family, educational) Socio-Emotional Functioning (including rating scales, observations, interviews, and narrative descriptions) Cognitive Functioning (including Executive Functions & Processing Areas) Special Education & Programming Issues Special Education & Programming Issues ‰ Medi-Cal/Access to mental health services Special Education & Programming Issues „ Questions to ask when developing a plan: ‰ What are the student’s particular challenges? Will it be part of the IEP as a Designated Instructional Service (DIS)? ‰ What does the student need in order to get ‰ Is student’s behavior impeding access to his/her „ Possible elements of a counseling program Build, maintain, and educate the school-based Provide a predictable, positive, and flexible Be aware of and manage medication side effects.
Be prepared for episodes of intense emotion.
Consider alternatives to regular classroom.
Lofthouse & Fristad (2006, pp. 220-221) „ Best Practices for School Psychologists ¾ Provide books on tape and/or reading partners ¾ Don’t punish or single out for sleepiness Account for Impaired Concentration, Focus, and Memory „ Provide assistance for missed assignments Allow students to work in calm environments Don’t allow student to be the focus of attention The Storm in my Brain A publication from the Child & Adolescent
Bipolar Foundation (CABF). Artwork for this booklet was created by
young people living with depression or bipolar disorder. These works were selected from over 100 entries to a national contest sponsored by DBSA and CABF. This is an easy to understand, colorful booklet that speaks to children about how it feels to have a mood disorder. „ The Bipolar Child by Demitri Papolos, M.D.
‰ and Janice Papolos (Broadway Books, 2006). „ Educational brochure: Educating the Child ‰
With effective treatment, you can live
an enjoyable and productive life
AACAP. (2007). Practice parameter for the assessment and treatment of children despite bipolar disorder.
and adolescents with bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 107-125.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Rev). Washington, DC: Author.
Baum, A. E., Akula, N., Cabanero, M., Cardona, I., Corona, W., Klemens, B., Schulze, T. G., Cichon, S., Rietsche, l. M., Nöthen, M. M., Georgi, A., Schumacher, J., Schwarz, M., Abou Jamra, R., Höfels, S., Propping, P., Satagopan, J., Detera-Wadleigh, S. D., Hardy, J., & McMahon, F. J. (2007). A genome-wide association study implicates diacylglycerol kinase eta (DGKH) and several other genes in the etiology of bipolar disorder. Molecular Psychiatry, [E-pub ahead of print]. Danielyan, A., Pathak, S., Kowatch, R. A., Arszman, S. P., & Jones, E. S. (2007). Clinical characteristics of bipolar disorder in very young children. Journal of Affective Disorders, 97, 51-59.
Faraone, S. V., Glatt, S. J., & Tsuang, M. T. (2003). The genetics of pediatric- onset bipolar disorder. Biological Psychiatry, 53, 970-977.
The biographies of Beethoven, Newton, and Dickens, in Geller, B., Tillman, R., Craney, J. L., & Bolhofner, K. (2004). Four-year particular, reveal severe and debilitating recurrent mood prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry, 61, 459-467.
Geller, B., Williams, M., Zimerman, B., Frazier, J., Beringer, L., & Warner, K. L. Massachusetts General Hospital (2008). School Psychiatry Program & Madi (1998). Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling. Journal of Affective Disorders, 51, 81-91.
Mayo Clinic (2008). Bipolar Disorder retrieved from Hajek, T., Carrey, N., & Alda, M. (2005). Neuroanatomical abnormalities as risk factors for bipolar disorder. Bipolar Disorders, 7, 393-403. Indianapolis Bipolar Parents Organization (2005, April). Helping children with NIMH. (2001). National Institute of Mental Health research roundtable on prepubertal early-onset pipolar to learn. Retrieved March 5, 2005, from biopolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, Indianapolis Bipolar Parents Organization (2005, April). Resource guide for NIMH. (2007). Bipolar disorder. Bethesda, MD: Author. Retrieved May 28, 2007, from parents of biopolar children. Retrieved March 5, 2005, from Pavuluri, M. N., Birmaher, B., & Naylor, M. W. (2005). Pediatric bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Lofthouse, N. L., & Fristad, M. A. (2006). Bipolar disorders. In G. G. Bear & K. M. Minke (Eds.) Children’s needs III: Development, prevention, and intervention Wozniak, J., Biederman, J., Kiely, K., Ablon, J. S., Faraone, S. V., Mundy, E., & Mennin, D. (pp. 211-224). Bethesda, MD: National Association of School Psychologists.
(1995). Mania-like symptoms suggestive of childhood-onset bipolar disorder in Masi, G., Perugi, G., Millepiedi, S., Mucci, M., Toni, C., Bertini, N., Pfanner, C., clinically referred children. Journal of the American Academy of Child & Adolescent Berloffa, S., & Pari, C. (2006). Developmental difference according to age at onset in juvenile bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 16, 679-685.
Delia Villasenor, Stephen Brock, & Beth Hopper


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