Understanding Bipolar Disorder in Children: Treatment Options

ADHD: A BIO-PSYCHO-SOCIAL APPROACH TO UNDERSTANDINGTreatment ApproachesGoals & ObjectivesDiscuss the essential need for and elements of a sound assessment and diagnostic evaluation.

Discuss the elements and benefits of a multi-systemic treatment approach.

Discuss the need for and options regarding pharmaceutical interventions.Finding Qualified ProfessionalsThis can be difficult to do:Fewer than 6,500 child psychiatrists in the U.S.Normally family members start with their pediatrician when they need guidanceCan be detrimental or beneficial depending on the doctors stance, knowledge level, diagnostic ability and referral sources

Finding Qualified ProfessionalsPediatricians can be very useful in ruling possible medical conditions out.

Has an expertise in ADHD and uses a variety of assessment tools and procedures to get the diagnosis

Communicates without jargon; and works well with parents and school systemsFinding Qualified ProfessionalsIs aggressive not afraid to initiate new medication trials to achieve stabilization

Wants to work along with the family, not to blame them.

Values parental input and has a good rapport with the child.Finding Qualified ProfessionalsOften there are specialty clinics in most larger cities who have specialized diagnostic and treatment programs for ADHD children and adolescents

Look for them in Childrens Hospital wings or in University HospitalsCritical Point for Mental Health Practitioners: Differential Diagnosis***Anger and prolonged tantrums and associated violence and rages are one of the most common features of pediatric, early on-set bipolar disorder.Assessment ProceduresEnergy LevelsTracks MoodSeverity of Energy Level Scale from (1-5 and -1/-5)Functional Impairment

Neuropsychological TestingA Suggested Battery of Testing

Tests of General IntelligenceWISC-IIIBoth Bipolar and ADHD children have been found to:Demonstrate significant disparity in scoresSubtests typically demonstrate a range of differences greater than a 3-5 pt. spread. Called a Scatter and represents a considerable interest variabilityNot Used to Diagnose: Just one of many observations gleaned from many tests

Neuropsychological TestingTests for Sustained AttentionConnors Continuous Performance TestTests of Variable Attention (TOVA)Both of these are computerized testsTests of Academic AchievementTests Of LanguageMotor Tests of Sequenced MovementProjectivesTests of Executive Function

Tests of Executive FunctioningThe Wisconsin Card sortTower of LondonTower of HanoiTrails A & BStroop color and Word TestConnors Rating Scale for TeachersConnors Rating Scale for ParentsNeuropsychological TestingTests of Executive Functioning:Directly Test Frontal Lobe efficiency and healthChildren have been found to:Have deficits in working memoryOrganization and problem assessmentInflexible when off trackGet stuck when strategizing problem solutionsEvidence of Dyspraxia: The inability to interact successfully with the physical environment and to plan, organize and carry out a sequence of behaviors

Assessment Procedures/Treatment that AssessesMedication TrialsIt is common for psychiatrists to try different medications to find the right types and dosagesFamily members should be coached regarding the validity of such proceduresCycle charts should monitor types, times, dosages and efficacy of each medicine

Elements of The Therapeutic TeamChild PsychiatristDiagnosisMedicationTrials/MonitoringPsychoeducationGeneral supportPsychotherapistPsychoeducation; family and childAbility to help family understand and differentiate between Disease related/psychological/social problems

Elements of The Therapeutic TeamPsychotherapistPlan and support behavioral and emotional treatment goalsAid parents in the advocacy for child in school

School PersonnelSchool PsychologistAid in testing and education of teachersMonitor IEP planning and follow through

Elements of The Therapeutic TeamTeacherEducated about ADHDFacilitation of IEP, monitoring, and willingness to maintain an open dialogue with parentsPharmacological TreatmentStimulants, Antidepressants, NeurolepticsPharmacological TreatmentADDERALL(Amphetamine)BUSPAR(Buspirone)CATAPRES(Clonidine)CYLERT(Pemoline)DESIPRAMINE(Norpramin)DEXEDRENE(Dextroamphetamine)PROZAC(Fluoxetine)RITALIN(Concerta)(Methylphenidate)STRATTERA(Asomexetine)TENEX(Guanfacine)TOFRANIL(Imipramine)WELLBUTRIN(Bupropion)Pharmacological TreatmentAntipsychotic MedicationsClozapineClozarilOlanzapineZyprexaQuetiapineSeroquelRisperidoneRisperdalZiprasidoneGeodonStimulantsStimulants include different formulations of methylphenidate: short acting, such as Ritalin and Focalin, with a duration of 3-5 hours intermediate acting, such as Ritalin SR, Metadate ER, and Methylin ER, with a duration of 3-8 hours long acting, such as Concerta, Rilatin LA and Metadate CD, with a duration of 8-12 hours and which can be used just once a day

The other type of stimulant includes different formulations of amphetamine: short acting, such as Dexedrine and Dextrostat, with a duration of 4-6 hours intermediate acting, such as Adderall and Dexedrine spansule, with a duration of 6-8 hours long acting, such as Adderall-XR

The Basics: Vyvanse is a treatment for ADHD. It is FDA approved and became available in July 2007.What it is Used For: Vyvanse is a once-a-day treatment for children who are six to 12 years old with ADHD.Vyvanse Fast Facts: It was formally known as NRP104. Its main ingredient is lisdexamfetamine dimesylate. It is a prodrug or 'conditionally bioreversible derivative' of dextroamphetamine, one of the main ingredients in Adderall, Adderall XR, and Dexedrine Spansules. Vyvanse can be taken either with or without food. If your child can't swallow the Vyvanse capsules, you can open them and either sprinkle it onto a small amount of food or into a few ounces of water (which is a benefit over other 'beaded' ADHD stimulant medicines, which don't dissolve in liquids). Vyvanse is commonly misspelled as Vyvance. Benefits of Vyvanse: Vyvanse, unlike other stimulants, has to go through the stomach and be digested before it can become active. That means it's much less likely that Vyvanse will be abused, since it can't be snorted, etc., like other ADHD medicines. Another potential benefit of Vyvanse is that it lasts a full 12 hours, whereas other long-acting ADHD medicines tend to last 10 to 12 hours.Forms of Vyvanse: Vyvanse is available in three dosage strengths: 30mg, 50mg, and 70mg.

Other Treatments showing EfficacyCognitive Behavioral TherapyAid in developing the Internal Thought processFamily therapy; identifying and helping to combat unreasonable behaviors/thoughts/emotionsAid in setting appropriate goals for the child and correcting any misinterpretations.

About.com Pediatricshttp://pediatrics.about.com/cs/adhd/a/adhd_guidelines.htmSide Effects of Vyvnase: Side effects of Vyvanse are similar to other ADHD stimulants and most commonly include abdominal pain, vomiting, weight loss, decreased appetite, headaches, insomnia, and irritability. Interestingly, side effects -- especially appetite suppression -- seem to quickly decrease over time.Warnings: Like other stimulant medications, Vyvanse should not be used by children with the following conditions: Heart disease or hardening of the arteries; moderate to severe high blood pressure; hyperthyroidism; glaucoma; high state of anxiety, tension, or agitation. It should also not be used by kids who have a history of drug abuse, who are taking or have taken within the past 14 days an anti-depression medicine (monoamine oxidase inhibitor or MAOI), or who are sensitive to, allergic to, or had a reaction to other stimulant medicines

Other Treatments showing Efficacyhttp://www.celebratecalm.com/Other Treatments showing EfficacyPsychosocial InterventionsSports, Girl Scouts, Boy Scouts, Summer programsCommunity action groups, volunteer programs, youth groups, church involvement.Peer support groups, leadership programs, summer camps.