Early onset bipolar spectrum disorder: Psychopharmacological, psychological, and educational management

Abstract

Although published research continues to advocate medication as the first line of treatment for early onset bipolar spectrum disorder (EOBSD; N. Lofthouse & M.A. Fristad, 2004), preliminary research demonstrating the utility of cognitive, cognitive-behavioral, and psychoeducational therapies is promising. It appears as if future treatment of EOBSD will most likely include a combination of psychosocial treatments and medications; however, additional research needs to be conducted to support this assumption. This article provides a brief overview of published research related to EOBSD, the most common medications used to treat EOBSD, and preliminary research on the effectiveness of psychological treatments with children and adolescents classified with EOBSD. Finally, due to the lack of published behavioral and educational management strategies, this article provides practical suggestions for helping children and adolescents with EOBSD within the home and school settings.

Understanding and Developing Academic and Behavioral Interventions for Students With Bipolar Disorder

“…Although no research-supported interventions are available, school personnel can draw from a number of strategies that will benefit these children and adolescents in the classroom and in the school based on preliminary research demonstrating the utility of psychoeducational therapies (McIntosh & Trotter, 2006). The following sections provide educators with a discussion of possible suggestions and strategies to assist these students based on this preliminary research.…”

“…R. Marc A. Crundwell, PhD, is a school psychologist at the Greater Essex County District School Board. His current interests include learning disabilities, behavior , 1997) to better understand the student's behavior and allow for the development of more proactive and preventive strategies Facilitate long-term lifestyle changes through proactive, positive, and functional strategies and interventions Develop positive behavioral supports that address affective supports, schedule and activity supports, and peer supports to support long-term changes (Jackson & Panyan, 2001) Promote positive support and positive discipline, and avoid negative consequences as these may in fact escalate undesirable behaviors associated with mood swings Establish a "safe" adult and place that the student may seek out when feeling overwhelmed (Child and Adolescent Bipolar Foundation, 2004) Social/behavioral, academic and Design interventions that address skill deficits resulting from the disorder vocational deficits (e.g., problem solving approaches, behavioral, and social deficits) Foster an environment of inclusiveness in the classroom through open discussion, providing appropriate peer mediation and support (Bowers, McGinnis, Ervin, & Friman, 1999;Fowler, Dougherty, Kirby, & Kohler, 1986), protect students from ridicule or rejection, and setting the occasion for positive, collaborative working relationships Include the student in social skills groups and increase playground and lunch time supervision to avert problems during those times Crisis management planning Due to unexpected and severe shifts in mood and emotion, identify possible triggers that precede a loss of control Develop a crisis management plan for the following areas: explicit instructions to manage the unsafe behavior (i.e., who does what, when and where), identification of a safe place for the student to go and who will provide appropriate supervision, alternative backup plans if the safe place does not work, recovery procedures for all involved following the crisis (e.g., distress and debrief the class with the student involved) Employ preventative measures (McIntosh & Trotter, 2006), such as shadowing by an adult throughout the day Allow the student to take a break or walk when she becomes frustrated by social or academic demands disorders, and interventions for learning disabilities and behavior disorders. Address: Kim Killu, University of MichiganDearborn, School of Education, 19000 Hubbard Dr., Dearborn, MI 48126; e-mail: kimkillu@umd.umich.edu.…”

Understanding and treating psychopathology in schools: Introduction to the special issue

“…It seems quite plausible that future treatments will include a combination of medication and psychological therapy. McIntosh and Trotter (2006) provide an overview of the diagnostic, medication, and psychological research published to date with the objective of helping school psychologists, school counselors, teachers, and parents better understand EOBSD. They also attempt to fill a gap in the literature by providing practical suggestions on how to address many of the symptoms of EOBSD, with particular attention to behaviors displayed within the school and home setting.…”

A case study exploration of placement in a therapeutic day school as an educational intervention package for children and adolescents with bipolar disorders

“…To this author's knowledge, to date, not a single study has explored any type of educational intervention for children and adolescents with bipolar disorders. Such deficits in research are problematic, because children and adolescents with bipolar disorders are likely to exhibit significant difficulty at school, within multiple domains of educational functioning (Grier, Wilkins, & Pender, 2007;McIntosh & Trotter, 2006).…”

“…The first category describes the services and accommodations available to them under the Individuals with Disabilities Education Improvement Act (IDEA;2004), a federal law that guarantees services such as special education to students with disabilities, and Section 504 of the Rehabilitation Act (1973), civil rights legislation that prohibits discrimination against individuals with disabilities and provides for accommodations (e.g., Fristad & Goldberg-Arnold, 2004;Grier, Wilkins, & Szadek, 2005;Papolos & Papolos, 2006). Much of this type of information includes guidelines and general recommendations for providing services and/or accommodations to students with bipolar disorders that are supported by apparent face validity, but are not backed by relevant empirical outcome data (e.g., Lofthouse, Mackinaw-Koons, & Fristad, 2004;McClure, Kubiszyn, & Kaslow, 2002;McIntosh & Trotter, 2006). The only data available within this domain are primarily demographic in nature, indicating that students with bipolar disorders are at increased risk for needing tutoring services, being placed in special/remedial classes (including special education classes), repeating a grade, and failing to graduate on time (Doyle et al, 2005;Faedda, Baldessarini, Glovinsky, & Austin, 2004;Findling et al, 2001;Henin et al, 2007;Pavuluri et al, 2006;Wilens et al, 2003;Wozniak et al, 1995).…”