The Importance of Properly Diagnosing Early Onset Bipolar Disorder

Although early onset bipolar disorder (EOBD) was first described in 150 AD, the diagnosis remains surrounded in controversy because no such diagnosis exists. A person either meets the criteria for bipolar disorder set forth in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or not. The problem is that, as with DSM-IV, the criteria describe bipolar disorder as it exists in adults. The child phenotype differs markedly from adult onset bipolar disorder. Children with this disorder exhibit a more chronic form of irritability, more rapid mood swings, intense emotional outbursts, and impulsive aggression.

An additional complication when making the diagnosis in children is that most of the symptoms associated with EOBD also exist in ADHD, OCD, and ASD. Moreover, children with EOBD also have high rates of comorbid conditions.

Though it was hoped that DSM-5 would resolve the main concerns, the following issues remain unaddressed:

  1. Technically, EOBD diagnosis still does not exist.
  2. Teens and children must meet adult criteria to be diagnosed as bipolar.
  3. Many children who would have received a diagnosis of bipolar disorder prior to the publication of DSM-5 will now receive a diagnosis of disruptive mood dysregulation disorder (DMDD).

Despite the hope for some consensus, experts in the field have yet to reach agreement on (a) what symptoms constitute the core features of EOBD, (b) how to differentiate bipolar disorder from other childhood disorders, and (c) how best to manage children who have the disorder.

When Drs. Richard M. Marshall and Berney J. Wilkinson began seeing children who exhibited severe symptoms of bipolar disorder, they used omnibus rating scales as part of their initial diagnostic assessment. To their surprise, many of the scales completed by parents and teachers had ratings in the normal range even though the children had symptoms of bipolar disorder. An item analysis revealed that existing rating scales did not contain a sufficient number of items associated with the disorder. To address these shortcomings, Marshall and Wilkinson developed the Pediatric Behavior Rating Scale (PBRS), a standardized, norm-referenced parent and teacher rating scale for use with children ages 3 to 18 years.

Rather than providing specific diagnoses, the PBRS enables clinicians to identify the core features of EOBD, thereby serving as the critical first step in differential diagnosis and intervention planning. The PBRS provides clinical researchers with another tool to assist in (a) defining this disorder, (b) differentiating EOBD from related disorders, and (c) evaluating the efficacy of interventions aimed at alleviating its symptoms.

Approximately 20% of our nation’s 50 million K–12 students meet diagnostic criteria for a mental disorder, and 10% experience significant functional impairments at home, at school, and with peers. Nevertheless, children exhibiting such symptoms are often punished for willful disobedience rather than receiving effective treatment. In fact, 80% of children with mental illness remain undiagnosed and untreated, resulting in increased risk for suicide, school failure, and criminal behavior. Accurate differential diagnoses of EOBD and related disorders is the key to effective interventions.

Unless otherwise cited, source material is attributed to:
Marshall, M. M., & Wilkinson, B. J. (2008). Pediatric Behavior Rating Scale. Lutz, FL: PAR.

What do you think? PAR wants to hear from you, so leave a comment and join the conversation!

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Explore the Mysteries of the Brain

In April 2013, President Obama announced the BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative. During the speech, he said, “We have a chance to improve the lives of not just millions, but billions of people on this planet through the research that’s done in this BRAIN Initiative alone.”

The BRAIN Initiative’s purpose is to help researchers better understand brain disorders such as Alzheimer’s and Parkinson’s diseases, depression, and traumatic brain injury. It will allow researchers to produce dynamic pictures of how the brain records, processes, uses, stores, and retrieves vast quantities of information and shed light on the complex links between brain function and behavior.

According to National Institutes of Health (NIH) Director Francis S. Collins, “The human brain is the most complicated biological structure in the known universe. We’ve only just scratched the surface in understanding how it works—or, unfortunately, doesn’t quite work when disorders and disease occur… This is just the beginning of a 12-year journey, and we’re excited to be starting the ride.”

Many technology firms, academic institutions, and scientists, such as the NIH, the Food and Drug Administration, and the National Science Foundation (NSF), have committed to advancing this initiative. The NSF has partnered with NBC Learn to produce a video series entitled “Mysteries of the Brain,” which draws on research conducted through the White House for the BRAIN Initiative. The series will discuss how the brain develops, controls emotions, and creates memories.

This eight-part video series will include the following segments:

  • Searching for Answers—Discusses how new research has begun to decipher the unsolved mysteries of the brain.
  • Thinking Brain—Discusses how the brain can store and process large amounts of information.
  • Evolving Brain—Discusses how the basic movements of a tiny fish can teach us big ideas about how the brain’s circuitry works.
  • Emotional Brain—Discusses using a virtual reality room to study how the brain reacts to positive and negative emotions.
  • Brain States and Consciousness—Discusses the study of a fruit fly to understand how the brain’s cells communicate to control sleep patterns.
  • Building a Brain—Discusses how the brains of tadpoles help us understand how neural circuits develop and absorb information from the surrounding environment.
  • Perceiving Brain—Discusses how functional magnetic resonance imaging allows researchers to view the brain and determine how it distinguishes important information from every day scenes.
  • Brain-Computer Interface—Discusses how devices can monitor and extract brain activity to enable a machine or computer to accomplish tasks, from playing video games to controlling a prosthetic arm.

The “Mysteries of the Brain” series is available for free viewing at NBCLearn, Science360, and the White House Blog. The National Science Teachers Association is developing lesson plans for middle and high school students, which will be available later this summer.

Did you watch the series? If so, what did you think? PAR wants to hear from you, so leave a comment and join the conversation!

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Clever Little Liars: Kids With the Best Lies Have the Best Memories

Children lie. They lie to get out of trouble, they lie for fun, or they lie out of habit. Parents everywhere admonish their children to tell the truth, but lying has its benefits, according to a study conducted by the Journal of Experimental Child Psychology. More than 100 6- and 7-year-old children were given tests to evaluate their verbal working memory, and then they were invited to play a trivia game consisting of three questions. Each question was written on an index card, along with four possible answers. The correct answer and a picture were placed on the back.

The first two questions were easy to answer correctly; however, the third question was about a fake cartoon. The children were asked, “What is the name of the boy in the cartoon Spaceboy?” After posing the question, the researcher left the room, leaving the card with the correct answer face down on the table and instructing the children not to look at it.

Video cameras recorded the children’s varying reactions, and approximately 25% of them peeked at the card even though they were told not to. The researcher then returned and asked the children to provide the correct answer and to guess the picture on the back of the card. Those who had ignored the instruction not to look at the card answered both questions correctly, and some of them were able to lie convincingly about how they had arrived at the correct answers.

The good liars were the same children who had scored highest on the verbal memory test, and high working memory scores mean their brains can store and process a higher volume of information than their more truthful peers. These children have the language skill and creativity it takes to lie, cover up the lie, and remember all of its details. According to professors M. J. Kane and R. W. Engle, differences in working memory capacity can predict intelligence and the speed with which a particular skill can be learned.

A child with good verbal memory isn’t necessarily more disposed to lie, but good liars generally have good verbal memory. While parents will likely never condone lying, they can at least see it as evidence of a brilliant mind at work.

What do you think? Are liars really smarter? PAR wants to hear from you, so leave a comment and join the conversation!

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Emotions Are Turned Inside Out in Pixar’s Latest Movie

Pixar’s Inside Out is a movie about being a child and all the emotions that accompany this tumultuous time. Director Pete Doctor and producer Jonas Rivera chose the movie’s core emotions based on research from Dr. Paul Ekman. Dr. Ekman identifies six primary emotions that are universal throughout various cultures—happiness, sadness, anger, surprise, disgust, and fear—and all but one of these appear in the film.

Eleven-year-old Riley’s parents have just moved from Minnesota to San Francisco, and she must come to terms with leaving her old school, best friend, and extracurricular activities. Although Riley is the story’s protagonist, the real characters are her emotions: Joy, Sadness, Anger, Disgust, and Fear, which are personified inside her brain.

The film teaches that emotions play a significant role in the development of Riley’s personality. Joy is the leader—Riley’s predominant emotion—and she strives to protect Riley from Sadness. Later, Joy tries to banish one of Riley’s negative memories, and, as a result, she and Sadness get thrown out of Headquarters, the emotional control center. Only Fear, Anger, and Disgust remain, leaving Riley moody and irritable. Conflict ensues as each emotion grapples for control.

During the challenges of trying to return to Headquarters, Joy and Sadness learn important lessons as each begins to empathize with the emotion of the other. By the movie’s conclusion, Joy understands that she and Sadness must learn to coexist. In a Newsweek article, child psychologist Dr. Fadi Haddad comments, “I thought that was a brilliant ending in the movie, to see the importance of having a feeling like Sadness. That’s what connects us many times to families, to sad events, to friends, to understanding the meaning of empathy.”

The acceptance of Sadness leads to a breakthrough for Riley, who then shares with her parents her pain about leaving Minnesota, which in the movie is also a symbol for leaving behind her childhood. Riley’s emotions are reunited, and they begin working together, leading to Riley’s emotional healing.

For a children’s movie, Inside Out is surprisingly mature, accurately depicting how emotions interact, how they change during adolescence, and how they affect memory. It is a scientific yet kid-friendly portrayal of how the brain works, emphasizing the importance of all emotions—both the good and the bad. Emotions can be very complex for adults, and even more so for children. However, Inside Out has made them more accessible.

Do you think Inside Out accurately depicted the psychology of emotions? PAR wants to hear from you, so leave a comment and join the conversation!

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