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The Bipolar Child.

The Bipolar Child By Demitri Papolos, MD, and Janice Papolos Broadway Books New York

According to the American Academy of Child and Adolescent Psychiatry, one third of the 3.4 million children who first seem to be suffering with depression will manifest the bipolar form of mood disorder. "Amid all the dry statistics stand several million suffering children as well as their mothers, fathers, brothers, sisters, and grandparents." (Papolos & Papolos, 1999, p. 4). The Bipolar Child is a book that provides families with the tools to navigate the health, social, and educational systems for their children. The authors present four parts (units), "Diagnosis and Treatment," "Inside the Brain and Mind," "Living and Coping with Bipolar Disorder," and "Life Goes On," with accounts from parents of bipolar children who responded to their questionnaire posted on the Parents with Bipolar Children Web site.

Diagnosis and Treatment

In the Diagnosis and Treatment unit, there are five chapters: "Voices from the Front," "The Diagnostic Dilemma," "How to Find Good Treatment," "Prescriptions for Treatment," and "Charting the Course of the Disorder." These chapters describe the challenges of accurate diagnosis and detail research-based available treatment. The assessment process of diagnosis provides DSM-IV criteria, the detailed symptoms and behaviors via a symptom check list, and the Mood Tree developed by Rosalyn NewPort Olsen. Of interest is the list of questions parents can ask the psychiatrist, which the authors propose judge a physician's ability to diagnose and treat bipolar disorder in children. This becomes a concern due to the nationwide shortage of pediatric psychiatrists. On pages 58-59 is a helpful list of prominent teaching hospitals with clinics for early-onset bipolar disorder. This unit emphasizes the importance of preparing families for the information necessary for clinical evaluation.

Inside the Brain and Mind

Inside the Brain and Mind contains three chapters. "The Genetic Aspects of Bipolar Disorder," "The Psychological Dimensions," and "What Causes This Condition" discuss the physiology of the behaviors displayed in bipolar disorder. In 1921, Emil Kraepelin found that there is a tendency for a family history of mental illness. Although the authors caution that further molecular and genetic studies are needed, the Genetic Aspects chapter presents the findings of linkage studies and tendency. The Psychological Dimensions chapter describes the physiology of behavior, which is followed by pictorial displays of the brain, ANS, the neuronal pathways of the fight or flight response, and circadian and ultradian rhythms for understanding what causes this condition. This unit provides a biological foundation and discusses bipolar disorder as a neurological brain disorder in a simplistic manner that is reader friendly for families.

Living and Coping with Bipolar Disorder

Living and Coping with Bipolar Disorder unit has five chapters: "The Impact on the Family," "School: A Child's World Beyond Home," "Navigating the Shoals of Adolescence," "When a Child is Hospitalized," and the "Insurance Maze." These chapters contain resources, situation-specific communication techniques for families, and encounters described by parents and are essential resources for pediatric nurses engaged in anticipatory planning with families.

The "Impact on the Family" chapter discusses dealing with day-to-day behaviors such as raging and the required personal safety plan, which includes sibling protection. In one example, comments are made about the child's behavior in public and the mother responds by handing out a card to the onlooker. The card explains the child's behavior as bipolar, thanks the onlooker for his or her concern, and explains why screaming and/or sarcastic comments may further inflame the child. The card lists the contact number of the National Alliance for the Mentally Ill for further information. The chapter concludes with the impact to the marital relationship and the value of respite care.

The School chapter presents the legal rights of children with bipolar disorder under the Individual with Disabilities Education Act and Individual Education Plan (IEP). In this chapter, families are guided through the IEP process and provided with an example of an IEP. The Shoals of Adolescence chapter provides parents with the hallmarks of adolescence and a college-bound section.

The agony of hospitalizing a child because he or she presents a danger to self or others is discussed in the chapter, "When a Child is Hospitalized." Family-centered care is promoted, and a detailed list of necessary information required at admission and what to pack is provided. Families are encouraged to discuss the quiet room seclusion and physical restraints protocols with the provider. The Living and Coping unit concludes with the "Insurance Maze" chapter, which is comprehensive and includes private insurance, Medicaid, and most importantly applying for SSI disability. The Living and Coping unit is an essential resource for anticipatory planning with families.

Life Goes On

In the final unit, The Bipolar Child proposes a National Agenda for the Future derived from the 12-month period in which the authors monitored the BPParents listserv and read an average of 175 daily messages. In the National Agenda for the Future, parents call for:

* a quicker diagnosis and less of a "wait and see" attitude;

* an update of the DSM-IV to reflect the realities of early onset bipolar disorder;

* mental health professionals to regard them as collaborators on the treatment team for their children;

* all doctors-psychiatrists, neurologists, or pediatricians to know about new treatment trials;

* managed care companies to stop placing limitations on access to care;

* more research focused on this devastating illness;

* more outreach and education for families struggling with this disorder;

* schools to educate teachers and other staff about this disorder;

* a greater choice of smaller, therapeutic schools that are appropriate; and

* twice-yearly screening for suicide beginning in the fourth grade.

Parents also made it clear that they do not want the juvenile justice system to become the hospitals of the future.

Pediatric nurses can support the agenda through awareness of the unique needs of bipolar children and their families depicted by Papolos and Papolos (1999) in The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder.

Additional Information

For more information on bipolar disorder contact: The Child and Adolescent Bipolar Foundation 1187 Willmette Avenue #PMB 331 Willmette, IL 60091 (847) 256-8525

The National Alliance for the Mentally Ill (NAMI) 200 N. Glebe Rd. Suite 1015 Arlington, VA 22203-3754 (800) 950-NAMI

Editors' Choice is a bimonthly "biased" book review on a hot new book for pediatric nurses! Each issue, a member of the Pediatric Nursing editorial board picks a recent favorite publication and offers readers a brief description of why they would recommend it for their personal or library collections,

Christine G. Leyden, MSN, RN, A-CCC, is Principal, Leyden, LLC, Bowie, MD.
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Title Annotation:Review
Author:Leyden, Christine G.
Publication:Pediatric Nursing
Article Type:Book Review
Date:Nov 1, 2000
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