Can My Child Have Bipolar Disorder? Pediatric Bipolar Disorder: Fact or Fiction

By Molly McVoy, M.D.   



Can children really have bipolar disorder?  Or, is it a parenting issue?  Is this mental illness overly-diagnosed?

Many of these questions have been raised in the media with increased frequency over the last several months.  What's most concerning is, that instead of focusing on diagnosis and treatment for children with serious mental illness, the debate has focused on who is to blame: is it parents, psychiatrists, drug companies, schools?  The bottom line is that children are suffering, and parents are struggling to keep their children safe, healthy, and happy.  More attention should be paid to actually helping these children, not to pointing fingers of blame.

Pediatric bipolar disorder is a rare but very real illness.  The most recent statistics indicate the mental illness affects approximately 1.5% of children.  Contrary to popular reports, the most recent studies also indicate the rates of pediatric bipolar disorder are not increasing over time, and the rates do not vary between US and non-US populations.¹

When pediatric bipolar disorder occurs, it can be very impairing.  Affected children have extreme mood swings – not for minutes at a time but for days.  Children can become suicidal, violent, and often feel quite out of control.  When properly diagnosed and treated, the lives of these children and their families can improve dramatically.  Treatment often involves a combination of mood stabilizing medication and intensive psychotherapy.  But when missed or misdiagnosed, these children may go on to suffer for a lifetime.



Stigma continues to be associated with a mental health diagnosis, and nowhere is that truer than in pediatric mental illness.  Perhaps, in the future, efforts will focus on how to help, not who to blame.

Links:

http://www.aacap.org/

http://www.bpkids.org/

References:

1. VanMeter, AR, Moreira, AL, Youngstrom, EA. Meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry. 2011, May 31.

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The Insanity Defense: Fact or Fiction?

By Molly McVoy, M.D. 

When you hear about a defendant pleading insane at the time he or she committed a crime, what thoughts cross your mind?  You may be thinking of those infamous court cases: John Hinckley, Andrea Yates, Brian David Mitchell (Elizabeth Smart's kidnapper), and most recently, Jared Laughner.  It's common to feel conflicting emotions - anger, confusion, even sympathy - as you remember these high-profile defendants and traumatic court cases.

The word “sanity” is a legal term, not a mental health or clinical term.  Generally, a determination of “sanity” in a court of law refers to whether a “mental disease or defect” (also a legal, not clinical term) causes a person to be unable to know the wrongfulness of his or her action.

Over time, the court clarified what qualifies as a “mental disease or defect,” and it's not always directly related to clinical diagnosis as used by practicing psychiatrists.  Typically, severe mood and psychotic disorders do classify as a “mental disease or defect,” but many other psychiatric illnesses and personality disorders do not.  Courts ultimately determine what illnesses do and do not qualify as a “mental disease or defect” under the “not guilty by reason of insanity” defense. 

The application of this defense has also changed in scope.  Early in American law, only if someone had total loss of memory or understanding would this defense apply.  But in time, that became more liberal -- applying if someone was unable to know the wrongfulness of his or her actions or, because of illness, was unable to resist the urge to commit the crime.

After the attempted assassination of Ronald Reagan by John Hinckley, the standard became narrower once again, returning to apply only to those whose “mental disease or defect” prevented him or her from knowing the wrongfulness of the crime.

Finally, some states have an additional “guilty but mentally ill” statute that affects eventual sentencing but not strict guilt or innocence.  You will probably hear more debate about the insanity defense in media's coverage of Jared Laughner.  There may always be misunderstanding and controversy for this complicated, highly sensitive issue.

 

For more information:

http://www.aapl.org/

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Shootings Stir Emotions, Call for Access to Affordable Care

By Molly McVoy, M.D.



The tragic shooting in Arizona has spurred many emotional headlines and provocative stories in the news. News stories have used the words “insane,” “coldblooded,” “bizarre,” “evil” and “troubled.”



Whenever tragedies such as this occur, emotions are stirred and people often look for clear answers. Unfortunately, tragedies like this do not have easy answers. Whether or not mental illness is involved in this case, this may be a moment to look at every way to reduce the risk of another tragedy such as this in the future.



Rep. Giffords



U.S. Rep. Gabrielle Giffords, currently in an Arizona hospital as a result of the shooting, is a friend to the National Alliance for Mental Illness (NAMI) and has served as co-chair of several fundraisers for NAMI in Southeast Arizona.



There are so many ways in which the mental health system in the United States is broken. Treatment is often hard to access and expensive. Consistent treatment is often nearly impossible for those with severe mental illness. Advocating for improved access to quality mental health care is critically important at a time like this.



In addition, it is also important to remember that the likelihood of violence from those who struggle with mental illness is very low. Most of the violence perpetrated in this country is by individuals without mental illness. Most individuals suffering from mental illness are not violent.



No matter the cause, a time like this calls for reflection and action: examining all the factors that can be changed to minimize the risk of something like this happening in the future.

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Parenting in the Internet Age

By Molly McVoy, M.D.

Facebook, blogging, Twitter, email, texting. How is a parent supposed to keep up with all of the technology available to children and teens in today’s world? Many parents and children struggle with safety on the Internet. Although there are no easy answers, some simple steps can help keep you and your child safe.

First, and most important: all of the things that make a good parent in everyday life also make a good parent on the Internet. Spend time with your child in their daily life and spend time with them learning about what they do online. Educate yourself on your child’s school and social life. In the same way, educate yourself about the websites they visit and who they are talking to online.

In addition, keep their access to technology limited and in public settings. Put the computer in the kitchen or the living room – in other words, in a place where secrecy is difficult and monitoring is easy. Online time should only come after homework and other activities are done for the day. Also, talk about what they are doing online, but do not invade their privacy by reading emails unless absolutely necessary. If you suspect dangerous things are happening by or to your child online, then invading their privacy may be necessary. Otherwise, encourage open communication and respect their privacy.

For more information:

http://www.webwisekids.org/

http://www.kids.gov/6_8/6_8_computers_internet.shtml

http://www.attorneygeneral.gov/uploadedFiles/Consumers/cybersafety.pdf

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Family-Based Treatment May Benefit Teens with Anorexia

By Molly McVoy, MD



A recent Wall Street Journal article reported on a study regarding teens with anorexia. The results of the study, published in the Archives of General Psychiatry, indicate that having parents actively involved in the treatment of adolescents with eating disorders is more effective than the traditional one-on-one treatment with a therapist.

The study looked at 120 teenagers using the Maudsley model versus traditional one-on-one therapy. The Maudsley model encourages parents to take charge of the eating habits of their children with eating disorders, such as anorexia. At one year, the study found that about 50 percent of patients treated with this family based therapy were in remission versus 23 percent in the more traditional individual therapy.



Anorexia nervosa is a serious, often life-threatening illness in which patients fear gaining weight to such a degree they restrict their diet and maintain a body weight below the 85 percent of a healthy weight. Successful treatment is intensive, involving medical monitoring, dietary interventions, therapy and, at times, medication.



This study adds to accumulating evidence that family involvement is critical in successful treatment of adolescents with eating disorders. As more studies are published with similar data, treatment centers for eating disorders and increasingly involving families in the intensive treatment programs.



The HealthyMinds.org has more information on eating disorders. 



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Anger: A Complicated Emotion

Anger is a normal emotion that can be useful in coping with the world. But anger expressed in excess or suppressed can cause problems. Healthy Minds blogger Molly McVoy, M.D., talks about anger, how to recognize inappropriate anger and what to do about it.

Mental Illness in School: No Child Left Behind?

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

Getting Help Gets a Good Customer Review

By Molly McVoy, M.D.



A recent survey published in Consumer Reports, found that respondents reported the highest satisfaction for the combination of medication and talk therapy, when compared to talk therapy or medication alone.



The survey reported on over 1500 people treated for anxiety, depression or both. They also found that readers reported a higher satisfaction with treatment by a psychiatrist than by other mental health professionals (psychologists, social workers, and licensed professional counselors).

 

This is good news for psychiatrists and the mental health community in general. This is one indicator that the public feels treatment works and that psychiatrists help.





In addition, this consumer report supports the scientific evidence we already have – depression and anxiety treatment does work! In study after study, approximately 2/3 of patients respond to treatment for depression with an even higher percentage responding to treatment for anxiety disorders.



The bottom line is, treatment works and, it appears, most of the public knows it!

How to Help Someone Who Refuses Help for a Mental Illness: Tips for Family Members and Friends

By Molly McVoy, M.D.



What do I do if my husband won’t listen to me? My mom? My friend? My daughter? I hear this question all the time. Someone recognizes the possibility of depression, anxiety, ADHD in a friend or relative, but the other person just doesn’t see it. They refuse to go see someone for help. What do you do?

You keep talking to them. It is quite common for individuals to be unaware of a mental health problem they may have or to actively deny that such a problem exists. Sometimes it takes hearing it for the tenth or even the 100th time before someone listens and seeks care. Even though you may feel you’re not being heard, you may be the one person who’s willing to plant the seed and start that person thinking about getting help.



Finally, you’re not alone. If you are worried someone in your family or group of friends is seriously ill, at risk of hurting themselves or hurting someone else, call for help. Most cities in the United States have a 24 hour suicide hotline, and nationally, you can call 1-800-suicide. There are people trained to help you with this, even if your friend or family member won’t call, you can and start the journey towards mental health.





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“What do I tell my kids?” Tips for talking to children about the Gulf Oil Spill

By Molly McVoy, M.D.





I did a quick Google search of kids and the Gulf oil spill, and I found everything from “Why are they killing all the birds and sea turtles?” to resources for environmentally minded children on how to start an environmental action plan of their own.





The oil spill in the gulf coast has many worried, from children through adults. The resources for how to talk to them are varied and sometimes confusing. Below are some basic tips for talking to children about the oil spill threatening the gulf coast.





Talking to your children about disasters can be challenging. Children ask tough questions and it can be difficult to know how best to answer them. However, times like this, during disasters, can be a golden opportunity with your children. When current events are scary or confusing, it can be a great opportunity for parents to show their children that there are people to help them and the country get through them.





The best advice I can give for talking to children about anything, but disasters in particular, is this - be honest, be simple and repeat, repeat, repeat. Don’t force your child to talk about the oil spill, but, if they ask, tell them the truth in language that fits with their age. Children know if they’re being told the truth, so answer them as simply and straightforwardly as you can. But, being a child, they will likely ask again and again (and again!). It’s okay if you have to repeat yourself, it’s the open dialogue and the reassurance that children are looking for during times of crisis.





So, as Bill Cosby said of fatherhood “You just need a lot of love and luck - and, of course, courage.”

The Kids Are Out of School, Now What?

By Gariane Phillips Gunter, M.D.



Summer is here, whoohoo! People of all ages, across the nation are having fun in the sun. However, the U.S. Consumer Product Safety Commission (CPSC) warns that summer also is the time of year consumers are most likely to be injured.



What can you do to keep you and your family safe?




• One of the easiest and most effective ways to stay safe this summer is to wear a helmet and other safety gear when biking, skating and skateboarding, and when riding scooters, all-terrain vehicles, and horses.




• If you are sending the kids to camp, be sure to check out the camp to ensure that your children will be supervised adequately for safety.




• Protect to prevent a swimming pool tragedy. This includes placing barriers completely around your pool to prevent access, using door and pool alarms, closely supervising your child and being prepared in case of an emergency.




• When cooking outdoors with a gas grill, check the air tubes that lead into the burner for any blockage from insects, spiders, or food grease. Check grill hoses for cracking, brittleness, holes, and leaks. Make sure there are no sharp bends in the hose or tubing. If you ever detect a leak, immediately turn off the gas at the tank and don't attempt to light the grill until the leak is fixed. Newer grills and propane tanks have improved safety devices to prevent gas leaks.




• Make sure your home playground is safe. Use safe surfaces that cushion falls. Concrete, asphalt or packed dirt surfaces are too hard.




• Use softer-than standard baseballs, safety-release bases and batting helmets with face guards to reduce baseball-related injuries to children.




• If you are a soccer mom or dad, beware that movable soccer goals can fall over and kill children. Make sure the goal is anchored securely at all times and never allow anyone to climb on the net or goal framework or hang from the cross bar. Remove nets when the goals are not in use.




• To prevent serious injuries while using a trampoline, allow only one person on at a time, and do not allow somersaults. Use a shock-absorbing pad that completely covers the springs and place the trampoline away from structures and other play areas.




• Don't allow a game of hide-n-seek to become deadly. CPSC has received reports of numerous suffocation deaths involving children who crawled inside old cedar chests, latch-type freezers and refrigerators, iceboxes in campers, clothes dryers and picnic coolers. Childproof old appliances, warn children not to play inside them.




• If summer plans include camping and you want heat inside your tent or camper, use one of the new portable heaters that are equipped with an oxygen depletion sensor (ODS). If oxygen levels start to fall inside your tent or camper, the ODS automatically shuts down the heater before it can produce deadly levels of carbon monoxide (CO). Do not attempt to use alternative sources of heat or power to warm a tent or camper. Traditional camping heaters, charcoal grills, camping lanterns, and gas generators also can cause CO poisoning.




• Install window guards to prevent children from falling out of open windows. Guards should be installed in children's bedrooms, parents' bedrooms, and other rooms where young children spend time. Or, install window stops that permit windows to open no more than 4 inches. Whenever possible, open windows from the top - not the bottom. Also, keep furniture away from windows to discourage children from climbing near windows.




• Summer also means yard work. When mowing, keep small children out of the yard, and turn the mower off if children enter the area. Never carry children on a riding mower.




• Although summer schedules can be chaotic, don’t forget to follow up with your mental health provider for appointments as directed!




Have a safe and happy summer!!