Bipolar questionairre link

[klmno]

Since there is question lately (everywhere- not just this forum) if bipolar in children and adolescents is under- or over- diagnosed, I thought others might be interested in this. It's unclear to me if this form is used for him to gather statistical data for an upcoming book or if he (staff) actually get back to the parent to provide feedback (not that I'd wanting him diagnosis'ing thru the mail!).

What I found most interesting is that all other evaluation forms I have seen have questions like "has child EVER...." and answer choices like "sometimes, often, never" without ever looking at the scenario of "20 times in one week but 0 times the previous and following 6 months", which to me, would make it impossible to diagnosis bipolar accurately.

http://www.bipolarchild.com/survey/bcq.html

Dr. Paopolos wrote "The Bipolar Child". I've started reading this book- haven't gotten very far. If anyone else has read it- is it all focused on younger children, or does it address bipolar onset in adolescents?

 

[ck1]

Thanks for posting this, I'm going to look at it soon. I have read the book "Bipolar Child" and agree that it talks more about younger children but I think I still got a lot of useful information from it for my teenager.

My difficult child has not been diagnosed with bipolar but I bought and read the book last year when I thought that diagnosis was coming, but I don't think I ever quite finished it. Maybe I'll do that soon...

 

[smallworld]

I'm not sure if the book specifically addresses adolescent onset, but it includes a chapter on "Navigating the Shoals of Adolescence."

What I'm going to say may be controversial, but I'll go ahead anyway. The problem with relying on the questionnaire written by Papolos is that some psychiatrists (including ours) believe that his diagnostic criteria are too broad and result in an overdiagnosis of BiPolar (BP) in kids. Dxing BiPolar (BP) in kids is inherently very challenging because kids are moving targets and their symptoms can change over time.

My son is a case in point. He had significant anxiety as a young child, ADHD-like inattention in his early elementary school years and huge mood issues that began at age 11. Does he have BiPolar (BP)? No one doctor that we've seen (and we've seen a ton at this point) will tell us definitively. They will say that he has a mood disorder with anxiety, depression and mood lability, and they are prescribing medications used in the treatment of BiPolar (BP) (both mood stabilizers and atypical antipsychotics). But they will not commit to a BiPolar (BP) diagnosis because they are not certain what he will look like as an adult and BiPolar (BP) is a lifelong disorder.

 

[Peaceful]

Hi. I've read the book and many other articles and studies on BiPolar (BP). It is focused more on the young ones but does offer insight that is used for older kids. There's also a new book out for teens with BiPolar (BP) by Miklowitz and George.

My difficult child is BiPolar (BP). She was misdxed at first as depressed and ADHD until we gave her stimulants which debilitated her with the side effects and made her go crazy.

She was diagnosed after her second suicide attempt at 8 yrs old (her first attempt was at 7) and was in the psychiatric hospital. I then did a medication wash to be sure and she almost had to be hospitalized again but it was pretty evident that without medications she couldn't make it. She's since been seen by Dr. Findling's team and at the Cleveland Clinic by pediatric neuro's and they all concur on the BiPolar (BP) diagnosis. her first psychiatrist wouldn't label her even after the suicide attempts and the severe mania. But it was her hang-up about the diagnosis.

It's a diagnosis that's made over time. There are very specific criteria that need to be met. Most parents don't stick with one psychiatrist for the length of time it takes for a diagnosis (sometimes up to 3 yrs depending on the child). I have no doubt there are kids not diagnosed that are and kids that are diagnosed that aren't. It's not like an Xray that gives a definitive answer. That's why it's so crucial to have someone familiar with the disorder and the treatment of it for your child.

Charting is the key for us and is for many families. Charting moods and their effects is very important. It allows one to be more assured in knowing ODD from BiPolar (BP) from ADHD etc. Good luck!

Peaceful

13 yo difficult child daughter BD, ODD, SAD, Generalized Anxiety Disorder (GAD) on medications
9 yo difficult child who's a great little brother
Mom raising her the best she can
Dad hanging in there

 

[klmno]

That's interesting, Smallworld, I wonder if that's why the psychiatrist on evaluation team didn't say difficult child was bipolar directly- she said he was cycling, his problems 1st started with- adjustment disorder and depression and either the way his acting out was dealt with and/or prozac triggered cycling, but she said if all that's dealt with, cycling might stop and he would no longer meet criteria of bipolar. I've just started looking at it like the pediatrician explained it to me- which was to compare it to asthma- also a lifelong thing. But, difficult child had asthmatic wheezing as young child, then "grew out of it". Pediatrician said she thinks there will be many cases like that as time goes on and more and more kids are diagnosis'd bipolar- not because they never needed a mood stabilizer or cycled, but because earlier detection that turn out to be manageable without medications later on, milder cases, etc. She said when difficult child was a baby there had been a sudden increase in asthma diagnosis's but now all these kids (older now) don't have that diagnosis. Was it wrong? She says no, she said they were having trouble breathing, needed asthmatic medications, and insurance wouldn't cover those medications if asthma diagnosis wasn't there. So, docs term it that diagnosis changes later on.

Which brings me to another thing I wonder about- I wonder if those steroids and albuterol as a baby thru 4 yo had something to do with a chemical imbabalance/mood disorder now. The only times I remember difficult child acting abnormally irate or emotional before the age of 10 yrs 9 mos was either if he was overly tired and WAY over stimulated (like late at night on July 4 or something) and right after albuterol or steroid medications.

 

[smallworld]

Actually, it may be the other way around. Steroids can trigger mood issues, even in people without BiPolar (BP).

FWIW, 30 percent (and it may actually be closer to 50 percent) of all kids who first present with depression go on to have bipolar disorder.

SSRIs like Prozac can absolutely trigger mania, suicidal/homicidal ideation and/or mixed episodes. It has happened with all three of my kids, but only one (my son) comes closest to the BiPolar (BP) diagnosis.

 

[klmno]

I should clarify more on what the pediat. said- she said that difficult child doesn't meet criteria for asthma diagnosis right nnow, but that doesn't mean he still doesn't have that tendency and she pointed out how I still avoid the combination of things that triggered the wheezing, ever since I figured out what it was and that still, when he's older (like 50+) he could be prone to emphazema(sp) or other breathing related problems, even full blown asthma again. She predicted the same regarding bipolar- he might find ways to manage (prevent mania and sever depression) without medications at some point but would probably still need to watch for signs that can trigger cycling and know (and be willing) to go to a therapist at first sign.

I'd like to ppoint out, it's not a lifelong bipolar diagnosis that petrifies me- a lot of functional people have and have had BiPolar (BP), as you all know. It's unmanaged BiPolar (BP) that petrifies me.

evaluation team was from Mood Disorders Clinic/Virginia Treatment Center for Children (VTCC), which is listed in The BiPolar (BP) Child book and I have read is only one of 17 (or something like that) in the US most qualified to diagnosis and distinguish between mood disorders. The psychiatrist on the team was the director there and also Chief of Child Psychiatry at Medical College of Virginia, which VTCC is a part of. She also knows the regular psychiatrist (Child & Adol. psychiatric). I was more afraid she would diagnosis BiPolar (BP) too quickly, but he already had that diagnosis so I was very happy that she didn't just confirm it, yet seemed to be much more focused on going back and getting treatment for initial problems to stop the cycling and said she thought there was a good chance, in his case, of this being successful.

 

[gcvmom]

In our case, psychiatrist (who has been treating difficult child 2 since he was a 5yo preschooler) will only give a mood disorder not otherwise specified designation at this time. He affirms that you cannot know for certain if it is truly BiPolar (BP) until after adolescence.

difficult child 2 has shown mood symptoms since the first grade (ADHD symptoms since age 3 1/2), and they have slowly evolved over the past five years. He had bad results with an SSRI (Zoloft), and did well on a-typical antipsychotics for several years (first Risperdal, then Abilify) until those stopped working.

He didn't become "manic" until this past spring when his stimulants stopped working and the Abilify stopped working, and in my desperation to control his ADHD symptoms by "upping" his doses between appointments, and the psychiatrist tossed Tenex into the mix. I got to see first-hand what "flight of ideas," "pressured speech," "rage," "delusions," "hypersexuality", "obsessional goal-directed activity", "dangerous risk-taking behavior", and "grandiosity" look like in a 10-year old boy. Not a sight for the faint-hearted. We were pretty much house-bound for the entire 10 weeks of medication wash and Depakote ramping this summer, both for his safety and my sanity. My summer from hell, to be sure.

I think that there is no black & white picture for BiPolar (BP) or any other mental illness, and am more of the mindset that people fall into a range of symptoms that belong to a particular disease category -- a spectrum with varying degrees of severity and varying assortment of symptoms within that disease family. I've got two difficult child's and a spouse with ADHD, and they are all VERY different in the way they present and the way they respond to medications.

Whatever you want to call what my difficult child's have, it doesn't really matter to me. All I care about is managing their symptoms so that their quality (and quantity) of life is as reasonably close to normal as possible. And even that criteria may end up being different for each of my kids in the long run. If a questionnaire can be used as a tool in the diagnostic process, I'm all for it, but I would be worried about the conclusions drawn if that were the ONLY tool used to make a diagnosis. Any diagnostician worth his/her salt has to consider much more than one source of information in forming their opinion on a patient, and it can't be done in one visit.

Wow -- you really got me on a roll with this post! :geek:

 

[klmno]

No problem GCV! I've been on a roll myself- for a couple of weeks now! I guess you guys will be glad to know I go back to work tomorrow!

Oh, I've seen manic stuff- similar to yours- and I've seen depressive stuff- and stuff I don't know where it fit. I agree whole-heartedly with the spectrum concept, too.

 

[Martie]

smallworld (and all),

I think your psychiatrist is taking the correct course. Although my ex-difficult child is not altogether "grown" (since research indicates brain development continues at least until 25,) he is not a young adolescent who presented in sequence with anxiety, depression, and ODD, but not ADHD as a child. He was medicated with a very high dosage level of Prozac because "oldest is best." This and Wellbutrin saved his life (at 80 mg of Prozac and 450 mg of Wellbutrin per day.) He was on a rule out bipolar at 14 because he was cycling beyond "normal," but never had a full-blown manic episode. He trialed 5 major mood stabilizers at EGBS (consulting psychiatrist was very good with medications and LISTENED to kids about side effects!) and not one did anything for ex-difficult child.

I was driven a bit nuts by the rule out bipolar because I wanted it "ruled out" or "ruled in." However, when I asked psychiatrist how one "got rid of "rule out BiPolar (BP)," he said, "make it to 40 without a manic psychotic episode." That seemed a bit extreme to me but he had a point: the longer ex-difficult child took high doses of SSRIs without a mood stabilizer to "buffer" and the older he got, the less likely it seemed that he would ever meet the diagnosis criteria for BiPolar (BP).

I consider it "ruled out" for all practical purposes. HOWEVER, in my less magnanimous moments, I am quick to point out that ex-difficult child is very "moody," and has classic "artistic temperament," which is not a diagnosis, but is very real to deal with some days. I guess it is fortunate for ex-difficult child that he lives in a world where this temperamental style is quite common....it might not go over well in some other occupational arenas. What this means to me is there are no definitive answers prospectively. Only retrospectively does the picture become clear(er)to me that all of this stuff is on a continuum and to call one thing a disorder and another a "tendency" is arbitrary and depends upon the psychiatrist's level of conservatism in Dxing.

From my perspective, the chances of functioning as a young adult are much better than as an adolescent in school. I believed this when ex-difficult child was young, and every year he has aged, he has made progress toward being more and more functional. I realize that difficult children on the more "conduct" end do not necessarily "improve with age" as they have bigger and better acting out opportunities. My comments are limited to adolescents with mood and other internalizing disorders. Stated a bit less formally, "it is the pits to be an adolescent with a mood disorder and things CAN get better." Even though I do believe that whatever is going on with ex-difficult child is life-long, the manifestations of it have changed over the years.
Best to you all,

Martie

 

[klmno]

Thanks, Martie, that sounds like a healthy perspective to me- and a positive one for your difficult child. We have anxiety and depression and eccentricity(sp) in my family so this is why I think there is a spectrum and difficult child inherited it- my terminology might be wrong or different but I think we're saying the same thing.

I'm not sure that psychiatrist is convinced difficult child is truly bipolar qualified, per diagnosis criteria- after his crime spree when prozac dosage was increased, psychiatrist said "oh no, that sounds manic", then my difficult child read some stuff I had on bipolar lying around and went to psychiatrist and told him he thought he was bipolar- of course, psychiatrist asked why and what symptons did he see in himself (looking for what difficult child noticed, not that he was going to let difficult child diagnosis himself). Yes, difficult child is on mood stabilizers, but the only time psychiatrist actually ever said bipolar was in a letter to the courts regarding difficult child's crime spree- and probably to insurance company. This might or might not be because it's simpler than explaining cycling and BiPolar (BP) criteria. At one point he wrote that it was suggestive of bipolar, then in another letter (for custody after my bro. was trying to make me and psychiatrist both look like quacks)psychiatrist wrote Bipolar not otherwise specified.

I don't think any diagnosis made right now is going to stick lifelong- I do think difficult child will have some depression, possibly anxiety or hyper tendencies, maybe some anger issues(hope not), because this runs in my family. No one ever diagnosis'd anyone else in my family with BiPolar (BP) but who knows- actually, no one has acted quite as erratic as difficult child. I just want it treated appropriately- like all of us here!! I will say, though, difficult child has told psychiatrist about certain "periods of time" that he feels pain differently and there have been clear, extreme changes in him for periods of time, and he's done the jumping out of car, fire setting, etc.

 

[totoro]

Our 1st psychiatrist from Chicago who is helping rewrite the next DSM and is on the board of CABF felt K was no doubt BiPolar (BP) but because of the DSM criteria put down Mood Disorder-not otherwise specified and (Bipolar Spectrum) she was not a fan of the BiPolar (BP)-not otherwise specified diagnosis...
We are part of a study with the Papolos' right now and I was talking to his ast. about how people think his questionaires are too easy to diagnosis BiPolar (BP) for people... we were both in agreement the we all believe if you truly want your child to "have" something you can mark the boxes anyway you see fit... If your child is truly having severe issues there is no question when you are answering those questions, especially on the JBRF site.
Likewise on the the Autism ones... if you are having to sit and think about it for a LONG time... I think the answer is NO.
His asst agreed, and felt the questions were not for self diagnosis... but for taking to your doctor... if red flags came up.
I think one of the problems is people look for easy ways out, (not here necassarily) they rush to look for a problem before trying any modifications... which is sad for those of us with kids with real issues.

Some psychiatristS will never give a BiPolar (BP) diagnosis to a young kid... it is pretty unheard of. They all "know" K is BiPolar (BP) but will not officially diagnosis her with it until she shows her true BiPolar (BP)... (BiPolar (BP)-I, BiPolar (BP)-II etc...) Right now she is an ultra, ultra rapid cycler in a mixed state!!!! Most wait until PUBERTY!!! YIKES!!!!

 

[klmno]

That's true Totoro, but one problem is that once a kid has gotten in trouble, sd, courts, etc, better see something getting changed/done or else they accuse the parent of not doing anything to address it and there are much bigger problems- we faced this in late winter 2 years ago. If I went to psychiatrist and said I want to try XXX instead of medications, he wouldn't call courts, but it would come out somehow and if whatever I tried didn't produce big miracles, I'd be in big trouble and difficult child probably wouldn't be living here. Also, they have trouble understanding that if psychiatrist and I have a conversation where he says "I'm thinking about trying this," and I say "can we wait a little or can we try this" that is not the same thing as me going against doctor's advice. Really, once difficult child got into trouble and sd and courts start scrutinizing, I have to be careful how I handle things regarding the medications and everything. I never wanted him on prozac to begin with- I truly wanted to try other modifications, but I couldn't even get tdocs to deal with anything other than behavior because difficult child had gotten into trouble and psychiatrist at psychiatric hospital wanted to start prozac- I was scared to death not to. This is exactly why, though, the real underlying issues have NEVER been addressed. And, why I'm glad psychiatrist on evaluation team said this is what needs to be taken care of FIRST. I just pray she puts that in writing and that I can get a copy. SOON!

 

[klmno]

Actually, as I read through the questionnaire more carefully, I took it to be for survey/research purposes- not diagnosis-ing purposes. I wouldn't let anyone diagnosis through the mail!

 

[smallworld]

Martie, thanks, as always, for sharing your perspective. I always value your insight because you have definitely been there done that.

What gets my son closer to a BiPolar (BP) diagnosis, I think, is that he has had two full-blown manic episodes -- one induced by taking 25 mg Zoloft for three weeks at age 12 and one very recently induced by anxiety over attending the day treatment program in which we have placed him. The first episode responded to a therapeutic level of Depakote. The second episode is slowly responding to Zonegran and Seroquel. In the past, he has also had bad reactions to Celexa, Prozac and Lexapro. The psychiatrists are in agreement that he needs treatment with mood stabilizers and/or atypical antipsychotics at this point.

It is also interesting to note that Dr. Ellen Leibenluft at NIMH is doing research on the very issue of how to differentiate BiPolar (BP) from other childhood mood disorders.

 

[Martie]

Smallworld,

Thanks for the link. I read about Leibenluft's work at NIMH last year. Did you send me the link then, too :wink: ?

I was extremely interested in the distinctions she is making due to ex-difficult child's lack of mania in the presence of EXTREME irritability (which can also be conceptualized as ODD as Green does in The Explosive Child.)However, ex-difficult child COULD look distracted in school (which he hated) but could "turn on" intense concentration at will, both for music and other things that interested him, thus ruling out ADHD...both by behavioral rating (Conners' & BASC) as well as neuropsychologist testing.

Maybe there is an even smaller subtype of extremely irritable, depressed, NON-ADHD children without mania. I was intrigued that some psychiatrists are taking frustration explosions as a manic equivalent. I can see the reasoning, but don't agree. Greene's explanation of the explosive behavior was much more helpful to me, probably because it made sense that ODD is one last refuge for an extremely irritable frustrated child.

I hope your difficult child benefits from his partial hospitalization program. I think that getting kids out of school and into an environment that is intensely therapeutic is necessary to adequately diagnosis and treat mood disorders. Schools just do not get it in my opinion although that may be an unfair generalization.

Best,

Martie

 

[TerryJ2]

Good points, klmno and smallworld.
Interesting discussion. I am 99% certain my difficult child is not Bi-p, but this topic still interests me. I like the idea of charting and taking 3 yrs for a diagnosis.

 

[BusynMember]

It usually takes ten years from the first time a person goes for help until they are dxd. with bipolar. While I was a mood, phobic child, my real moodswings didn't kick in full force until I was thirteen. Then each mood lasted at least a year. I'm not sold on the "rapid cycling." There is no way to know for sure if you have bipolar unless you have a full blown episode, and then there are four types of bipolar. I think one day they will all be called Mood Spectrum Disorder. Without x-rays, you really DON'T know for sure unless, like me, you can physically feel yourself getting depressed or high. I did not have a "good" hour and a "bad" hour or a good or bad few days. They went on forever, so it was a little more obvious. It still took me ten years to get dxd. And I"m still not sure it's full blown bipolar. It's very confusing. All these disorders are almost impossible to diagnose with 100% certainty.

 

[totoro]

I wasn't saying you could self diagnosis, and give yourself and actual diagnosis, but that you could sway the diagnosis... to look like your child was BiPolar (BP)... and take it to the pediatrician or whoever, if a parent wanted to. It has been obviously done many times before.
I wasn't saying people on the board here. But that was the complaint about the Papalos' questionaire, that people were answering it and not being "honest" and their kids were looking BiPolar (BP) when they were maybe just having tantrums or needed some behavior mods and parenting mods...

But you could do that with any questionaire... really.
I would not feel so strongly about K being BiPolar (BP) if I did not have such a strong genetic link and wasn't myself BiPolar (BP) and my Mom and many family members... My mom's brother... My brother most likely... My Father has many issues... my little brother... my husband side of the family has issues...
Because of her severity at such a young age... it is pretty clear. If someone said N is, I would be very hesitant to accept that...
She has issues but not so clear cut.
There is nothing wrong in my mind with waiting for the diagnosis, until she hits puberty... as long as someone is treating her. Or until the DSM gets re-evaluated.
She has a diagnosis... that will cover her in school or if she gets in trouble and for the medications. That is all I care about.

 

[klmno]

Wow, I really opened up a can of worms here. Sorry- that wasn't my intent.

From what I've read, which isn't everything by any means, the current diagnostic manual states a certain period of time that phases must last in order to meet the criteria for bipolar. Apparently this has been this way for quite some time, however, some psychiatrists are starting to think the cycling can happen quicker for younger people. So, these psychiatrists think that's why it has taken 10 years in the past to diagnosis and get adequate treatment. (Not all agree with that.) I interpret that to mean the line for diagnostic criteria might be moving, albeit maybe it's moving too far to the extreme. I wasn't aware that Dr. Papolos was considered as a psoc who had moved that line too far. Really, I just want to support any research efforts that can help hone in on this.

My difficult child has had extreme, erratic behavior in the past. Much of it meets bipolar symptons, some can equally meet unipolar depression. I'll do anything I can to help get the diagnosis right if the medications are so different that one can make him manic and the other can cause him to have life long side effects.

I certainly can't diagnosis him, much less anyone else's difficult child. I hope everyone can understand that I'm not pushing for this answer or that answer, I just want THE ANSWER for my difficult child. I got help for myself in my early 20's and it makes me feel extremely guilty and inadequate that I can't feel confident in the "help" he's being provided. I don't want him to get back to the point where I'm in fear of him dying or hurting someone else.