Archive for the 'Bi-polar' Category

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EBD goes to college

Published on 8 December 2006 in Acting in, Bi-polar, Depression, Families and News. 0 Comments

For students with Emotional and Behavioral Disorders who make the transition to post-secondary education and for their families, the challenges are substantial, according to a story entitled “Off to College on Their Own, Shadowed by Mental Illness” by Lynette Clemetson of the New York Times. Ms. Clemetson uses two separate cases to illustrate her observations.

Her mother called it a negotiable proposition. But to Jean Lynch-Thomason, a 17-year-old with bipolar disorder who started college this fall, her mom’s notion to fly from their home in Nashville to her campus in Olympia, Wash., every few weeks to monitor Jean’s illness felt needlessly intrusive.

“I am so totally aware of the control you have over me right now,” Jean said, sitting in her parents’ living room one evening last June, before coolly reminding her mother of her upcoming 18th birthday. “In a few months the power dynamic is going to be different.”

For Chris Ference, 19, who is also bipolar, the fast-approaching autonomy of his freshman year held somewhat less appeal. His parents had always directed every aspect of his mental health care. Last summer, over Friday night pizza at his home in Cranberry Township, Pa., he told them that assuming control felt more daunting than liberating.

“If it was up to me, I would just have it so you could make those decisions for me up until I was like, 22,” he said. “I mean, you’ve raised me well up to now. You know me better than anyone.”

This is an important topic, so I’m glad that Ms. Clemetson brought it to the fore. Follow this link (free subscription required) to read Ms. Clemetson’s story. Fortunately, there are resources on which college students with EBD can depend; learn more about some of them at these sites:

  • Active Minds on Campus is a national (US) organization that Ms. Clemetson mentioned; Active Minds encourages student-managed groups on college and university campuses to promote awareness of mental health issues, advocate for mental health and mental illness resources, encourage fellow students to seek help when it is needed, and establish relationships with the mental health community. (I’m glad to note that there’s a chapter at U.Va., the institution where I am employed.)
  • The American Psychological Association provides a special section of its outreach Web site devoted to college mental health.
  • APA’s college mental health section.
  • Cope.Care.Deal, which is funded by the Annenberg Foundation Trust a Sunnylands, provides resources for adolescents.
  • Colleges and universities that receive US federal funds are required to provide services for individuals with disabilities, and this requirement goes beyond ensuring that campuses have wheelchair-accessible facilities; search for “disability” at any school’s Web site.

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10 December 2006 Update: On Psych Central, John Grohol covered this story, too. Here’s a link to his entry.

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Diagnoses galore

Published on 11 November 2006 in ADHD, Bi-polar, Families, Musings and News. 0 Comments

Children receive diverse psychiatric diagnoses of Emotional and Behavioral Disorders that leave parents and the children bewildered, according to a story entitled “What’s Wrong With a Child? Psychiatrists Often Disagree” by Benedict Carey, in the New York (NY, US) Times. Mr. Carey recounts multiple examples of children who have been characterized as having bipolar disorder, attention deficit disorder, oppositional-defiant disorder, pervasive developmental disorder, depression and anxiety.

At a time when increasing numbers of children are being treated for psychiatric problems, naming those problems remains more an art than a science. Doctors often disagree about what is wrong.

A child’s problems are now routinely given two or more diagnoses at the same time, like attention deficit and bipolar disorders. And parents of disruptive children in particular — those who once might have been called delinquents, or simply “problem children” — say they hear an alphabet soup of labels that seem to change as often as a child’s shoe size.

In my opinion, this is a pretty predictable consequence of approaching these problems as something that should be handled by medical practices, when many of them would be better managed by environmental manipulations. We need to identify the specific needs of the children and design methods for teaching them how to do things. If the problem is “argues with adults,” we should analyze the conditions under which the behavior occurs—the antecedents and the consequences of arguing—and either modify those events or teach the child a self-management strategy (or both). If the problem is fidgeting (is that really a problem?), we need to determine what fidgeting does for the child and address that function; I suspect that most children can learn non-fidgets activities and, when we make them more rewarding than fidgeting, the salience of the problem will be reduced greatly.

What happens too often, in my view, is that we go through a checklist of “symptoms” looking for a secret, hidden pattern that represents an underlying disorder. We’re still trying to do Freud here. What we actually get, of course, is a cluster problems. Evidence may show that these problems do, in fact, cluster together, but such clustering doesn’t necessarily indicate that they reflect an underlying organic base for the individual problems.

I also recognize that providers of mental health care for children must use a diagnostic system so that costs of providing services can be charged to insurance companies. Just because someone has to pay for therapy doesn’t mean that therapy has to be medications nor that we should ignore simple and practical means of addressing problems.

Link to Mr. Carey’s article (free subscription may be required).

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Bi-polar academic

Published on 31 May 2006 in Bi-polar, News and Research. 0 Comments

Children with bipolar disorder, whether with or without attention deficit-hyperactivity disorder have deficits in cognitive skills that are associated with lower academic outcomes, according to an abstract for a study to be published in Biological Psychiatry. Here’s the abstract.

Impact of Neurocognitive Function on Academic Difficulties in Pediatric Bipolar Disorder: A Clinical Translation.

Biol Psychiatry. 2006 May 25;

Authors: Pavuluri MN, O’connor MM, Harral EM, Moss M, Sweeney JA

BACKGROUND: Previous research has demonstrated that academic and neuropsychological functions are compromised in pediatric bipolar disorder (PBD). Investigation of the degree to which neuropsychological deficits might contribute to those academic problems is needed to aid in the recognition and intervention for school achievement difficulties in PBD. METHODS: A sample of 55 children and adolescents with PBD with and without attention-deficit/hyperactivity disorder (ADHD) (PBD group, n = 28; PBD+ADHD group, n = 27) were tested with a computerized neurocognitive battery and standardized neuropsychological tests. Age range of subjects was 7-17 years, with the mean age of 11.97 (3.18) years. Parents completed a structured questionnaire on school and academic functioning. RESULTS: Logistic regression analyses indicated that executive function, attention, working memory, and verbal memory scores were poorer in those with a history of reading/writing difficulties. A separate logistic regression analysis found that attentional dysfunction predicted math difficulties. These relationships between neuropsychological function and academic difficulties were not different in those with PBD+ADHD than in those with PBD alone. CONCLUSIONS: In PBD neuropsychological deficits in the areas of attention, working memory, and organization/problem solving skills all contribute to academic difficulties. Early identification and intervention for these difficulties might help prevent lower academic achievement in PBD.

Link to the abstract.

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