Bipolar disorder in children
Encyclopedia
Bipolar Disorder formerly known as "Manic Depression", is characterized by extreme changes in mood that range from depressive "lows" to manic "highs" (typified by feelings of excessive happiness or rage). It is important to note that these moods exceed normal responses to life events, represent a change from the individual's normal functioning, and cause problems in daily activities --- for instance, in getting along with family, friends and teachers, or in completing schoolwork.
Depressive symptoms of BPD often include sadness, irritability, an inability to enjoy one's usual activities, changes in appetite or weight, and/or sleeping more than normal or having difficulty falling/staying asleep even when tired.
Manic symptoms of BPD may include the following: inflated or unrealistic self-esteem; needing less sleep than normal and still feeling energetic; talking more/faster than normal; changing the topic of conversation so quickly/often that it interferes with communication; feeling that one's thoughts are "racing"; increased distractibility; difficulty sitting still; an unusual drive to engage in activities or pursue goals (e.g., excessive cleaning, making clearly unrealistic plans); and engaging in risky or dangerous behaviors (e.g., riding a bike on the highway; inappropriate sexual behaviors).
Identifying BPD in youth is challenging. While adults with BPD often have distinct periods of depression and mania that last for weeks, months, or longer, youth with BPD frequently have depressive and manic symptoms that occur daily, sometimes even simultaneously. As co-occurring disorders are common, determining what symptoms are signs of BPD and which are due to other disorders (e.g., depression, ADHD, disruptive behavior problems) is critical.
Diagnosis of bipolar disorder in children is controversial. While some believe the DSM-IV criteria should be followed others have proposed other behavioral markers specific for children BD. Another origin for controversy is the rise in the number of diagnosis in the last years, specially in the USA, with several possible causes for this increase. When following DSM criteria prevalence of BD in children is around 2% of the population
Management usually consist in pharmacological and psychological therapy. Drugs most commonly used are mood stabilizer
s and atypical antipsychotic
s. Psychological treatment usually combines education on the disease
, group therapy
and cognitive behavioral therapy. Both kind of treatments are in many cases chronic.
Cases of BD in children have been known for long, although they were thought to be rare. This view changed in the last part of the twentieth century. Future research directions include improving treatments, diagnostic criteria and the knowledge of BD in children.
than healthy children. Severe manic and depressive symptoms are associated with early age of diagnosis, meaning children often display more acute symptoms than adults. In children, mania often presents with psychotic symptoms and mixed manic depressive episodes. Such a presentation of mania often differs from classic descriptions of mania in adults, yet children who are diagnosed with bipolar disorder show the same brain abnormalities as adults, further complicating diagnosis. Children with PBD display anger, dysphoria, irritability, belligerence, and mixed-manic depressive symptoms more commonly and for more erratic time periods than adults.
's Diagnostic and Statistical Manual (DSM-IV-TR) requires a "distinct period of abnormally and persistently elevated, expansive or irritable mood" during at least four days, and a number of extra behavioral and cognitive symptoms such as grandiosity, reduced sleep need and risk seeking behaviors. Regarding diagnosis of children some experts recommend to follow the same DSM criteria than for adults, although taking into account the age of the individual and the normal behavior of those of his age. Others believe that these criteria do not separate correctly children with BD from other problems such as ADHD, and emphasize fast mood cycles. Still others argue that what accurately differentiates children with BD is the distinct irritability with which it courses. The practice parameters of the American Academy of Child and Adolescent Psychiatry
encourage the first strategy.
had been more aggressively applying the diagnosis
to children, rather than that the incidence of the disorder
has increased.
The reasons for this increase in diagnosis are unclear. On the one hand, the recent consensus from the scientific community (see above) will have educated clinicians about the nature of the disorder and the methods for diagnosis and treatment in children. That, in turn, should increase the rate of diagnosis. On the other hand, assumptions regarding behavior, particularly in regard to the differential diagnosis of bipolar disorder, ADHD, and conduct disorder in children and adolescents, may also play a role. In addition, some argue that the rise in diagnosis of pediatric bipolar disorder is the result of the influence of the pharmaceutical industry on psychiatry, especially with regard to big pharma's recent push to expand the market of atypical antipsychotics to children and the elderly.
Studies in clinics using these criteria show that up to 20% of youth referred to psychiatric clinics have bipolar disorder.
Drug prescription is commonly used as the initial treatment. It aims to reduce symptomatology and maximize the positive effect of psychotherapeutic interventions that may come afterwards. It usually consists in mood stabilizer
s, atypical antipsychotic
s, or a combination of both. Among the formers lithium
is the only compound approved by the Food and Drug Administration
for children with BD (above 12 years old). Combined therapy has been recommended for cases with partial or no response to a single medication and for individuals with psychosis
.
Medications can produce important side effects so interventions have been recommended to be closely monitored and families of patients be informed of the different possible problems that can arise. Atypical antipsychotics may produce weight gain
s as well as other metabolic problems, including diabetes mellitus type 2
and hyperlipidemia
. Extrapyramidal
secondary effects may appear with these medications. These include tardive dyskinesia
, a difficult-to-treat movement disorder (dyskinesia
) that can appear after long-term use of antipsychotics. Liver
and kidney
damage are a possibility with mood stabilizers.
Psychological treatment usually includes some combination of education on the disease
, group therapy
and cognitive behavioral therapy. Children with BD and their families are informed, in ways accordingly to their age and family role, about the different aspects of BD and its management including causes, signs and symptoms and treatments. Group therapy aims to improve social skills and manage group conflicts, with role-playing
as a critical tool. Finally cognitive-behavioral training is directed towards the participants having a better understanding and control over their emotions and behaviors.
Family therapy has strong support for treatment of pediatric bipolar disorder. Family Therapy is a branch of psychotherapy that works with families. It tends to view change in terms of the systems of interactions between family members. Families are seen as an interconnected force where the actions of the family members affect the health or dysfunction of each individual and the family as a whole. Family therapists focus on relationship patterns and are generally more interested in what goes on between family members rather than within one or more individuals. One family member may have a problem and the family relationships may be contributing to or maintaining that problem. For example, when a child has a behavior problem, family therapists may see the child as a 'scapegoat' and view the problem as actually residing within the family system. Family therapists avoid blaming any family member for the problem, and instead help the family interact in different ways that may solve the problem. There are both general, historical models of Family therapy (i.e., Structural, Strategic, Bowenian) and more specific, evidence-based approaches that are based on the earlier models. Strong research evidence suggests that both general and specific family therapy approaches are effective with a wide variety of clinical problems, including the treatment of bipolar spectrum disorders.
Cognitive behavioral therapy (CBT) is also effective in treating bipolar disorder in young people. CBT is the term used for a group of psychological treatments that are based on scientific evidence. These treatments have been proven to be effective in treating many psychological disorders among children and adolescents, as well as adults.
When all treatment options are ineffective clozapine
and electroconvulsive therapy
have been proposed as last choice possibilities.
medication is often needed, with relapses of individuals reaching rates over 90% in those not following medication indications and almost to 40% in those complying with medication regimens in some studies. Compared to adults, a juvenile onset has in general a similar or worse course, although age of onset predicts the duration of the episodes more than the prognosis. A risk factor for a worse outcome is the existence of additional (comorbid
) pathologies.
in the 1920s noted that mania episodes were rare before puberty. In general BD in children was not recognized in the first half of the XX century with first reviews of cases being published in the 60s. True recognition came twenty years after, with epidemiological studies showing that in approximately 20% of adults with BD already had symptoms in childhood or adolescence. Nevertheless onset before age 10 was thought to be rare, below 0.5% of the cases. During the second half of the century misdiagnosis with schizophrenia
was not rare in the non-adult population due to common co-occurrence of psychosis
and mania, this issue diminishing with an increased following of the DSM criteria in the last part of the XXth century.
Depressive symptoms of BPD often include sadness, irritability, an inability to enjoy one's usual activities, changes in appetite or weight, and/or sleeping more than normal or having difficulty falling/staying asleep even when tired.
Manic symptoms of BPD may include the following: inflated or unrealistic self-esteem; needing less sleep than normal and still feeling energetic; talking more/faster than normal; changing the topic of conversation so quickly/often that it interferes with communication; feeling that one's thoughts are "racing"; increased distractibility; difficulty sitting still; an unusual drive to engage in activities or pursue goals (e.g., excessive cleaning, making clearly unrealistic plans); and engaging in risky or dangerous behaviors (e.g., riding a bike on the highway; inappropriate sexual behaviors).
Identifying BPD in youth is challenging. While adults with BPD often have distinct periods of depression and mania that last for weeks, months, or longer, youth with BPD frequently have depressive and manic symptoms that occur daily, sometimes even simultaneously. As co-occurring disorders are common, determining what symptoms are signs of BPD and which are due to other disorders (e.g., depression, ADHD, disruptive behavior problems) is critical.
Diagnosis of bipolar disorder in children is controversial. While some believe the DSM-IV criteria should be followed others have proposed other behavioral markers specific for children BD. Another origin for controversy is the rise in the number of diagnosis in the last years, specially in the USA, with several possible causes for this increase. When following DSM criteria prevalence of BD in children is around 2% of the population
Management usually consist in pharmacological and psychological therapy. Drugs most commonly used are mood stabilizer
Mood stabilizer
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder.-Uses:...
s and atypical antipsychotic
Atypical antipsychotic
The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...
s. Psychological treatment usually combines education on the disease
Psychoeducation
Psychoeducation refers to the education offered to people who live with a psychological disturbance. Frequently psychoeducational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as...
, group therapy
Group psychotherapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
and cognitive behavioral therapy. Both kind of treatments are in many cases chronic.
Cases of BD in children have been known for long, although they were thought to be rare. This view changed in the last part of the twentieth century. Future research directions include improving treatments, diagnostic criteria and the knowledge of BD in children.
Signs and symptoms
Pediatric bipolar disorder (PBD) causes a significant impairment in the ability of children to function normally, especially in academics and psychosocial areas, and it is a chronic disorder that persists throughout the lifetime. Children with PBD experience chronic periods of mania, characterized by elevated and irritable moods, or depression. PBD patients are ten times more likely to commit suicideSuicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
than healthy children. Severe manic and depressive symptoms are associated with early age of diagnosis, meaning children often display more acute symptoms than adults. In children, mania often presents with psychotic symptoms and mixed manic depressive episodes. Such a presentation of mania often differs from classic descriptions of mania in adults, yet children who are diagnosed with bipolar disorder show the same brain abnormalities as adults, further complicating diagnosis. Children with PBD display anger, dysphoria, irritability, belligerence, and mixed-manic depressive symptoms more commonly and for more erratic time periods than adults.
Diagnosis
The diagnosis of childhood BD is controversial, although it is not under discussion that BD typical symptoms are dysfunctional and have negative consequences for minors suffering them. Main discussion is centered on whether what is called BD in children refers to the same disorder than when diagnosing adults, and the related question on whether adults criteria for diagnosis are useful and accurate when applied to children. More specifically main discussion over diagnosis in children circles around mania symptomatology and its differences between children and adults. For the diagnosis of mania the American Psychiatric AssociationAmerican Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
's Diagnostic and Statistical Manual (DSM-IV-TR) requires a "distinct period of abnormally and persistently elevated, expansive or irritable mood" during at least four days, and a number of extra behavioral and cognitive symptoms such as grandiosity, reduced sleep need and risk seeking behaviors. Regarding diagnosis of children some experts recommend to follow the same DSM criteria than for adults, although taking into account the age of the individual and the normal behavior of those of his age. Others believe that these criteria do not separate correctly children with BD from other problems such as ADHD, and emphasize fast mood cycles. Still others argue that what accurately differentiates children with BD is the distinct irritability with which it courses. The practice parameters of the American Academy of Child and Adolescent Psychiatry
American Academy of Child and Adolescent Psychiatry
The American Academy of Child and Adolescent Psychiatry is a 501 non-profit professional association in the United States dedicated to facilitating psychiatric care for children and adolescents. Established in 1953, the Academy is headquartered in Washington, D.C...
encourage the first strategy.
Increase
Number of American children and adolescents diagnosed of BD in community hospitals increased 4-fold reaching rates of up to 40% in 10 years around the beginning of the current century, while in outpatient clinics it doubled reaching the 6%. Outpatient office visits for children and adolescents with bipolar disorder in the United States increased from 20,000 in 1994–95 to 800,000 in 2002–03. The data suggest that doctorsPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
had been more aggressively applying the diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...
to children, rather than that the incidence of the disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
has increased.
The reasons for this increase in diagnosis are unclear. On the one hand, the recent consensus from the scientific community (see above) will have educated clinicians about the nature of the disorder and the methods for diagnosis and treatment in children. That, in turn, should increase the rate of diagnosis. On the other hand, assumptions regarding behavior, particularly in regard to the differential diagnosis of bipolar disorder, ADHD, and conduct disorder in children and adolescents, may also play a role. In addition, some argue that the rise in diagnosis of pediatric bipolar disorder is the result of the influence of the pharmaceutical industry on psychiatry, especially with regard to big pharma's recent push to expand the market of atypical antipsychotics to children and the elderly.
National differences
Another factor is that the "consensus" regarding the diagnosis in the pediatric age group seems to apply only to the USA. The British National Institute on Health and Clinical Excellence (NICE) guidelines on bipolar disorder in 2006 specifically described the broadened criteria used in the USA to diagnose bipolar disorder in children as suitable "only for research" and "were not convinced that evidence currently exists to support the everyday clinical use of (pediatric bipolar phenotype) diagnoses" which increase the "risk that medicines may be used to inappropriately treat a bipolar diathesis that does not exist."(p526). A 2002 German survey of 251 child and adolescent psychiatrists (average 15 years clinical experience) found only 8% had ever diagnosed a pre-pubertal case of bipolar disorder in their careers. A similar survey of 199 child & adolescent psychiatrists (av 15 years clinical experience) in Australia and New Zealand also found much lower rates of diagnosis than in the USA and a consensus that bipolar disorder was overdiagnosed in children and youth in the USA. Concerns about overdiagnosis in the USA have also been expressed by American child & adolescent psychiatrists and a series of essays in the book "Bipolar children: Cutting-edge controversy, insights and research" highlight several controversies and suggest the science still lacks consensus with regard to bipolar disorder diagnosis in the pediatric age group.Epidemiology
Studies using DSM criteria show that up to 2% of youth may have bipolar disorder.Studies in clinics using these criteria show that up to 20% of youth referred to psychiatric clinics have bipolar disorder.
Treatment
Usual treatment involves medication and psychotherapy. Nevertheless studies on the treatment of BD in children are scarce and of low quality, and many times approaches are directly derived from studies and practice with adults.Drug prescription is commonly used as the initial treatment. It aims to reduce symptomatology and maximize the positive effect of psychotherapeutic interventions that may come afterwards. It usually consists in mood stabilizer
Mood stabilizer
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder.-Uses:...
s, atypical antipsychotic
Atypical antipsychotic
The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...
s, or a combination of both. Among the formers lithium
Lithium pharmacology
Lithium pharmacology refers to use of the lithium ion, Li+, as a drug. A number of chemical salts of lithium are used medically as a mood stabilizing drug, primarily in the treatment of bipolar disorder, where they have a role in the treatment of depression and particularly of mania, both acutely...
is the only compound approved by the Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
for children with BD (above 12 years old). Combined therapy has been recommended for cases with partial or no response to a single medication and for individuals with psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
.
Medications can produce important side effects so interventions have been recommended to be closely monitored and families of patients be informed of the different possible problems that can arise. Atypical antipsychotics may produce weight gain
Weight gain
Weight gain is an increase in body weight. This can be either an increase in muscle mass, fat deposits, or excess fluids such as water.-Description:...
s as well as other metabolic problems, including diabetes mellitus type 2
Diabetes mellitus type 2
Diabetes mellitus type 2formerly non-insulin-dependent diabetes mellitus or adult-onset diabetesis a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. Diabetes is often initially managed by increasing exercise and...
and hyperlipidemia
Hyperlipidemia
Hyperlipidemia, hyperlipoproteinemia, or hyperlipidaemia is the condition of abnormally elevated levels of any or all lipids and/or lipoproteins in the blood...
. Extrapyramidal
Extrapyramidal system
In human anatomy, the extrapyramidal system is a neural network located in the brain that is part of the motor system involved in the coordination of movement. The system is called "extrapyramidal" to distinguish it from the tracts of the motor cortex that reach their targets by traveling through...
secondary effects may appear with these medications. These include tardive dyskinesia
Tardive dyskinesia
Tardive dyskinesia is a difficult-to-treat form of dyskinesia that can be tardive...
, a difficult-to-treat movement disorder (dyskinesia
Dyskinesia
Dyskinesia is a movement disorder which consists of effects including diminished voluntary movements and the presence of involuntary movements, similar to tics or choreia. Dyskinesia can be anything from a slight tremor of the hands to uncontrollable movement of, most commonly, the upper body but...
) that can appear after long-term use of antipsychotics. Liver
Liver
The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
and kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
damage are a possibility with mood stabilizers.
Psychological treatment usually includes some combination of education on the disease
Psychoeducation
Psychoeducation refers to the education offered to people who live with a psychological disturbance. Frequently psychoeducational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as...
, group therapy
Group psychotherapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
and cognitive behavioral therapy. Children with BD and their families are informed, in ways accordingly to their age and family role, about the different aspects of BD and its management including causes, signs and symptoms and treatments. Group therapy aims to improve social skills and manage group conflicts, with role-playing
Role-playing
Role-playing refers to the changing of one's behaviour to assume a role, either unconsciously to fill a social role, or consciously to act out an adopted role...
as a critical tool. Finally cognitive-behavioral training is directed towards the participants having a better understanding and control over their emotions and behaviors.
Family therapy has strong support for treatment of pediatric bipolar disorder. Family Therapy is a branch of psychotherapy that works with families. It tends to view change in terms of the systems of interactions between family members. Families are seen as an interconnected force where the actions of the family members affect the health or dysfunction of each individual and the family as a whole. Family therapists focus on relationship patterns and are generally more interested in what goes on between family members rather than within one or more individuals. One family member may have a problem and the family relationships may be contributing to or maintaining that problem. For example, when a child has a behavior problem, family therapists may see the child as a 'scapegoat' and view the problem as actually residing within the family system. Family therapists avoid blaming any family member for the problem, and instead help the family interact in different ways that may solve the problem. There are both general, historical models of Family therapy (i.e., Structural, Strategic, Bowenian) and more specific, evidence-based approaches that are based on the earlier models. Strong research evidence suggests that both general and specific family therapy approaches are effective with a wide variety of clinical problems, including the treatment of bipolar spectrum disorders.
Cognitive behavioral therapy (CBT) is also effective in treating bipolar disorder in young people. CBT is the term used for a group of psychological treatments that are based on scientific evidence. These treatments have been proven to be effective in treating many psychological disorders among children and adolescents, as well as adults.
When all treatment options are ineffective clozapine
Clozapine
Clozapine is an antipsychotic medication used in the treatment of schizophrenia, and is also used off-label in the treatment of bipolar disorder. Wyatt. R and Chew...
and electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
have been proposed as last choice possibilities.
Prognosis
ChronicChronic (medicine)
A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...
medication is often needed, with relapses of individuals reaching rates over 90% in those not following medication indications and almost to 40% in those complying with medication regimens in some studies. Compared to adults, a juvenile onset has in general a similar or worse course, although age of onset predicts the duration of the episodes more than the prognosis. A risk factor for a worse outcome is the existence of additional (comorbid
Comorbidity
In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...
) pathologies.
History
Emil KraepelinEmil Kraepelin
Emil Kraepelin was a German psychiatrist. H.J. Eysenck's Encyclopedia of Psychology identifies him as the founder of modern scientific psychiatry, as well as of psychopharmacology and psychiatric genetics. Kraepelin believed the chief origin of psychiatric disease to be biological and genetic...
in the 1920s noted that mania episodes were rare before puberty. In general BD in children was not recognized in the first half of the XX century with first reviews of cases being published in the 60s. True recognition came twenty years after, with epidemiological studies showing that in approximately 20% of adults with BD already had symptoms in childhood or adolescence. Nevertheless onset before age 10 was thought to be rare, below 0.5% of the cases. During the second half of the century misdiagnosis with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
was not rare in the non-adult population due to common co-occurrence of psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
and mania, this issue diminishing with an increased following of the DSM criteria in the last part of the XXth century.
Research directions
Current research directions for BD in children include optimizing treatments for this population through well designed clinical trials, increasing the knowledge of the genetic and neurobiological basis of the pediatric disorder, finding out why so many pediatric cases are among boys whereas many adult cases are in women, and improving diagnostic criteria. Regarding the latter the mental health professionals charged with forming the new Diagnostic and Statistical Manual for Mental Disorders (the DSM-V) have proposed a new diagnosis, Disruptive Mood Dysregulation Disorder, which (though it is still a biologically based mental illness requiring drug and psychotherapeutic treatment) is considered to cover some presentations involving behavioral outbursts in different settings and locations that is as of now currently thought of as simple childhood-onset bipolar disorder occurring before puberty.Handbooks for researchers and clinicians
Bipolar Disorder in Childhood ad Early Adolescence. Gellar, B., & BelBello, M. (ed)Resources for parents
- "Information about Bipolar Disorder - Resources For Parents and Teachers, Provides information about IEPs and school issues, as well as sample letters."
- "Message Boards (Forums) For Parents of Children with Bipolar Disorder"
- "Information about Bipolar Disorder"
- "What is Family Therapy?"
- "What is CBT?"
- The Ups and Downs of Raising a Bipolar Child: A Survival Guide for Parents by Judith Lederman, Candida Fink - 2003 - 320 pages
- The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder. by Demitri Papolos, Janice Papolos - 2007 - 474 pages
- Bipolar Disorder and The "Quest For The Test"
- Understanding the Mind of Your Bipolar Child: The Complete Guide to the Development Treatment and Parenting of Children with Bipolar Disorder. by Gregory Thomas Lombardo - 2006 - 364 pages
- Straight Talk about Your Child's Mental Health: What to Do When Something Seems Wrong by Stephen V. Faraone - 2003 - 390 pages
- Parenting a bipolar child: what to do & why by Gianni Faedda, Nancy B. Austin - 2006 - 278 pages