Management of bipolar disorder is complicated and needs to be individually tailored to the needs of the individual child and family. A treatment plan should take into account the fact that the child's symptoms will vary with developmental and environmental changes. Also, symptoms may vary due to the fluctuating nature of the disorder. Therefore, successful treatment plans for bipolarity in children require flexibility and openness by the treating clinician.
Conceptualizing the child's treatment and needs as moving targets is a good way to plan the treatment of this complicated illness. Generally, management of a bipolar child requires pharmacological treatment of manic symptoms and other comorbid psychiatric symptoms. Also, management of suicidal and other emergency behaviours, management of school functioning, management of family stress and caregiver burden, and mental health treatment of other family members is necessary. Hospitalization of the child may be needed during a full-blown manic episode to ensure patient and family safety. Suicidal threats and gestures need to be taken seriously. The family should develop a crisis plan with the members of the treatment team so that in an emergency the parents know how to access the appropriate services efficiently. In acute manic state, clinicians must avoid getting into any arguments or questions regarding the delusional system of the child. After recovery, clinicians should not remind the child of his or her foolish or embarrassing behaviour. It is critical that parents are aware of their child's mood symptoms, sleep habits and pattern of cycling so that they can make environmental and behavioural interventions and abort the development of a full-blown episode.
In addition, parents should be aware of the possible educational impairment associated with bipolar disorder. Bipolar children and adolescents are at risk for learning disabilities . Therefore, psychoeducational testing is important in the comprehensive treatment plan once the child's mood is stable. A bipolar child can be unfocused, unmotivated and lethargic because of mood symptoms, and impulsive, inattentive, anxious or disabled because of comorbid conditions. Prescribed medication may also result in cognitive dullness, fatigue and poor handwriting. Unfortunately, some of these side effects may not completely go away despite careful medication monitoring, dosage reduction and changes in time of administration. Both clinicians and parents should be aware of the long-term implications of this illness pertaining to schooling and career planning. A bipolar child generally falls under the educational label of serious emotional disturbance (SED). According to the 1999 report by the US Department of Education, SED children are four times more likely to drop out of high school than their peers .
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