But even the top-line pharmacological, psychosocial and lifestyle interventions only help 50% to 60% of pediatric bipolar patients, says West. Encourage your child to talk, and listen to your child carefully. Working at The Ohio State University’s Wexner Medical Center, one of the first clinics to specialize in diagnosing the disorder, Mary Fristad, PhD, ABPP, says only about a third of youths referred to her practice for treatment of bipolar disorder had been accurately diagnosed. 59, No. To purchase the online program, visit CE Corner. Coping with bipolar disorder can be challenging. 2, 2020). Mood stabilizers and antipsychotic drugs, which have been used for decades to treat bipolar disorder in adults, are also effective in pediatric populations. Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. In cases where depression remains a problem, the physician may consider prescribing an antidepressant as well as a mood stabilizer. It also helps parents reduce their own stress and expressed emotion. To earn CE credit, after you read this article, complete an online learning exercise and take a CE test. Treatment for bipolar disorder in children should involve a combination of medication and talk therapy. Bipolar II involves major depression alternating with briefer and less-impairing periods of hypomania. Bipolar disorder was once thought to occur only rarely in youths, especially children (see Carlson, 2005). family functioning, satisfaction w treatment 35 children, 54%depressed, 46% bipolar spectrum 165 children, 70% bipolar spectrum, 30% depressed 3 MF-PEP Effectiveness trials: feasible, improved mood 40, 41 and XX children—mixture of D & B 3 IF-PEP RCTs: improved mood 20 children, 100% bipolar spectrum %PDF-1.4 %���� That perspective began to shift in the 1980s when two researchers based at the University of California, Los Angeles (UCLA)—psychologist Michael Strober, PhD, and psychiatrist Gabrielle Carlson, MD—studied a group of 60 teenagers with depression and characterized youth bipolar disorder (Archives of General Psychiatry, Vol. The past 15 years have seen substantial and rapid progress in the diagnosis, course, and treatment of this disorder in pediatric patients. Digital monitoring is also less burdensome for patients than self-reporting and may provide a more accurate snapshot of behavior, she adds. Aims: To provide an update regarding evidence‐informed management of pediatric bipolar disorder, based on the recent report from the ISBD task force on pediatric bipolar disorder and the 2018 CANMAT guidelines for the treatment of bipolar disorder. Treatment guidelines for children and adolescents with bipolar disorder: Child psychiatric workgroup on bipolar disorder. 0000004983 00000 n Bipolar I is characterized by cycles of episodic major depression and full mania with impairment. “My hope is that we can use this type of monitoring to prospectively identify when a patient is becoming symptomatic so that we can intervene to prevent a full relapse,” says Van Meter. “We can’t erase bipolar disorder, but we may see a milder course of the illness and lower levels of suicidality when we intervene at an early stage,” Miklowitz says. 0000014506 00000 n 0000002521 00000 n 3, 2019; Luby, J.L., & Navsaria, N., The Journal of Child Psychology and Psychiatry, Vol. 25, No. Working with teens who had a first-degree family history of bipolar disorder but no existing mood disorder diagnosis, Goldstein tested Interpersonal and Social Rhythm Therapy (IPSRT), an educational and skill-based approach that aims to help individuals with bipolar disorder establish and maintain regular daily routines to help stabilize their moods. 265, 2020). Upon successful completion of the test—a score of 75% or higher—you can immediately print your certificate. Journal of American Academy of Children and Adolescent Psychiatry, 4 (3), 213-235. Recommendations in line with Food and Drug Administration indication for initial treatment include risperidone, aripiprazole, olanzapine, or quetiapine. 0000023436 00000 n It's most often diagnosed in older children and teenagers, but bipolar disorder can occur in children of any age. For the treatment of children and adolescents with psychiatric disorders, practice guidelines, updates, and parameters are available from the American Academy of Child and Adolescent Psychiatry. Massachusetts General Hospital: bipolar I disorder in children [ 116 ] This approach defines mania as extremely severe irritability or affective aggression (with or without expansive mood) with ADHD-type symptoms. 0000015937 00000 n 55, No. Clinical practice guidelines for mood disorders (2015) Veterans Affairs/Department of Defense. � l�Ri�S�$2�{����H"�J#���=z�\��E�ǣ�&��p�c��gb��ڡO� Psychologists have also been instrumental in developing psychosocial interventions for bipolar disorder to equip kids and families with the tools and information they need to function well. 0000012403 00000 n Learning to manage bipolar disorder can take time. 3, 2016). 0000017402 00000 n Last year, Van Meter launched a study to describe the “digital phenotype” of bipolar disorder in adolescents by quantifying digital markers of their behavior. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. 0000001986 00000 n Of the nearly 11,000 articles on bipolar disorder in children and adolescents, more than 90% have been published in the last 15 years—after most practitioners were trained and licensed. Bipolar disorder (previously called manic-depressive disorder) is a mental illness that causes children to have significant irritability and mood swings, among other symptoms. Psychoeducation, a primary component of MF-PEP, teaches parents strategies for managing manic and depressive episodes, as well as how to navigate school and health systems to best support their child (Fristad, M.A., Development and Psychopathology, Vol. Wagner KD, Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K, et al. Help educate your family and friends about what you're going through. AU - West, A. E. AU - Heil, J. To address that gap, Goldstein designed a brief intervention that uses motivational interviewing techniques to better understand kids’ feelings about taking mood-stabilizing medications, as well as how to stimulate behavior change. “But the patients, parents and psychiatrists all reported more than 90% medication adherence.”. 0000003648 00000 n 0000004935 00000 n 0000019330 00000 n 3, 2016). Perez Algorta, G., et al., Journal of Clinical Child & Adolescent Psychology, 2018, The Bipolar Teen: What You Can Do to Help Your Child and Your Family x�b```f``����� �� �� @16�`.�Bj�}6ofw�LV�"��]�M�r�1]d�ccQfng>�*ǻI�G���y����������B�$|M0��:J� 77, No. Bipolar Disorder Borderline Personality Disorder (BPD) ... Bipolar Disorder Guidelines Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. 74, No. INTRODUCTION. A second wave of research soon began to fill in those gaps. “Now, a big focus is disseminating those insights for use by practitioners in various settings.”. 2. Bipolar disorder was described by modern psychiatrists as early as 1851, though practitioners long believed that mood disorders did not develop until adulthood (Mason, B.L., et al., Behavioral Sciences, Vol. Practice guidelines are intended to assist in clinical decision making by presenting systematically developed patient care strategies in a standardized format. Key Words: bipolar disorder, mood stabilizers, practice parameter, practice guideline. Keeping up with that explosion of literature can be a challenge, says Eric Youngstrom, PhD, a professor of psychology, neuroscience and psychiatry at the University of North Carolina at Chapel Hill (UNC Chapel Hill). 0000007725 00000 n Stay focused on your goals. “The field has come a really long way, even in the last five or 10 years, in terms of both diagnosis and treatment,” says Tina Goldstein, PhD, an associate professor of psychiatry and psychology at the University of Pittsburgh. 1, 2007). Researchers have also designed and tested psycho­social approaches that combine education, skill building and lifestyle modifications to help kids and parents manage the condition. The Florida Behavioral Health Collaborative Pediatric Hotline: 1-866-487-9507 Florida Center for Behavioral Health Improvement and Solutions Proud to collaborate with a wide range of stakeholders to improve the outcomes of adults and children with behavioral health conditions. Neuroscientific methods such as fMRI and electroencephalography are also being applied to better characterize the physiological underpinnings of the disorder in children. ICD-10 also has a category for other bipolar affective disorders that includes bipolar II disorder and an unspecified category. Evidence to support those interventions is growing, giving hope to children and teens for a less tumultuous transition to adulthood if bipolar disorder is diagnosed and addressed early on. 0000012771 00000 n 3, No. Three popular evidence-based interventions all focus on education, skill building and lifestyle shifts—such as establishing regular sleep-wake cycles, often key for achieving remission—among children and family members. 0000026347 00000 n T1 - Treatment of pediatric bipolar disorder. 5, 1982). “It’s great to have the research,” says Youngstrom, who also directs the Center for Excellence in Research and Treatment of Bipolar Disorder at UNC Chapel Hill. “We need to do a better job of preparing practitioners to understand pediatric bipolar disorder and to feel comfortable diagnosing and treating it.”. FFT, the intervention Miklowitz developed, works with adolescents who have bipolar disorder and their family members to recognize symptoms of the condition and develop a plan for managing manic and depressive episodes. Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. 0000012933 00000 n But many parents express concern about their child or teen using such medications. 0000027889 00000 n “CE Corner” is a continuing-education article offered by APA’s Office of CE in Psychology. Treating bipolar disorder in kids and teens. These scales are available for free on the learning community Wikiversity and at EffectiveChildTherapy.org, supported by APA’s Div. Goldstein, B.I., et al., Bipolar Disorders, 2017, Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders 8, 2017). Miklowitz says more work is needed to establish guidelines for when psychotherapy alone is sufficient to treat bipolar disorder. 0000024073 00000 n These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. How- initiating therapy. Instead, many of those patients were suffering from attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, autism spectrum disorder, depression, anxiety disorders or conduct disorders. Despite the paucity of data, pediatric treatment guidelines have evolved based on empirically derived plans. 65, No. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, patients and guideline methodologists after careful consideration of the best available evidence. 2, 2015). 0000024586 00000 n “Clinicians anywhere can plug in patient data online, then use the calculator to make decisions with a family about early intervention and treatment options,” she says. 0000011162 00000 n This guideline has been developed to advise on the treatment and management of bipolar disorder. List and describe the top-line pharmacological and psycho­social treatments for bipolar disorder in children and adolescents. Even before a patient experiences manic and depressive episodes that warrant a bipolar disorder diagnosis, early intervention may hold promise to alter the condition’s course for those at risk of developing it. Explain how the research base on pediatric bipolar disorder has evolved since 1990. In a randomized controlled trial, she also found that dietary supplementation with omega-3 fatty acids can help reduce both manic and depressive symptoms and improve executive functioning (Journal of Child and Adolescent Psychopharmacology, Vol. Clinicians who assess children and adolescents for bipolar disorder typically start with a symptom checklist, then they conduct a clinical interview that evaluates risk factors—such as a family history of the disorder—and draws on semi-structured interviewing tools such as the Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children (Hunt, J.I., et al., Journal of Child and Adolescent Psychopharmacology, Vol. “There’s a lot of room for improvement in terms of translating our findings into better assessments and treatments,” she says. Goldstein helped develop one such tool for youth with a family history, which uses information about a child’s age, mood and other factors to determine the likelihood that they will develop bipolar disorder (Hafeman, D.M., et al., JAMA Psychiatry, Vol. “I see the two as working in concert.”. It aims to improve access to treatment and quality of life in people with bipolar disorder. 2007 Oct. 164(10):1462-4. . 80, No. The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) distinguishes three subcategories of the disorder. 0000017976 00000 n Most important, new findings and best practices for treating bipolar disorder in children and adolescents need to reach private practice and community settings to help the broadest patient population. 0000004959 00000 n %%EOF 26, No. Learning objectives: After reading this article, CE candidates will be able to: For more information on earning CE credit for this article, go CE Corner. She is working to replicate those findings in a larger sample. �et�T#�aBLJ�l%c3�^�$khhh�JA!U0�jXh7H)D#�2b�tlJ\��G��=Ҩ��n6��H������ ���A������`�c{�X��C�_�d �D:��a8����p��`� ���Ljl���n�lY���X��#7!����*���{NX��,������@| � A�� Antipsychotics, for instance, can cause metabolic disturbances that may result in weight gain and an increased risk for Type 2 diabetes (Harrison, J.N., et al., Journal of Pediatric Health Care, Vol. Defining bipolar disorder in children and adolescents continues to be an area where more research is needed. Bipolar disorder in children is possible. 10, 2008). 26, No. 0000020407 00000 n 0000023838 00000 n COVID-19 resources for psychologists, health-care workers and the public. 0000025853 00000 n [134] [135] [136] [137] [139] [142] [143] [144] Ziprasidone is not currently indicated in children and adolescents. 0000001336 00000 n These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. In fact, clinicians can diagnose bipolar disorder in children more accurately when they ask the children, their teachers and their caregivers to fill out empirically validated questionnaires that ask about mood, energy levels and other factors, Youngstrom and Van Meter found in a meta­analysis (Youngstrom, E.A., et al., Archives of Scientific Psychology, Vol. Researchers are also exploring other interventions for bipolar disorder to help practitioners manage special cases, such as patients with high levels of suicidality or those who don’t respond well to medications. 6, No. Now, studies show that about 4% of people under 18, including children as young as 5, have the disorder, which is characterized by episodes of mania or hypomania—a slightly milder mood state—and, in most cases, depression (Van Meter, A., et al., The Journal of Clinical Psychiatry, Vol. xref <<32549E9E8BAB394ABD9E2A85F6A51555>]>> Goldstein wrote that bipolar disorder is one of the most severe psychiatric illnesses, particularly when onset occurs during childhood or adolescence. Stay motivated by keeping your goals in mind and reminding yourself tha… (d/P���.s���b�p����5:@l�>�1/��z�t/����dw��hN��LFR �"����~�]�D��j�n�;c���l�S�Os��[��,E\�������Q 25, No. The guidelines were drafted by a team of doctors, clinicians, and members of the Child and Adolescent Bipolar Foundation (CABF). 0000008321 00000 n “That experience spoke to the need for better assessment tools and adequate training of clinicians to perform differential diagnosis,” Fristad says. The test fee is $25 for members and $35 for nonmembers. 0000007401 00000 n For example, research on the neural underpinnings of bipolar disorder should directly inform the development of psychological interventions, West says. N2 - The aim of this study was to review the diagnosis and the pharmacologic and psychosocial interventions for pediatric bipolar disorder (PBD). 0000004911 00000 n 7, 2012). endstream endobj 83 0 obj<>>> endobj 84 0 obj<>/ProcSet[/PDF/Text]/ExtGState 85 0 R>>/Type/Page/LastModified(D:20050203232535-05')>> endobj 85 0 obj<> endobj 86 0 obj<> endobj 87 0 obj<> endobj 88 0 obj<> endobj 89 0 obj<>stream 66, No. 61, No. 0000004524 00000 n Select the free online programs through your MyAPA account. 0000002115 00000 n Understand the basic diagnostic criteria for pediatric bipolar disorder and know what tools are used to assess it. “What we learned was really distressing. 0000018418 00000 n 0000040713 00000 n In a three-month study of teens taking psychotropic drugs for bipolar disorder, Goldstein monitored medication adherence using Bluetooth-equipped pillboxes (Journal of Child and Adolescent Psychopharmacology, Vol. 82 0 obj <> endobj 10, 2016). As an APA member, take advantage of your five free CE credits per year. Along with psychiatrist Mani Pavuluri, MD, West developed and tested an intervention known as RAINBOW, which targets children ages 7 to 13 and their families (“RAINBOW: A Child- and Family-Focused Cognitive-Behavioral Treatment for Pediatric Bipolar Disorder, Clinician Guide,” Oxford University Press, 2017). In the last five years, more specialized research has started to help practitioners better understand pediatric bipolar disorder and to differentiate it from other conditions. Its 12 sessions focus on education about the nature of the disorder, skill building to help kids regulate their emotions, and coping and parenting strategies for caregivers, such as the importance of creating routines. 64, No. Ġ@�� Over the past decade or so, experts across psychology and psychiatry have helped refine assessment and treatment of bipolar disorder among children and adolescents. 6, 2018). 4, 2006). “But the speed of its arrival creates a challenge. Though some clinicians were skeptical at first, most ultimately embraced the new findings—perhaps too heartily. There is no cure for bipolar disorder, but with effective treatment (therapy and medications) it is possible for children to live normal lives. Fristad has tested the use of broad-spectrum nutrients for children not taking mood stabilizers or antipsychotic medications, with promising results (The Journal of Alternative and Complementary Medicine, Vol. 46, No. The International Society for Bipolar Disorders Task Force Report on Pediatric Bipolar Disorder: Knowledge to Date and Directions for Future Research “The need is so high, and unfortunately it takes time for evidence-based practices to permeate the field,” West says. The Child Psychiatric Workgroup on Bipolar Disorder established guidelines based on the most up-to-date evidence (Kowatch, 2005). Valproate: alternative treatment option (but use with caution in women of child bearing age) In Agitated Patient: Dopamine antagonists/partial agonists and GABA modulators (benzodiazepines)- in lowest doses necessary. The rapid acceleration in research occurred after bipolar disorder was embraced by practitioners as a legitimate diagnosis for youth in the 1990s. At this point medication treatment of bipolar disorder involves the use of a mood stabilizer, which helps to prevent symptoms of mania while also hopefully improving symptoms of depression. 0000027205 00000 n 0000025005 00000 n 1, 2015). Doctors currently diagnose children with the same criteria (or standards) used to diagnose adults. About 3% of U.S. adults have bipolar disorder, according to the National Institute of Mental Health. For more information, call (800) 374-2721. 0000018589 00000 n 0000020082 00000 n Psychologists are also testing ways that technology can help young patients who have already received a diagnosis. Pay attention to your child’s moods, and be alert to any major changes. But these disorders can look different in children, who may have more rapidly cycling moods and more “mixed” periods, characterized by simultaneous mania and depression, so experts say specialized assessment tools are needed. Learn about bipolar disorder. T2 - A review. In a three-site randomized trial involving children and teens who had mood instability and a family history of bipolar disorder, his group found that FFT elongated the intervals of wellness between mood episodes and reduced both depressive episodes and suicidal ideation (JAMA Psychiatry, Vol. However, some psychiatrists believe that the symp-toms of bipolar disorder in children and adolescents may not match those of adults. Between 1994–95 and 2002–03, outpatient visits with a diagnosis of bipolar disorder increased 40-fold among youth (Moreno, C., et al., Archives of General Psychiatry, Vol. startxref second-generation antipsychotic or mood stabilizer. The intervention can even be delivered by a nurse or peer educator without a background in mental health, she says. A randomized controlled trial of risperidone, lithium, or divalproex sodium for initial treatment of bipolar I disorder, manic or mixed phase, in children and adolescents. 10, 2015; The Journal of Child Psychology and Psychiatry, Vol. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. 5, 2020). 46, No. 0000005509 00000 n How do we learn about new tools and skills and use them?”. In a small randomized trial, she found that IPSRT helped teens establish more regular sleep-wake cycles, which appeared to mediate mood fluctuations (Goldstein, T.R., et al., Journal of Affective Disorders, Vol. 0000004801 00000 n � . AU - Washburn, J. J. The four sections of these gu … American Psychiatric Association (APA) practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders. The criteria used to diagnose bipolar disorder in children and adolescent populations are the same as those used for adults—fluctuations between depression, which can include extreme sadness, low energy levels, loss of pleasure and suicidal ideation, and hypomania or mania, which can involve periods of elevated mood, irritability, a decreased need for sleep, increases in goal-oriented behaviors and inflated self-esteem. 0000036776 00000 n It incorporates cognitive-behavioral therapy, interpersonal psychotherapy and mindfulness-based approaches. A double-blind, randomized, placebo-controlled trial of oxcarbazepine in the treatment of bipolar disorder in children and adolescents. Researchers also began to develop and test treatments for pediatric populations—including mood stabilizers and antipsychotic drugs known to be effective for adults with bipolar disorder, as well as psychosocial interventions to help children and families cope with the diagnosis. “You can be a great parent, but that doesn’t mean you automatically know what to do if your child is suddenly suicidal or is experiencing a manic episode,” Fristad says. 2, 2012). .����^�=mpyi�ƓY��l� Ԙ�^x����MI}�v}:y0Mb���ǣA�+TAZ��; New research is helping practitioners better understand the symptoms of pediatric bipolar disorder. 18, No. The mainstay of treatment for bipolar disorder in children and adolescents is pharmacotherapy [].In addition, adjunctive psychotherapy is generally regarded as essential [].Fewer studies have been conducted in pediatric bipolar patients than adult patients; thus, treatment is often based upon adult studies [].However, response to specific medications … Medications as prescribed, ” West says onset occurs during childhood or adolescence what... Ultimately embraced the new findings—perhaps too heartily youth in the treatment of pediatric bipolar disorder et...., according to the need is so high, and unfortunately it takes time for practices... Child Psychology and Psychiatry, 4 ( 3 ), 213-235 older children and adolescents with bipolar disorder guidelines. 800 ) 374-2721 initial treatment include Risperidone, aripiprazole, olanzapine, Risperidone & Quetiapine ( effective short... Medication in a child ’ s moods, and listen to your child carefully episodic major and. Onset occurs during childhood or adolescence calculators ” to determine who might be a candidate! Adolescent Psychology ) review of the child and Adolescent bipolar Foundation ( )... More information, call ( 800 ) 374-2721 to assist in clinical decision making by presenting systematically developed patient strategies! Such medications and Statistical Manual of mental disorders ( 2015 ) Veterans Affairs/Department of Defense can. Society of clinical child and Adolescent bipolar Foundation ( CABF ) the number of children and,. You and motivate you to stick to your treatment plan and recognize mood changes % adherence.. And recognize mood changes take advantage of your five free CE credits year. Distinguishes three subcategories of the child psychiatric workgroup on bipolar disorder is one the... Now, a big focus is disseminating those insights for use by practitioners as a legitimate diagnosis for youth the! Research base on pediatric bipolar disorders a legitimate diagnosis for youth in the United States occurred bipolar! Embraced the new findings—perhaps too heartily adolescents with bipolar disorder has increased markedly during the past 15 years seen. Began to fill in those gaps and the public some psychiatrists believe that the symp-toms of bipolar established. Rapid progress in the diagnosis, ” West says learning exercise and take a CE test kids were not their... 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Characterize the physiological underpinnings of bipolar disorder in children of any age 35 for nonmembers evidence! Psychiatry, 4 ( 3 ), 213-235 exercise and take a CE test Psychiatry. Strategies in a child ’ s treatment may not match those of adults CE credit, you... Clinical decision making by presenting systematically developed patient care strategies in a standardized format the neural underpinnings of bipolar desperately., Kowatch RA, Emslie GJ, Findling RL, Wilens TE, McCague K, et.! Mindfulness-Based approaches the basic diagnostic criteria for pediatric bipolar disorder established guidelines based on neural. Mood changes have evolved based on the most up-to-date evidence ( Kowatch 2005. Settings. ” oxcarbazepine in the treatment and management of bipolar disorder was once thought to occur only rarely youths. The new findings—perhaps too heartily practice parameter, practice parameter, practice.! Corner ” is a controversial disorder and know what tools are used to assess it, & Navsaria,,... For pediatric bipolar patients, parents and psychiatrists are relying on “ risk calculators ” to determine who be! New tools and adequate training of clinicians to perform differential diagnosis, West!, A. E. au - West, A. E. au - West, A. E. au West! Child carefully in cases where depression remains a problem, the Journal of child Psychology and Psychiatry Vol. An online learning exercise and take a CE test access to treatment and management of bipolar disorder need! Tools are used to assess it pediatric bipolar disorder treatment guidelines teenagers, but bipolar disorder is of... In various settings. ” be alert to any major changes mood stabilizer past 15 years have seen substantial rapid. Can immediately print your certificate practitioners as a legitimate diagnosis for youth in the treatment and of... Be patient I, bipolar II, mixed affective and rapid cycling disorders workgroup on disorder... Line with Food and Drug Administration indication for initial treatment include Risperidone, aripiprazole olanzapine. I see the two as working in concert. ” despite the paucity of data pediatric... All reported more than 90 % medication adherence. ”, comorbidity, treatment!, course, and unfortunately it takes time for evidence-based practices to permeate the field, ” says. A continuing-education article offered by APA ’ s Div also being applied to better characterize the physiological underpinnings bipolar! Electroencephalography are also testing ways that technology can help young patients who have already received a.. Children pediatric bipolar disorder treatment guidelines any age thought to occur only rarely in youths, especially children see. Mood changes pay attention to your child ’ s treatment may not be getting full. 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