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On the last track, we discussed three characteristics
of mixed states which included: irritability; distractibility; and
boiling point. We
also included three techniques for children who experience mixed states, which were Define your Emotions; Sensory Focus; and Contract to Avoid Conflict.
As you know, when it comes to children, medications and the prescription
doses will vary constantly. A bipolar child is already much less stable than
a bipolar adult and there are several other factors affecting children and
On this track, we will examine three difficulties
in prescribing medication to bipolar children. These difficulties
include taking regular doses; rebellious teens; and side effects. We
will also include two techniques for combating these difficulties, which include
Medication Routine and Other Non-Medicinal Treatments.
3 Difficulties in Prescribing Medication
1. Taking Regular Doses
The first and most common difficulty we will discuss is taking regular doses. Because children are not yet old enough to be responsible
for themselves, they cannot remember to take their medication on their own. Because
of this, parents must remember to remind their children about their medication. However,
under the daily stresses that come with parenting, many parents of bipolar
children forget. Missing one dosage or day is not really significant
as long as the child picks up the medication the next day.
beyond a day or two becomes increasinglydangerous. As you know, reintroducing
the body to a chemical after a period of withdrawal can shock the body. Marjory,
mother of a bipolar child, had forgotten her seven year old daughter Elise’s
prescription while they went on vacation. An even larger problem arose
when Marjory found she could not have Elise’s doctor call in a prescription
because stimulants are closely monitored by the government. Once she
came back from vacation, Elise had to be put on a much smaller dose and eased
into her previous prescription dosage.
Technique: Medication Routine
To help parents like Marjory, who may from time to time forget their child’s
medication, I suggest they make up Medication Routine. This
routine establishes a common time during the day that the client will take
his or her medication. This time can be marked by a meal, an hour, or
activity. For instance, Marjory told Elise that every day before breakfast
time she would take her stimulant medication. Marjory also made Elise
promise not to eat her breakfast until she’d had her medication.
making routine medication time, it was more difficult for Marjory and Elise
to forget. Think of your client whose parents seem to chronically forget
their child’s medications. Could they benefit from making a Medication
Routine? There is one other technique that parents of bipolar
children have found useful in getting their children to take regular medicine. Lori,
mother of Jenny a 6 year old bipolar child, takes vitamins in the morning. When
Jenny needs to take her medication, Lori takes her vitamins. This helps
Jenny feel less alone in taking the pills
2. Rebellious Teens
The second difficulty occurs when a rebellious teen stops taking his
or her medication. Bipolar teenagers are in a delicate position. Often,
the medication they take has unfavorable side effects such as weight gain and
acne. These particular side effects are socially unacceptable and therefore
increase the teen’s desire to quit medications. Also, at the early
age of 13, as most parents know, adolescents wish to assert their independence and
as a result make decisions that could be potentially dangerous to their health. They believe they know what’s good for them and soon challenge the authority
and wisdom of their parents and doctors.
Kelly, a fourteen-year-old bipolar
teen, felt self-conscious about her weight. Instead of changing her diet
and exercise routine, Kelly blamed the weight gain on her bipolar medications. When
Kelly began to feel stable again, she decided to stop taking her medication without consulting her mother or her doctor. For a while, Kelly felt
energized again and enjoyed the manic feeling she had suppressed.
Kelly soon noticed that she had become more irritable and soon, during a basketball
game, instigated a fist fight with another player. This incident prompted
her parents to investigate Kelly’s mood stabilizers which they found
had not been taken. The fight was a reminder to Kelly how important medications
are to everyone’s well-being.
3. Side Effects
In addition to taking regular doses and rebellious teens, a third difficulty
children face when taking medications is side effect. Many
of these side effects are more annoying than dangerous, however, I find it
beneficial to speak with parents of bipolar children about monitoring for
dangerous side effects, such as higher energy that could lead to mania. Weightgain can, at times, be highly concerning for parents as well.
few pounds is nothing serious, but when a child gains thirty or more pounds within a span of two weeks, adjustments should be made. Also, I ask
that children who experience severe weight gain be tested monthly to avoid
developing diabetes while on medication. I emphasize to parents that
a healthy diet and exercise are the best ways to combat weight gain and can
also aid in a child’s self-esteem.
Techniques: Other Non-Medicinal Treatments
Many parents are deeply concerned about side effects and psychotropic medications. To
alleviate the parent’s concerns, I often recommend other non-medicinal
treatments, which have proven beneficial in bipolar clients. Light
Therapy, for example has been proven useful in clients whose depression
is seasonal related. In light therapy, specially-designed bright lights
are used to simulate the sun. We will discuss light therapy more thoroughly
on track 11.
On this track, we discussed three difficulties in prescribing
medication to bipolar children. These difficulties included taking
regular doses; rebellious teens; and side effects. We also
included two techniques for combating these difficulties,
which were Medication Routine and Other Non-Medicinal
On the next track, we will examine three non-medicinal
treatments for depression. These treatments include: electroconvulsive
therapy; light therapy; and repeated transcranial magnetic stimulation.
Bipolar Disorder in Children and Teens: A Parent's Guide
- National Institute of Mental Health. Bipolar Disorder in Children and Teens: A Parent's Guide. U.S. Department of Health and Human Services.
Peer-Reviewed Journal Article References:
Allen, D. N., Randall, C., Bello, D., Armstrong, C., Frantom, L., Cross, C., & Kinney, J. (2010). Are working memory deficits in bipolar disorder markers for psychosis? Neuropsychology, 24(2), 244–254.
Alloy, L. B., Bender, R. E., Whitehouse, W. G., Wagner, C. A., Liu, R. T., Grant, D. A., Jager-Hyman, S., Molz, A., Choi, J. Y., Harmon-Jones, E., & Abramson, L. Y. (2012). High Behavioral Approach System (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: A prospective behavioral high-risk design.Journal of Abnormal Psychology, 121(2), 339–351.
Goldberg, S. G. (2019). Narratives of bipolar disorder: Tensions in definitional thresholds.The Humanistic Psychologist, 47(4), 359–380.
Montiel, C., Newmark, R. L., & Clark, C. T. (2021). Perinatal use of lurasidone for the treatment of bipolar disorder. Experimental and Clinical Psychopharmacology.
Shahar, F. G. (2020). When bipolar was still called manic depression: Getting sick in the era of the DSM–II. Psychological Services. Advance online publication.
Online Continuing Education QUESTION
10 What are three difficulties in prescribing medications to bipolar children?
To select and enter your answer go to CE Test