Medication treatment of bipolar disorder in developmentally disabled children and adolescents

Abstract

If systematic data on the treatment of bipolar disorder in children and adolescents is meager, information on treatment of bipolar disorder in developmentally disabled children is virtually nonexistent. Not only are many of the challenges to diagnosing young children relevant to persons with autism and intellectual disability of any age, but also, accumulating a sample size large enough to randomize to treatment alternatives would require financial resources that are not likely to be forthcoming any time soon. This chapter, then, begins with a review of the treatment of bipolar disorder (BD) in normally developing youth, summarizes current treatment of BD in adults with developmental disabilities (DD), and then moves to the review of available literature on the treatment of developmentally disabled children and adolescents with BD. We conclude with our thoughts about treatment in this vulnerable population. Our understanding of BD as a recurrent disorder in which mood and activity level are either significantly increased (hypomania and mania) or decreased (depression) with return to premorbid levels of functioning in between emerged largely from the vast clinical experience of psychiatrists such as Kraepelin in the early 20th century recognizing syndromal similarities of hundreds of his patients. Our initial understanding of BD in youth, however, emerged from attempts to find pediatric equivalents of what adult psychiatrists appeared to be describing (see Glovinsky, 2002; Carlson, 2005). This form of manic depressive illness did indeed exist in youths, occurred mostly in adolescents, was depressive, and familial. In the early 1950s, a volume of a journal called The Nervous Child raised the issue of an alternative form of manic depression, children whose behavior fluctuated and might be construed as cycling. Anthony and Scott (1960) explored the question of strictly defined, classical manic depressive psychosis in preadolescents in a literature review, and they found it to be uncommon, generally beginning to emerge at around age 11. © 2009 Springer New York.