Colleagues Response week 8

 Assignment: 

Respond to at least two of your colleagues who argued the opposite side as you by countering their argument with evidence. Identify at least two consequences to support your position.

Response Post #1

Against Diagnosing Pediatric Patients with Bipolar Disorder

           Bipolar disorder is genetic, and 60 to 90 percent of studies on twins indicates that it is passed down from generation to generation. Studies indicate that changes in the prefrontal cortex and subcortical area of the brain are associated with bipolar disorder (Sadock & Ruiz 2014).   Bipolar Disorder is a persistent mental health disorder that occurs with severe and single mood swings, either high with a lot of energy or low with a feeling of depression, according to the National Institute of Mental Health (2018).   The genetic aspect of Bipolar Disorder causes signs to be seen in pediatric patients and in the DSM-5 manual without meeting the diagnostic criteria.

           According to the DSM-5 manual, hypomanic or manic episodes (talkative, a flight of thoughts, diminished need for sleep, distractibility, high-energy agitation, and outburst) are the diagnostic criteria for Bipolar Disorder (APA, 2013).  This diagnosis criterion is close to the Attention-Deficit / Hyperactive Disorder criteria. ADHD requirements include (flight of thoughts, concentration difficulty, non-stop conversation, higher energy, etc.) (APA, 2013).  Therefore, an ADHD child with Bipolar Disorder is extremely likely to be misdiagnosed.

           The American Association of Psychology recognized children's irritability, rage, and mood swings and agreed to add another diagnosis; Destructive Mood Dysregulation Disorder  (APA, 2013). Chronic irritability in between periods of rage or temper tantrums seen in the Bipolar Disorder criteria is the main characteristic of DMDD.  Diagnosis of DMDD is a child-specific symptom that aids in the proper care and removes the controversies in children around Bipolar Disorder.  There is a need to be particular when diagnosing children.  Developmental and hormonal changes in children have their psychological effects and may be temporary.  Therefore, other treatment options should be explored before rushing to diagnose a child with Bipolar Disorder. 

Response Post #2

Against

Pediatric Bipolar Depression Disorder Debate

           Pediatric Bipolar Depression Disorder (PBDD) has been a controversial subject for decades. The concept of PBDD came about by United States researchers in the middle of the 1990s (Duffy, Carlson, Dubicka, & Hillegers, 2020). The following will provide information that supports that PBDD is not an appropriate diagnosis for children.

Against the Diagnosis

According to the diagnostic criteria form the DSM-5, pediatric diagnosis of Bipolar Depression Disorder can be made with irritability rather than depression, sleep disturbances, psychomotor agitation, inappropriate guilt, problems concentrating, fatigue, and/or thoughts of death. The question I present is: How does a provider determine if those symptoms are due to trauma, ADHD, or other mental health concerns? Another question is: Why is the United States the one country who embraces the diagnosis of PBDD?

A case review highlighted by the NCTSN showed that a 12 year old child who had been subjected to extreme neglect, sexual abuse, domestic violence, and parental substance use was diagnosed with Oppositional Defiant Disorder and Pediatric Bipolar Disorder (2019). Further screening and assessment by a trauma-informed clinician found that the symptoms she was presenting was linked to complex trauma. Perry and Levin (2012) highlighted that not only trauma, but ADHD, can lead to the presentation of symptoms that are congruent with the diagnosis of PBDD.

In the facility I work, we provide trauma-informed care. Many of the children we care for are diagnosed with ADHD, anxiety, ODD, and Bipolar Disorder. We are finding that once we have switched to trauma informed care, children are leaving our care with LESS diagnoses. Duffy et al. (2020) highlights that the determination of PBDD does not take into account the environmental factors, social factors, and adverse childhood factors that may be contributing to the presenting symptoms.

Conclusion

           The controversy of over medicating children and causing significant long-term harm has been an issue that all providers need to be aware of. What if a child is diagnosed with PBDD and treated with medications that are not warranted? What if a trauma-informed approach could decrease or even eliminate the symptoms? Are you willing to make a lifelong diagnosis, treat the child with medications that may be unnecessary and harmful, and not take into account the possibility of a childhood disorder or trauma?  I know I am not.