Pediatric Bipolar Disorder ~ The Fear-of-Harm Phenotype

On a previous posts I wrote What Are Some Symptoms of Juvenile Bipolar Disorder and  Depressing Facts of Juvenile Bipolar Disorder. I promised I would soon explain about The Fear-of-Harm phenotype (FOH). This group of children have a more severe form of pediatric bipolar disorder with higher frequency and severity of manic and depressive symptoms, greater rates of hospitalization and greater likelihood of school performance difficulties.

The Juvenile Bipolar Research Foundation web site gives this explanation: “Investigators were able to define a subgroup of children who are at greatest risk for the most severe form of this manic/depressive syndrome. They call this subgroup the “Fear of Harm” (FOH) phenotype. In addition to the high risk of self injury, injury to others and suicide threat that are important characteristics of this phenotype, children in this group also experience an early age of onset, severe manic and depressive symptoms, early and frequent psychiatric hospitalizations, significant social impairment and school problems.”

The eight items that define “Fear-of-harm “is called the FOH index. The following six traits come from the YBOCS (the Yale Brown Obsessive Compulsive Scale):

*Fear might harm self
*Fear might harm others
*Fear harm might come to self
*Fear harm might come to others (may be because of something child did or did not do)
*Fear will act on unwanted impulses (i.e. to stab a family member)
*Fear will be responsible for something else terrible happening (I.e. fire, burglary)

Two traits come from the OAS (the Overt Aggression Scale).

*Mutilates self, causes deep cuts /bites that bleed, internal injury, loss of consciousness, loss of teeth.
*Attacks others, causing severe physical injury (broken bones, deep lacerations, internal injury)

As we all know, early detection greatly improves a child’s outcome by setting into motion early intervention. If you think your child exhibits some of these traits, go on the Juvenile Bipolar Research Foundation and read the summary of the JBRF sponsored research. Check the Core Phenotype Child Bipolar Questionnaire (CBQ) Index Subscale. Investigators compiled a list of 22 CBQ symptoms and it is called the Core Phenotype. It is, in their minds, a more accurate list of symptom criteria by which to identify a child at risk for bipolar disorder.

Hello, parents of today, none of this was available when our children were growing up! Please take advantage of all the resources available with a click of your fingers and seek professional help immediately.

One day without treatment is one day too many.

The Depressing Facts About Juvenile Bipolar Disorder

Derryck Smith, head of psychiatry at the Children's and Women's Health Centre of British Columbia, wrote in the Canadian Journal of Psychiatry last July: "There is no greater controversy in child and adolescent psychiatry than that related to the diagnosis, treatment and increasing prevalence of childhood-onset bipolar disorder."

While the debate rages on, parents and children struggle on. The following facts do not paint a pretty picture of the situation. Doctors, researchers and experts at children's hospitals, mental-health support groups and referral services must push for answers and programs to help families crippled by Juvenile Bipolar Disorder.

The Depressing Facts:


*Some psychiatrists suspect that under broad definitions, childhood bipolar disorder may be more prevalent than autism - affecting between 1 and 2 per cent of all children.


*Bipolar disorder was thought to be the result of chemical imbalances in the brain, now researchers can also identify specific areas of the brain that are affected by the illness.


*According to the Child and Adolescent Bipolar Foundation, 15% of children diagnosed with ADHD may actually be bipolar.


*Many of the frustrating or objectionable behaviors displayed by students with bipolar disorder are actually symptoms of neurological instability in the brain rather than willful misconduct.


* The disorder is often suspected by a knowledgeable parent, psychiatrist, pediatrician, psychologist, therapist, or social worker based on information and observations from the patient, family members, and others who know the child well.


*A correct and thorough evaluation as early as possible is critical since psycho stimulant medications, often prescribed for ADHD, may worsen manic symptoms of juvenile bipolar disorder.


*According to the Child and Adolescent Bipolar Foundation (CABF), children with bipolar disorder can be charming and charismatic during an appointment. They initially may appear to a professional to be functioning well. Therefore, CABF suggests you take daily notes of your child's mood, behavior, sleep patterns, unusual events and statements made by your child that cause you concern. Share these notes with the child and adolescent psychiatrist who you choose to evaluate your child.


*Bipolar disorder tends to run in families. When one parent has bipolar disorder, the risk to each child is estimated to be l5-30%. When both parents have bipolar disorder, the risk increases to 50-75%.


* Juvenile Bipolar disorder has always stood out as one of the toughest psychiatric disorders to diagnose, manage and monitor because of the ultra-ultra rapid mood swings of mania and depression and the other comorbid conditions.


*Health care professionals may be reluctant to prematurely "label" a young person with a mental illness diagnosis. Yet early diagnosis and treatment of depressive disorders are critical to healthy emotional, social, and behavioral development.

*Research suggests the earlier the disease strikes, the more severe the illness will become.

*Bipolar children are at risk for failing grades and drug abuse. Prone to suicide, reckless behaviour and delusions of grandeur, no mental illness results in more premature deaths than bipolar depression.

An Educator's Guide to Pediatric Bipolar Disorder February 5, 2010, on the Child and Adolescent Bipolar Foundation website gives this advice:

"A child with bipolar disorder needs medical treatment, but medication is just one element of an effective treatment plan. It is equally important for the child to be surrounded as much as possible by supportive people in settings that minimize daily stress.

 An effective treatment plan for bipolar disorder requires three essential elements:

• Medication

• Lifestyle and environmental changes

• School accommodations

Bipolar disorder is a chronic, lifelong condition. However, medications can help alleviate and reduce symptoms so they are less intrusive, smooth out mood fluctuations, reduce anxiety and distractibility, and increase frustration tolerance. Because stress is a trigger that intensifies bipolar symptoms and causes a decline in overall level of functioning, lifestyle and school changes should be made to reduce stress."

As grim as all this sounds, focus on the big picture. Create opportunities for your bipolar child to shine and feel good about him/herself…this little star has talents, gifts and a whole life ahead that you are instrumental in making  happier and brighter. "If you think you are too small to be effective, you have never been in the dark with a mosquito”

Leave us a comment telling us the support or services in your area for families affected by Juvenile Bipolar Disorder.