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Dr. Henin and her research team have been involved in a series of studies in high-risk children focusing on a variety of emotional disorders including ADHD, depression and bipolar disorder. High-risk studies in children typically include children whose parents suffer from a mental disorder. High-risk bipolar studies in children typically include children with at least one parent with bipolar disorder. Risk of bipolar disorder has been estimated at 25% for those with one parent with bipolar disorder and between 50 and 75% for those with both parents having the disorder.
Dr. Henin’s follow-up study of bipolar high-risk children confirms the risk for early onset of a mood disorder in this group—50% have met criteria for major depression by age 18 with 30% exhibiting an episode of mania and therefore meeting criteria for a diagnosis of bipolar disorder.
Children of a parent with bipolar disorder have increased rates of emotional disorder above and beyond the mood disorder category. This group of children also was found to have increased risk for an anxiety disorder, substance use disorders, ADHD and other disruptive behavior disorders such as oppositional defiant disorder and conduct disorder. Since many of these disorders occur before the typical age of onset of bipolar disorder, they may signal a higher risk for later onset of bipolar disorder. These children also demonstrated high rates of a temperament type characterized by disinhibition—a tendency to take risks in novel environmental settings.
Children of a parent with bipolar disorder have increased rates of emotional disorder above and beyond the mood disorder category. This group of children also was found to have increased risk for an anxiety disorder, substance use disorders, ADHD and other disruptive behavior disorders such as oppositional defiant disorder and conduct disorder. Since many of these disorders occur before the typical age of onset of bipolar disorder, they may signal a higher risk for later onset of bipolar disorder. These children also demonstrated high rates of a temperament type characterized by disinhibition—a tendency to take risks in novel environmental settings.
Identifying risk factors for bipolar disorder in this high risk sample requires controlling for effects of diagnostic comorbidity in parents and controlling for the potential effects of medication use. Parental anxiety disorders and substance use disorders increase risk for substance in the high-risk children. Children developing bipolar disorder show neuropsychological impairments found in adult bipolar populations including deficits in executive function (planning, organization, multi-stage goal directed behavior), working memory, attention, mathematical skills and verbal memory. However, many of these cognitive problems may be attributable to ADHD or worsened by the co-occurence of ADHD.
Examining the role of medication, the Harvard group found a link between mood stabilizer drug use (i.e. lithium and valproate) and slowed cognitive processing. Some of the neuropsychological deficits found in children with bipolar disorder are also present in their siblings who do not yet meet criteria for a bipolar disorder diagnosis.
Examining the role of medication, the Harvard group found a link between mood stabilizer drug use (i.e. lithium and valproate) and slowed cognitive processing. Some of the neuropsychological deficits found in children with bipolar disorder are also present in their siblings who do not yet meet criteria for a bipolar disorder diagnosis.
Neuroimaging studies in this high-risk child and adolescent sample suggests reduced glutamine and myoinositol in the anterior cingulate cortex. This suggests reduction in brain glial cells in this brain region. Unaffected sibs and those with partial symptoms show higher anterior cingulate glutamine, possibly a protective factor for the full expression of the disorder.
Dr. Henin concluded her presentation with a brief summary of a psychotherapy model to treat adolescents and young adults with bipolar disorder. This program combines cognitive behavior therapy with elements of motivational interviewing to reduce the frequency of problem behaviors. The study is ongoing but preliminary findings support the intervention as more effective than wait list in overall improvement and reducing risk behavior frequency.
Given the high number of concurrent other emotional disorders in bipolar high-risk children, diagnosis is a complex process. Often longitudinal follow-up, symptom monitoring, assessing response to drug therapy and using a family members perspectives are required for accurate diagnosis. Additional research is necessary to aid clinicians in the diagnostic process and to inform improved treatment and prevention strategies.
Photo of U.S. Ryder Cup golfer Hunter Mahan (Camillo Villegas in backgroung) at 2010 PGA Championship.
Henin A, Mick E, Biederman J, Fried R, Wozniak J, Faraone SV, Harrington K, Davis S, & Doyle AE (2007). Can bipolar disorder-specific neuropsychological impairments in children be identified? Journal of consulting and clinical psychology, 75 (2), 210-20 PMID: 17469879
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