The Bipolar Teen: What You Can Do to Help Your Child and Your Family

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<ul><li><p>This hands-on aggressive approach could be viewed as arelief from the more slow-building first half of the book. Thelevel of detail is ideal for parents who are highly motivated andhave the skills to put the techniques successfully into action.Alternatively, understanding and implementing the actionscould feel intimidating to insecure, less organized, or dis-tractible parents.Your Defiant Teen is an empathy-building, empowering,</p><p>and practical book. It is a wonderful tool for highly motivatedparents looking to master techniques for dealing with de-fiance. Parts of the book may be somewhat overwhelmingfor less confident parents. Still, the sections of the book thathelp build insight into defiance as the task of adolescence andframe general healthy interactions could be helpful to all typesof parents dealing with defiance. Defiance is a tough foe, andthis book should be a real help to parents struggling to putdefiance in its place.</p><p>Rebecca P. Barclay, M.D.Massachusetts General Hospital</p><p>Boston, MArbarclay@partners.org</p><p>10.1097/CHI.0b013e318196b932</p><p>Disclosure: The author reports no conflicts of interest.</p><p>The Bipolar Teen: What You Can Do to Help Your Childand Your Family. By David J. Miklowitz and Elizabeth L.George. New York, NY: The Guilford Press; 2008, 356 pp.,$17.95 (softcover).</p><p>Bipolar disorder is one of the most controversial and per-haps stigmatizing mental illnesses facing adolescents. The lackof consensus diagnostic guidelines in the field today can leadto years of frustration and strain for both the patients andtheir family.In their new book, The Bipolar Teen, David Miklowitz and</p><p>Elizabeth George seek to educate parents on the realities ofbipolar disorder in hopes of supporting them through theuncertainty of diagnosis and treatment, while still offeringoptimistic real-life suggestions for living and coping with theillness. Miklowitz, author of The Bipolar Disorder SurvivalGuide published in 2002, has been treating children withpsychiatric illness and their families for more than 20 years.Together with George (a private practitioner), Miklowitzdraws on his extensive clinical and research background tocreate a thoughtful book written for the parent strugglingwith the journey of bipolar disorder.The first chapter is heavily laden with introductions of each</p><p>subsequent chapter, which may discourage or overwhelm the</p><p>average reader. However, after this initial hiccup, the chaptersto come are filled with valuable information, making TheBipolar Teen an engaging and informative tool. The authorsconsolidate information from many sources into an easy-to-understand narrative that introduces necessary medical jargonin a palatable way.In Chapter 2, BA Close Look at the Symptoms,[ hallmark</p><p>manic and depressive symptoms are thoroughly explained,enabling parents to identify potential symptoms in their ownchildren. The authors effectively describe symptoms butdiscourage parents from making their own diagnosis. Instead,they strongly encourage parents to seek appropriate evalua-tion from a licensed board-certified child and adolescent psy-chiatrist and/or psychologist.The multiple types of bipolar disorder are clearly described,</p><p>as well as diagnostic criteria for manic, depressed, and mixedepisodes. The diagnostic process is presented as complexand ever evolving, one in which the parent may grapple withambiguity. One section prepares parents for the initial sessionwith the assessing clinician, offering checklists and worksheetsto assist in compiling information on family medical historyand their childs developmental history. Simple rating scales,including BThe Mood Disorder Questionnaire[ and theBGeneral Behavior Inventory,[ are included to measure fre-quency and duration of particular behaviors.The text presents a firm foundation of the biopsychosocial</p><p>model, beginning with an emphasis on genetics, which in-cludes discussions on kindling theory and the potential in-volvement of the prefrontal cortex and the limbic system.Neurotransmitters and cortisol production are explained tosupport the concept that stress can lead to permanent brainchanges such as neuronal cell loss with exacerbations ofsymptoms.One of the most effective chapters covers medication op-</p><p>tions. Here, the authors overview mood stabilizers, atypicalantipsychotics, and antidepressants and also tackle the diffi-cult subject that many medications prescribed for bipolardisorder are not yet approved for children by the Food andDrug Administration. Medication is touted as one of severalnecessary tools in the treatment process, although side ef-fects and issues of long-term maintenance are examined. Theauthors explain that relapses may still occur even with medi-cations but that episodes may be shorter or less intense.In later chapters, the authors use several sample parentY</p><p>child dialogues to discuss types of psychotherapy, how toscreen for a good therapist, and methods to encourage youngpatients to accept medications. Short case studies are powerfuland presented from multiple points of view: the teen, theparent, and the sibling. This allows readers to envision a dayfrom their childs perspective, for example, illuminating rea-sons why their child might refuse medications. Once a diag-nosis has been made, this volume also provides worksheets</p><p>BOOK FORUM</p><p>WWW.JAACAP.COM 343J . AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 48:3, MARCH 2009</p></li><li><p>such as the mood chart BHow I Feel[ and BSchedulingPleasurable Activities[ that can be used by the child, parent,and treatment provider. Parents may find these forms helpful;however, it may be considerably more difficult to convince ateenager to make use of these forms.A chapter devoted to suicide prevention introduces this</p><p>sensitive topic without a tone of blame. It impresses on thereader the importance of speaking with their child aboutsuicide and educates parents that there is no evidence thatsimply addressing the topic increases riskVa commonconcern among parents. The final chapter, BTackling theSchool Environment,[ offers advice and schooling options,including suggestions in dealing with school counselors andadministrators. Here, the pros and cons of section 504 plans,Individual Education Plans, public versus private schools,home schooling, therapeutic day schools, and residentialtreatment facilities are each thoroughly overviewed andbalanced against the financial and emotional cost. In addition,the book closes with a section of additional resources tailoredto this audience, citing national organizations and otherrelevant texts.A few shortcomings are evident in this otherwise valuable</p><p>resource for parents, mainly regarding organization ofinformation. The authors are, at times, repetitive, therebymaking the book lengthier than needed, although some mayargue that this merely reinforces difficult concepts. Incontrast, relevant information is sprinkled across multiplechapters, when it may have been more effective if conciselypresented in its own section. Useful pearls like BFrequentlyAsked Questions[ and worksheets to be completed by familymembers are placed awkwardly, and readers may findthemselves flipping forward or back in a search of associatedinformation.In conclusion, the authors educate readers on bipolar</p><p>disorder being best treated with both medication andpsychotherapy. In addition, the authors admit that ourunderstanding of bipolar disorder is incomplete, althoughevolving. Written for a nonprofessional audience, this bookby Miklowitz and George is a compilation of an informa-tive volume with individual vignettes combined with clinicaldata and useful advice. The Bipolar Teen is an excellentresource for any caretaker of a child or adolescent facingbipolar disorder.</p><p>Anna Kerlek, M.D.New York University School of Medicine</p><p>New York, NYanna.kerlek@nyumc.org</p><p>10.1097/01.CHI.0000314058.89413.be</p><p>Disclosure: The author reports no conflicts of interest.</p><p>Cyberbullying: Bullying in the Digital Age. By Robin M.Kowlaski, Ph.D.; Susan P. Limber, Ph.D.; and Patricia W.Agatson, Ph.D. Malden, MA: Blackwell Publishing; 2008, 218pp., $27.95 (softcover).</p><p>The recent surge in school violence has dramatically in-creased awareness around the negative impact of bullying.Only recently, media sources reported on the tragic ac-count of Lawrence King, a 15-year-old boy living in Oxnard,California, who was brutally murdered on school groundsby a 14-year-old classmate, presumably because of his sexualorientation. In the days leading up to his death, he had beenthe victim of harassment and bullying after publicly an-nouncing that he was gay.</p><p>In the unsettling wake of these kinds of tragedies, thequestion of BWhy?[ is often raised, and rarely do we stumbleon what seem like satisfactory answers. It has been 9 yearssince 12 students and a teacher lost their lives in Columbine,Colorado. Although a myriad of social influences likely con-tributed to this particular event, suddenly, school bullyingwas not just the stuff that after-school-specials were made of.Nationwide, it became something for teachers and super-vising adults to remain vigilant for and to squash at everyopportunity. Simply put, bullying represented a clear andpresent danger.</p><p>Increasingly, schools are implementing protocols for ad-dressing bullying behavior among their students, includingthe Olweus Bullying Prevention Program, a widely used toolpioneered by Norwegian researcher Dan Olweus to fosterschool-wide awareness of bullying.1 The academic discourseon bullying has even broadened to include state legislators andpublic health officials.2 However, just as we seem to bemaking progress in building a more comprehensive under-standing of school-based aggression and victimization, a newwrinkle has been introduced to complicate our thinking: theInternet.</p><p>How do we even begin to address bullying behavior thatoccurs in the virtual realm of the World Wide Web? Moreand more, kids are spending significant amounts of timeonline, much of it unsupervised. The Pew Internet andAmerican Life Project estimated, in 2005, that 87% of U.S.teenagers use the Internet, more than half of them goingonline on a daily basis. Nearly 45% of American teens owna cell phone, and a third of them use it regularly for textmessaging.3 Such numbers only seem to be growing ashandheld electronic devices become more technologicallyadvanced and affordable. The idea of not being Bconnected,[at least in the electronic sense, is going the way of thetransistor radio.</p><p>Although the Internet has revolutionized the ways in whichwe communicate in the 21st century, the technology itselfseems to be advancing by leaps and bounds ahead of our</p><p>BOOK FORUM</p><p>344 WWW.JAACAP.COM J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 48:3, MARCH 2009</p></li></ul>

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