Evidence-Based Psychosocial Treatments for Child and Adolescent Bipolar Spectrum Disorders

Abstract

Pediatric bipolar spectrum disorders (BPSDs) are serious conditions associated with morbidity and mortality. Although most treatment research has examined pharmacotherapy for pediatric BPSDs, growing literature suggests that psychosocial interventions are also important to provide families with an understanding of symptoms, course, and treatment of BPSDs; teach youth and parents methods for coping with symptoms (e.g., problem solving, communication, emotion regulation, cognitive-behavioral skills); and prevent relapse. Thirteen psychosocial intervention trials for pediatric BPSDs were identified via a comprehensive literature search and evaluated according to the Task Force on the Promotion and Dissemination of Psychological Procedures guidelines. All interventions were examined adjunctive to pharmacotherapy and/or treatment as usual (TAU). No well-established or questionably efficacious treatments were identified. Family psychoeducation plus skill building was probably efficacious (i.e., Multi-Family Psychoeducational Psychotherapy, Family-Focused Treatment); cognitive-behavioral therapy (CBT) was possibly efficacious. Dialectical behavior therapy (DBT) and interpersonal and social rhythm therapy (IPSRT) were experimental. Limited research precluded subdivision of treatments by format and age. Only single- and multiple-family psychoeducation plus skill building and CBT were evaluated with children. Only single-family psychoeducation plus skill building and DBT, and individual (commonly with limited familial involvement) CBT and IPSRT were evaluated with adolescents. In conclusion, psychosocial interventions that involve families, psychoeducation, and skill building may offer added benefit to pharmacotherapy and/or other TAU. Limitations of current research include few outcome studies, small samples, and failure to use stringent control conditions or randomization. The review concludes with a discussion of mediators and moderators, recommendations for best practice, and suggestions for future research.

Acknowledgments

This article was supported by three National Institute of Mental Health (NIMH) funded studies: R01 MH073801 Longitudinal Assessment of Manic Symptoms (LAMS); R34MH085875; R34 MH090148. The findings and conclusions presented in this article are those of the authors alone and do not necessarily reflect the opinions of NIMH. Potential conflicts of interest: Dr. Fristad is the author of a treatment manual (Guilford Press, Inc.) and MF-PEP workbooks (www.moodychildtherapy.com) for which she receives royalties.

Notes

Note. BP = bipolar disorder; NOS = not otherwise specified; MDD = major depressive disorder; DD = dysthymic disorder; IQ = Intellectual Quotient; MSI = Mood Severity Index (combines scores from the Young Mania Rating Scale and the Children's Depression Rating Scale – Revised); LCP = Licensed Clinical Psychologist; LISW = Licensed Independent Social Worker; MF-PEP = Multi-Family Psychoeducational Psychotherapy; TAU = treatment as usual; WLC = waitlist control; K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children; DRS = Depression Rating Scale; MRS = Mania Rating Scale; A-LIFE = Adolescent Longitudinal Interval Follow-up Evaluation; FFT-A = Family Focused Treatment for Adolescents; EC = Enhanced Care; YMRS = Young Mania Rating Scale; CDRS-R = Children's Depression Rating Scale–Revised; PSR = Psychiatric Status Rating; FMSS = Five-Minute Speech Sample; FFT-HR = Family Focused Treatment for youth at high risk for bipolar disorder; FEC = Family Education Control; EE = Expressed Emotion.

Note. BP = bipolar disorder; DD = dysthymic disorder; MDD = major depressive disorder; IQ = Intellectual Quotient; UMDQ = Understanding Mood Disorders Questionnaire; EEAC = Expressed Emotion Adjective Checklist; SSS = Social Support Scale; CASA = Child and Adolescent Services Assessment; LCP = Licensed Clinical Psychologist; LISW = Licensed Independent Social Worker; MF-PEP = Multi-Family Psychoeducational Psychotherapy; TAU = treatment as usual; WLC = waitlist control; NOS = not otherwise specified; MSI = Mood Severity Index (combines scores from the Young Mania Rating Scale and the Children's Depression Rating Scale–Revised); IF-PEP = Individual-Family Psychoeducational Psychotherapy.

Note. BP = bipolar disorder; NOS = not otherwise specified; CBCL = Child Behavior Checklist; K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children; DRS = Depression Rating Scale; MRS = Mania Rating Scale; FFT-A = Family Focused Treatment for Adolescents; MDD = major depressive disorder; YMRS = Young Mania Rating Scale; CDRS-R = Children's Depression Rating Scale – Revised; A-LIFE = Adolescent Longitudinal Interval Follow-up Evaluation; FFT-HR = Family Focused Treatment for youth at high risk for bipolar disorder; UMDQ = Understanding Mood Disorders Questionnaire; MF-PEP = Multi-Family Psychoeducational Psychotherapy; LISW = Licensed Independent Social Worker; LCP = Licensed Clinical Psychologist; TAU = treatment as usual.

Note. BP = bipolar disorder; NOS = not otherwise specified; YMRS = Young Mania Rating Scale; IQ = Intellectual Quotient; CGI-BP = Clinical Global Impressions Scale for Bipolar Disorder; CGAS = Children's Global Assessment Scale; CFF-CBT = Child- and Family-Focused Cognitive-Behavioral Therapy; LISW = Licensed Independent Social Worker; ADHD = attention-deficit/hyperactivity disorder; CMRS-P = Child Mania Rating Scale–Parent; SDQ = Strengths and Difficulties Questionnaire; PSS = Parental Stress Scale; TOPS = Therapy Outcomes Parents Scale; CDI = Children's Depression Inventory; GBI = General Behavior Inventory; CBT = cognitive-behavioral therapy; IDS = Inventory of Depressive Symptoms; LCP = Licensed Clinical Psychologist.

Note. BP = bipolar disorder; NOS = not otherwise specified; MESSY = Matson Evaluation of Social Skills with Youngsters; K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children; DRS = Depression Rating Scale; MRS = Mania Rating Scale; MSSI = Modified Scale for Suicidal Ideation; LCP = Licensed Clinical Psychologist; DBT = dialectical behavior therapy; NSSI = nonsuicidal self-injury; BDI = Beck Depression Inventory; BPRS-C = Brief Psychiatric Rating Scale for Children; CGAS = Children's Global Assessment Scale; YMRS = Young Mania Rating Scale; IPSRT-A = Interpersonal and Social Rhythm Therapy for Adolescents; SRM-A = Social Rhythm Metric for Adolescents.