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Infant evaluations

Posted by Margaret Donohue on June 16, 2014 at 9:05 AM

I evaluate all ages from preterm infants in neonatal units of hospitals to the old old.  A parent brought in their one year old for an SSDI evaluation because they believe their infant has bipolar disorder.  


Bipolar disorder previously was known as Manic Depressive illness.  The diagnosis generally starts in someone's 20's and lasts throughout their life.  It is characterized by a manic phase in which someone has difficulty managing their internal state and things spin out of control.  They can't sleep and engage in grandiose fantasies.  Their thoughts run so fast they can only speak in snippits of unintelligible conversation.  In prolonged manic phases the person can die of manic exhaustion.  This phase can last for a few days to a week.  The other phase is a depressed phase that can range from a psychotic level of depression to a more mild depressive state that can last longer.  Episodes of mania that occur more than twice a year are referred to as rapid cycling.


A few years ago, there was an article on children with bipolar disorder.  The article targeted irritability and mood swings.  Something almost every child has temporarily at points in their childhood.  The diagnostic category has little clarity and doesn't seem to corellate with later diagnoses of bipolar disorder in adults.  In addition there seems to be some confusion about the diagnosis of personality disorders such as borderline personality disorder and bipolar disorder.  There also appears to be some diagnostic confusion with ADHD diagnoses and with psychotic disorder such as schizophrenia.    There are about 11 forms of ADHD, one of which presents with mania.  Schizophrenia can have a mood disorder component including a bipolar component, the diagnostic label changes to schizoaffective disorder.  


I've evaluated one infant in my 30 year career that appeared to have symptoms of mania.  I suspect the infant had a neurological disorder.  Since the infant was in foster care, the request for medication evaluation to help the child sleep and reduce the level of frantic activity went through court order as did the request for neuroimaging.  I don't know the outcome of the case.  I've evaluated lots of infants in my career.  Many of the infants with reported psychological difficulties actually have neurological impairment.  Psychological and neuropsychological testing can clarify learning problems, neurological difficulties localized to areas of cortical functioning, and problems with parenting and parental attachment.


In other cases there are children with psychotic symptoms and severe sleep disorders that have had neuroimaging showing abnormal brain structures.  This is not a bipolar disorder diagnosis.  This is a neurological condition.    Seizures and sleep apnea can cause symptoms that look like ADHD or mania in children.


Psychological or neuropsychological testing can bring clarity to diagnostic issues.  No the infant didn't have bipolar disorder, or ADHD.  But the relationship between the mother and the child was problematic and would benefit from early intervention and treatment.  The infant was anxiously attached to the mother and was seeking attention, soothing and comfort.  The mother was distant and uninvolved.  She seldom looked at the baby.  He kept calling "mama" and at one point hit her to gain a response.  She explained he "always" did that. He came over to me and patted my arm and looked at my bracelet.  He made good eye contact.  He was not frantic in his interactions with me.  I talked to him and he related socially in a normal way.  He spoke in two word phrases.  He seemed bright for his age and well within normal limits of temperment and engagement.  It was only with his mother that he started being frantic and attention seeking.  During the one hour evaluation, she spoke to him one and didn't interact with him at all.  No he's not bipolar.  He has an anxious attachment with a mother that is indifferent. 


Psychological and neuropsychological testing can assist in diagnostic clartification.  If you are interesting in having yourself or your child evaluated please contact our office.

Categories: General Psychology, Diagnosis, Ethics

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