Pediatric bipolar disorder (PBD) is a severe illness that has devastating consequences for affected children and families. Children with bipolar disorder demonstrate significant behavioral problems, academic difficulties, poor social skills, and conflictual family relationships. Despite what we know about the burden of this disorder on psychosocial and interpersonal functioning, there are few empirically-supported psychosocial treatments for PBD that integrate child and family work to address the range of psychosocial and interpersonal impairments specifically associated with bipolar disorder with pre-pubertal onset. Child- and family-focused cognitive-behavioral therapy (CFF-CBT) is designed to meet the developmental needs of these younger children with bipolar disorder. It combines work with children and their parents and incorporates psychoeducation with cognitive-behavioral and interpersonal psychotherapy techniques to address the range of affective, cognitive, and interpersonal difficulties characteristic of PBD. Results from our preliminary trial of CFF-CBT demonstrated its feasibility and promise. The professional goal of this candidate is to develop proficiency as an independent psychosocial treatment researcher in pediatric bipolar disorder. The proposed focus of education and training are in three specific areas: (1) practical issues in conducting clinical research for PBD;(2) foundation in intervention research design, methodology, and statistics;and (3) knowledge pertinent to designing and testing psychosocial treatments for bipolar disorder.
The specific aims of this proposal involve refining a manual and conducting a preliminary randomized clinical trial of the CFF-CBT intervention. A sample of 90 subjects will be randomly assigned to either the CFF-CBT condition or treatment as usual. They will be assessed for symptom severity, global functioning, and a range of psychosocial and interpersonal variables (self-concept, parenting stress, social competence, and coping skills) at baseline, weeks 4 and 8, post-treatment, and 6- month follow-up. By completing the proposed development program, the award candidate will attain a comprehensive knowledge base in the area of psychosocial treatment for bipolar disorder, and will pursue an independent program of research aimed at developing and testing adjunctive psychosocial therapies for PBD. Public health significance: Pediatric bipolar disorder is a significant public health concern, placing an enormous burden on the educational and health care systems, and on families of affected children. Children with PBD evidence increased behavioral problems, family stress, and academic underachievement, as well as an alarmingly high rate of repeated hospitalizations and suicide attempts. As adults, they are likely to demonstrate impaired functioning, greater mental health utilization, and lower rates of school graduation.
