Neuroscience-Based Formulation and Treatment for Early-Onset Bipolar Disorder: a Paradigm Shift

Treating pediatric bipolar disorder (BD) requires new knowledge based on emerging and consistent neuroscience findings. It entails recognition and addressing the deficits in eight domains such as emotion processing, executive function, attention, impulse control, working memory, reward and risk response, perspective taking, and, finally, the interface of emotion and cognition. Skillful integration of four components: (A) assessment (disorder and domain functions), (B) educating the families that it is early-onset brain dysfunction based on what we now know through research, (C) chemotherapy with the hope of reversing the brain dysfunction, and (D) addressing the individual dynamics specific to the family and through neuroscience informed psychological treatment such as RAINBOW therapy. Imaging findings in pediatric BD offered four major contributions: (1) prefrontal cortex regions improve in function with some pharmacological agents, while amygdala in the subcortical region does not reach normality till after longer-term treatment; (2) various medications differentially engage different brain circuitry regions, supporting why combined therapy is required in severely ill BD; (3) there is invariable interlink between affective and cognitive domain dysfunctions in pediatric BD, by the virtue of early-onset illness diathesis; and (4) consistent and strong evidence that negative stimuli impact both affect regulation and cognitive function argues towards not using negative “punishment” in psychological treatment, thereby leading to the construction and completion of the randomized controlled trial of RAINBOW therapy or child- and family-focused cognitive behavior therapy. Ultimately, translating the new research findings to clinically ill population and educating researchers on clinical challenges are both critical steps towards a determined advancement with a singular focus to help children and their families.