Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2015 Decision Making and Pediatric Bipolar Disorder Assessment/Diagnosis: A Phenomenographic Study Kristen Davies Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Clinical Psychology Commons, Counseling Psychology Commons, and the Psychiatric and Mental Health Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Social and Behavioral Sciences This is to certify that the doctoral dissertation by Kristen Davies has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Sandra Rasmussen, Committee Chairperson, Psychology Faculty Dr. Linda Whinghter, Committee Member, Psychology Faculty Dr. Jonathan Cabiria, University Reviewer, Psychology Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Decision Making and Pediatric Bipolar Disorder Assessment/Diagnosis: A Phenomenographic Study by Kristen Davies MA, Goddard College, 2006 BA, University of Massachusetts-Dartmouth, 1991 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University June 2015 Abstract Prior to the 1990s, bipolar disorder, a behavioral disorder characterized by severe mood fluctuations, was not considered an suitable diagnosis for children. However, in recent decades, an increase in pediatric bipolar disorder (PBD) diagnosis has occurred in the U.S. The purpose of this study was to explore the perceptions and lived experiences of licensed mental health clinicians regarding their decision-making processes used during assessment and diagnosis of PBD. This phenomenographic study utilized individual, semi-structured interviews to explore the perceptions and lived experiences of 14 licensed clinicians in the Commonwealth of Massachusetts who assess and diagnose PBD. Data were collected with a 7-question face to face interview. Using NVivo 10 software several key phrases and words were identified, coded, and used to locate patterns, themes, and concepts. Data analysis revealed that significant issues related to PBD assessment and diagnosis may exist, including: inconsistencies in assessment/diagnostic processes; reticence to diagnose the disorder; failure to use available assessment instruments; a lack of attention to comorbidities; and trouble differentiating between PBD symptoms and other issues, such as trauma or dysfunctional family dynamics. Given the reluctance of these mental health professionals to diagnose PBD, implications for social change underscore the important role of education, training, and ongoing clinical supervision to help other mental health professionals accurately assess and diagnose PBD. Recommendations emanating from study findings suggest further research on PBD assessment and diagnosis to help professionals develop more effective diagnostic frameworks for clinical training and practice. Decision Making and Pediatric Bipolar Disorder Assessment/Diagnosis: A Phenomenographic Study by Kristen Davies MA, Goddard College, 2006 BA, University of Massachusetts-Dartmouth, 1991 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Psychology Walden University May 2015 Table of Contents List of Tables ..................................................................................................................... v Chapter 1: Introduction ...................................................................................................... 1 Introduction .................................................................................................................. 1 Background .................................................................................................................. 3 Problem Statement ....................................................................................................... 4 Purpose of the Study .................................................................................................... 4 Research Question ....................................................................................................... 5 Theoretical Framework ................................................................................................ 5 Nature of the Study ...................................................................................................... 6 Definitions .................................................................................................................... 7 Assumptions ............................................................................................................... 10 Scope and Delimitations ............................................................................................ 10 Limitations ................................................................................................................. 10 Significance ................................................................................................................ 11 Summary .................................................................................................................... 11 Chapter 2: Literature Review ........................................................................................... 13 Introduction ................................................................................................................ 13 Search Strategy .......................................................................................................... 14 Theoretical Foundation .............................................................................................. 14 Bipolar Disorder ......................................................................................................... 17 Types of Bipolar Disorder ................................................................................... 17 Long Term Prognosis ........................................................................................... 19 i Pediatric Bipolar (PBD) ............................................................................................. 22 Unique Aspects of PBD ............................................................................................. 22 Increases in Diagnosis ................................................................................................ 23 Potential Misdiagnosis ......................................................................................... 23 Challenges with Diagnosis ................................................................................... 27 Overdiagnosis ...................................................................................................... 28 Underdiagnosis .................................................................................................... 28 Diagnostic Tools ........................................................................................................ 29 Treatment for PBD ..................................................................................................... 35 Biological Causes ....................................................................................................... 37 Environmental Causes ............................................................................................... 39 Stigma ........................................................................................................................ 41 Diagnostic Consistency .............................................................................................. 43 Cross-Cultural Analysis ............................................................................................. 45 Summary .................................................................................................................... 47 Chapter 3: Research Methods .......................................................................................... 49 Introduction .............................................................................................................. 49 Context and Purpose Statement ................................................................................ 49 Research Design and Rationale ................................................................................ 50 Role of the Researcher ............................................................................................. 51 Methodology ............................................................................................................ 53 Participants ........................................................................................................... 53 Instrumentation .................................................................................................... 54 ii Data Collection .................................................................................................... 55 Data Analysis ....................................................................................................... 55 Issues of Trustworthiness ........................................................................................