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After several difficult years, a gifted young artist received a new diagnosis and new treatments.
Family’s gift launches Cognition Research initiative
When Nancy Kimmerly and John Neal’s first child, Abby (pictured at far left), was born 11 years ago, the couple – like most new parents – had little idea of what to expect other than what they had gleaned from parenting books. At 18 months, when Abby began to scream through the night, the couple assumed she was hungry or maybe just an irritable baby.
When, in preschool, their daughter would overreact to even the most minor setback or triumph, “We figured Abby was just a very sensitive child,” says Kimmerly.
It was not until the couple’s second child, Julia (photo, second from right), was born that Kimmerly and Neal began to realize that something might be wrong with their firstborn. “We didn’t appreciate how different Abby’s behavior was until we had Julia,” says Neal.
Abby’s first few years of school were often very difficult for her and her family, who relocated from the Boston area to Utah six years ago. An extremely creative, bright child, Abby was exceedingly driven to succeed, but could become derailed very easily.
Over the course of several years, Kimmerly and Neal took Abby to a string of specialists in Massachusetts and Utah. Their daughter was incorrectly diagnosed with anxiety disorder and put on medication that only made her symptoms worse. One psychiatrist decreed that Abby was just “being manipulative.”
FINALLY, AN ANSWERDeeply concerned about their daughter, Kimmerly and Neal decided to have her evaluated by MGH psychiatrist Janet Wozniak, MD, director of the Pediatric Bipolar Disorder Clinical and Research Program. Abby, then in second grade, traveled with her parents from Utah to Boston to meet with Wozniak.
Following a comprehensive evaluation, Abby was correctly diagnosed with bipolar disorder (BPD). This is a serious mental illness characterized by recurring episodes of extreme mood swings that go from depression to mania or, in some people – often children – extreme irritability. Like Abby, many children with BPD also have related conditions such as attention deficit/ hyperactivity disorder (ADHD), anxiety, obsessive-compulsive disorder (OCD) and pervasive developmental disorder (PDD).
According to Wozniak, until about a decade ago it was widely believed that BPD was extremely rare in children. “Today most mental health professionals know that this condition affects children as well as adults,” she says.
EASILY OVERLOOKED OR MISDIAGNOSED“Bipolar disorder can easily be overlooked or misdiagnosed in children,” Wozniak notes. One reason is that the manic phase of the disease is not the typical euphoric “high” seen in adults, but more often extreme, frequent irritability along with explosive anger and aggression.
The consequences of misdiagnosis can be “dire,” says Wozniak, as drugs for depression, ADHD, anxiety disorder and OCD can make BPD worse, and delaying treatment can lead to a host of later complications.
Fortunately, there are treatments for BPD, including a new generation of drugs that usually do not cause the troublesome side effects of the earlier medications. Although not a cure, these drugs can help stabilize patients’ moods so they can function better. While this is the first priority, other medications that target the co-occurring disorders may be “cautiously added,” says Wozniak.
While the recognition and management of pediatric BPD have clearly improved in recent years, many important questions remain. One is how the condition and the medications used to treat it affect cognition – specifically something known as executive function, which includes abilities such as attention, reasoning, inhibition and working memory. Recent research conducted at MGH indicates that children with BPD and ADHD exhibit deficits in executive function, which is critically important for complex human behavior.
“We felt it was very important to find answers as to why change in executive function happens and what to do about it. We have the greatest admiration for Dr. Wozniak, Dr. Biederman and their colleagues at MGH and knew our gift would be put to very good use.” – Nancy Kimmerly
“Every year for a developing child is critical, so early diagnosis and prompt, aggressive treatment is essential to achieving the best possible outcomes. With this generous and much-appreciated gift, we can do the research that will enable us to find some answers that can help children like Abby and their families.” – Janet Wozniak, MD
GIFT LAUNCHES RESEARCH INITIATIVEKimmerly and Neal made a generous, extended commitment to establish a Cognition Research Initiative within the Department of Psychiatry’s Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, which is directed by Joseph Biederman, MD. The couple became interested in this research because they noticed that Abby, now 11, began losing some of her executive function as she got a little older.
The Cognition Research Initiative is monitoring a comprehensive, multi-faceted research agenda aimed at better understanding, diagnosing, measuring and ultimately treating executive-function deficits in children with BPD, ADHD and PDD.
One of the goals of this initiative is to find ways to diagnose BPD as early as possible. “Early diagnosis and prompt, aggressive treatment is essential to achieving the best possible outcomes,” says Wozniak. “With this generous gift, we can do the research that will enable us to find some answers that can help children like Abby and their families.” For more information about ways to support the Cognition Research Initiative, please contact Carol Taylor in the MGH Development Office at 617.724.8799 firstname.lastname@example.org.
Eleven-year-old Abby Neal, a gifted artist who has bipolar disorder, created this watercolor painting of paper cranes, which she had fashioned by hand. The actual painting measures about 21⁄2 by 4 feet.
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