Educating the Child with Bipolar Disorder - isu.edu

CHILD & ADOLESCENT BIPOLAR FOUNDATION EDUCATING
THE CHILD
WITH
BIPOLAR
DISORDER

Commonly What is Pediatric
Seen Bipolar Disorder?
Behaviors
Bipolar disorder is a biological brain disorder
• crying for no apparent causing severe fluctuations in mood, energy,
reason thinking and behavior. It was previously known
as manic depression, as it causes moods to shift
• an expansive or irritable between mania and depression. Children—whose
mood symptoms present differently than those of
adults—can experience severe and sudden mood
• depression changes many times a day. Symptoms of mania
and depression can also occur simultaneously.
• rapidly changing moods Young people with this disorder are frequently
lasting a few minutes to anxious and have very low frustration tolerance.
a few days
At least one million American children and
• explosive, lengthy, and teenagers struggle with bipolar disorder, most
often destructive rages of them undiagnosed and untreated. Children
with bipolar disorder are at risk for school
• separation anxiety failure, substance abuse, and suicide. The
lifetime mortality rate for bipolar disorder (from
• defiance of authority suicide) is higher than some childhood cancers.
Yet children who are stable and have the right
• hyperactivity, agitation, support can thrive in school and develop
and distractibility satisfying peer relationships.

• sleeping too little or too Depressed children may not appear to be sad.
much Instead they may withdraw, not want to play, need
more sleep than usual, display chronic irritability,
• night terrors or cry for no obvious reason. Children may
also talk of wishing to die and may need to be
• strong and frequent hospitalized for harm to themselves or others.

• cravings, often for Symptoms of mania may include elation,
carbohydrates and grandiose thinking, racing thoughts, pressured
sweets speech, hypersexuality, and decreased need for
sleep. Since hyperactivity can be seen in both
• excessive involvement bipolar disorder and ADHD, a growing number of
in multiple projects and researchers believe that many children who are
activities diagnosed with “severe ADHD” may actually have
undiagnosed bipolar disorder.
• impaired judgment,
impulsivity, racing
thoughts, and pressure
to keep talking

• dare devil behaviors

• inappropriate or
precocious sexual
behavior

• delusions and
hallucinations

• grandiose belief in
personal abilities that
defy the laws of logic
(ability to fly, knows
more than the teacher or
principal)

• extreme irritability

2

Bipolar disorder is a chronic, bodies change as they grow,
lifetime condition that can be managing medication to ensure
managed, but not cured, with continued stability is a complex and
medication and lifestyle changes. ongoing challenge.
Because the symptoms wax and
wane on their own, and children’s

How Bipolar Disorder Affects
Cognition and Learning

Recent brain imaging studies In addition, bipolar disorder
show biological differences in can cause a child to be at times
patients with bipolar disorder. impulsive, talkative, distractible,
The disorder affects learning in withdrawn, unmotivated, or difficult
a number of ways, ranging from to engage. Medications to manage
difficulties with sleep, energy, the illness can cause cognitive
school attendance, concentration, dulling, sleepiness, slurring of
executive function, and cognition. speech, memory recall difficulties,
Side effects from medications can and physical discomfort such as
affect the child’s learning and energy. nausea and excessive thirst.
Moreover, while many of these
children are uncommonly bright Despite all these challenges, a
or creative, they often have co- student with bipolar disorder can
occurring learning disabilities. succeed in the classroom with the
right supports and accommodations.
Even when moods are stable, the
condition often causes cognitive
deficits, including the ability to:

• Pay attention

• Remember and recall
information

• Think critically, categorize, and
organize information

• Employ problem-solving skills

• Quickly coordinate eye-hand
movements

3

Strategies For Teaching
a Child with Bipolar Disorder

The teaching skills that make a The ability to laugh at oneself and
classroom teacher successful with at situations.Teachers who can laugh
typical students are essential when at their own mistakes, and bring
working with children who have fun and humor into the classroom
bipolar disorder: reduce the level of stress that
students feel.
Flexibility to adapt assignments,
curriculum and presentation style as
needed.

Patience to ignore minor negative
behaviors, encourage positive
behaviors, and provide positive
behavioral choices. Most important
is the ability to stay calm and be a
model of desired behavior.

Good conflict management
skills to resolve conflicts in a non-
confrontational, non-combative, safe,
and positive manner.

Receptivity to change and to
working collaboratively with the
child’s parents, doctors, and other
professionals to best meet the needs
of the child.

Booklet for children DVD for teens about
describing how it feels to mood disorders
Available on
have a mood disorder.
4 Available at www.bpkids.org www.depressedteens.com

Teaming Up to Help the Child

Since bipolar disorder affects all Parents should identify patterns in
aspects of a child’s life, it takes a behavior that could signal a change
well-coordinated team of concerned in the illness, and help teachers
adults to give the child the best brainstorm better ways of handling
chance for a full and productive specific situations. Teachers and
life.The team might include school personnel also need to know
parents, teachers, special education about changes in the child’s home
specialists, a guidance counselor, life or medication in order to work
an adjustment counselor or social around them constructively at
worker, a school psychologist, an school.
occupational therapist, a speech
therapist, and the school nurse. At times of transition, the current
or previous year’s teacher needs to
The school team should feel work closely with the new teacher
comfortable consulting with the or team to smooth the way—change
child’s psychiatrist and/or outside is difficult for any child, but even
therapist. more difficult for the child with a
neurological disorder.
It is critical to work closely with
the child’s family to understand the
symptoms and course of the illness.

Suggested Accommodations

Students with bipolar disorder or lulls in the day
benefit enormously from stress- • Scheduling the student’s most
reducing accommodations such as:
challenging tasks ata time of
• Consistent scheduling day when the child is best
that includes planned and able to perform (allowing for
unplanned breaks medication-related tiredness,
hunger, etc.)
• Seating with few distractions,
providing buffer space and 5
model children

• Shortened assignments and
homework focusing on quality,
not quantity

• Prior notice of transitions
or changes in routine—
minimizing surprises

• A plan for unstructured time

Successful Teaching Strategies

Students with bipolar disorder Contact should be frequent, timely,
face tough challenges navigating and focused on facts and solving
through the many pressures problems (rather than blame).The
of a typical school day.Their school needs to inform parents
neurologically-based mood disorder regularly about how the student
affects emotion, behavior, cognitive is performing.This can be done
skills, and social interactions. via a notebook that goes back and
forth to school with the child, or
These students are very a daily chart or e-mail that records
vulnerable to stress that can easily successes, progress, difficulties, and
overwhelm their coping skills. mood information. Parents can then
Therefore, it is paramount to their reinforce and support the teacher
success in the classroom to reduce and the child. Parents can also spot
exposure to stressors and help them trends in the child’s illness and
build coping skills that they will respond before problems reach a
need throughout their lives. More crisis.They should inform teachers
than anything else, these children of any unusual stressors at home and
need structure and predictability changes in medication.
to frame the day, provided by
supportive and flexible teachers who One of the challenges of working
calmly help them stay in control with these children is that even
when any difficulties develop. tried-and-true strategies may not
work consistently due to the
The most important factor in frequent mood shifts the students
these children’s success is the experience. Being prepared with
way adults respond to and work a variety of approaches certainly
with them.The teachers who increases a teacher’s odds of dealing
work best with these students successfully with their students’
are resourceful, caring, and calm, challenges.
and know how to work positively
with children’s shifting moods
and cognitive weaknesses. Praise,
encouragement, and key words elicit
positive behaviors, while negativity
helps the child spin out of control.
Experts recommend some praise
for all children at least once every 5
minutes, or 12 positive comments for
every negative statement.

Good communication between
home and school is essential.

6

How to Handle Changing Moods

In a manic mood, children may of mania or depression because
exhibit distractibility, increased children with bipolar disorder often
energy, grandiose thinking, rapid experience both states at once,
speech, and a strong goal orientation. producing chronic agitation and
Help them direct all that energy irritability. Defiance and aggression
productively with hands-on projects are probably the most challenging
and increased activity. The child moods to manage.The best strategy
will need help to set realistic goals. for addressing these behaviors is
During lulls in the classroom, give to not take it personally, keep your
the child an OT break, send the child composure, and do not get involved
on errands, or assign tasks involving in power struggles. Remain a positive
motor activity, such as washing the model. Prompt children who are
board or moving items. Provide rude to rephrase statements politely
opportunities for the student to and try again. Be firm and consistent,
move around during class, work on and give the child acceptable,
computers, or use manipulatives and positive choices. An ultimatum or
encourage him/her to get involved in threat can easily force the child to
other interactive activities.You might make poor choices.
even set up games and intervention
strategy that allow the children to At times all students are more
become more conscious of and demanding or just need a lot of
better able to control their need for attention. Greet them when they
movement. enter the classroom, seat them
near where you teach, give them
When children are sad or opportunities to work with other
depressed, exhibiting low energy, students, use their names in spelling
shorten their assignments and check sentences, math problems, etc, and
in frequently to help them stay on acknowledge them when they stay
track. Sometimes, simply asking what on task.Try to ignore inappropriate,
is wrong and how you can help is attention-getting behaviors as
enough to get the child back on much as possible. Use “bossiness” to
track. Children in a depressed state everyone’s advantage by making the
can find it extremely hard to wake child a leader or teacher.
up in time for school, particularly at
certain times of the year.They should 7
not be penalized for tardiness that is
biologically based.Any talk of suicide
must be taken seriously and reported
to the child’s parents.

You might not be able to
discern clearly defined episodes

Using Social Stories to Rehearse
New Situations

Like children with other Carol Gray, noted expert on social
neurologically-based disorders, stories, provides the following
children with bipolar disorder often guidelines* for writing your own
have difficulty in novel situations social stories:
and don’t know how to behave
appropriately. When given some sort • Picture the goal
of structure or script, however, they
are far more successful. Social stories, • Gather information
which have been used by children
with autism spectrum disorders, • Tailor the text
prepare the child in advance for a
given situation so he can respond • Teach with the title
appropriately when that situation
occurs. • * Additional Resources

Social stories can be simple, such www.thegraycenter.org/
as talking through and role-playing socialstories.cfm
how to perceive that someone
else doesn’t want to be splashed. www.polyxo.com/
They can also be longer, such as a socialstories/introduction.
20-page book on going to a new html#needforintervention
camp or school. It’s important to
not only give the child information
on the situation, but also to reassure
the child that he is capable of
handling it.The story can also be
a jumping off point for discussing
“what if”scenarios, so the child has
a chance to practice appropriate
reactions for different outcomes.
Involving the child in creating the
story, either by coming up with what
the child might say or by illustrating
it, is a great way to capture the
child’s interest.

8

Managing Challenging Behavior

Bipolar disorder affects the and making amends.Those who
areas of the brain that regulate work with the child need training
memory, speech, thought, emotions, in nonviolent crisis prevention,
personality, planning, anxiety, focusing on verbal de escalation
frustration, aggression, and impulse techniques, to avoid crises.
control. It’s no surprise, then, that
these children have difficulty Reward positive behavior with
behaving appropriately in all praise and privileges but don’t set
situations.Although medication up a reward system in advance.
helps the children control their Programs that reward the child for
behavior, they are highly influenced positive behavior, while punishing
by their impulses and surroundings negative behaviors set the child up
even when moods are stable. for failure, raising stress. Punishing
a child with bipolar disorder for a
Children with bipolar disorder fit of anger is akin to punishing an
need adults around them who asthmatic child for an asthma attack.
are positive, calm, firm, patient,
consistent, loving, and who A child with bipolar disorder
encourage them to behave often feels overwhelmed by the
appropriately. Praise and key words
elicit positive behaviors, while intensity of their emotions
negativity helps the child spin out of Experts recommend some praise
control. In fact, experts recommend at least once every 5 minutes, or
some praise at least once every 5
minutes, or 12 positive comments to 12 positive comments to every
every negative comment. one negative comment.

In addition, the child’s team
should have a behavior intervention
plan.When a child is stable, the team
needs to build the child’s skills that
lead to appropriate reactions and
behavior, including emotion labeling,
empathy, anger management, social
rules, nonverbal communication,

9

Modifying the
Physical Environment

Children with bipolar disorder uncommon. Ear plugs for loud events,
generally need an environment that headphones that screen out noise, or
reduces distractions and improves even calming music can help a child
their ability to focus and behave focus. If music is more distracting
appropriately.They benefit from than helpful, try a tape with a
accommodations like those made background noise such as ocean
for students with ADHD, and in sounds to filter out random classroom
fact many of these children have noises.
ADHD in addition to bipolar
disorder. Preferential seating near Discomfort from heat and light
model students, with few nearby can be distracting. If you don’t have
distractions, is critical. Some students control over the temperature in your
do better near the teacher so that the classroom, suggest the child dress
teacher can unobtrusively check in in layers to ensure comfort. Children
and keep them on task, while others who are tired or depressed may fall
need extra space to pace or move sleep if it’s too dark in the room.
around. Others, if they’re sensitive to bright
light, can be made more comfortable
Noise is an issue for some by sitting in carrels or away from
children with bipolar disorder, as bright sunlight.
sensory integration problems are not

Other Accommodations for Comfort

Students with bipolar disorder sleepiness, thirst, frequent urination,
need an established “safe” person— or constant hunger.Work out a plan to
an adult to go to when feeling keep these issues from affecting the
overwhelmed—and a safe place.This child’s success.
safe place should be a private location
used for regaining composure or Some students, particularly
collecting one’s thoughts, away from younger ones, may need one-on-one
peers or other staff. Sometimes the adult supervision, not only in the
student simply needs to take a walk. classroom, but at times of transition
Make arrangements in advance that or unstructured activities full of peer
do not call undue attention to the interaction, such as recess or lunch
student, but also consider policies on time.
safety.
Consider extending education
Many children experience side about diversity to include learning
effects from medication, including differences and how individual minds
can work differently.This information
10 can increase peer acceptance and
reduce stigma for these students.

Adjusting the Schedule

Many factors affect the way • warnings before a change in
children with bipolar disorder activities
experience time, including
difficulties with sleep, concentration, • more time for turning in
memory, and moods, plus medication homework or large projects
side effects and a tendency to hyper
focus. Students with bipolar disorder • extra time for tests
may need several or all of the
following schedule accommodations: • breaking tests or assignments
into shorter segments with
• permission to arrive later when breaks
necessary
• scheduling stimulating courses
• a shorter school day early in the day to get interest
flowing
• scheduling difficult tasks for a
time of day when the student is • periodic checks on progress
best able to perform during an assignment to ensure
the student is on schedule

Optimizing Testing Situations

Brain imaging shows that • tools such as a calculator or
people with bipolar disorder have word bank
differences in their brains in the
areas that control memory.With • offering an alternative type of
help, however, such as the following assignment to reduce the stress
testing accommodations, students of testing
with bipolar disorder can succeed
in demonstrating their knowledge 11
more effectively:

• modified time constraints

• altered or simpler instructions

• oral testing or the use of a scribe

• an altered environment (such
as a room with few or no other
students)

• multiple-choice or matching
rather than open-ended
questions

Special Education Classification

When developing an IEP for symptoms are not always within
a child with bipolar disorder, the child’s control, although
educators are sometimes unsure proper medication can help.
of the most appropriate way
to classify the student’s special • Repeated episodes of bipolar
education needs. CABF advocates disorder cause deficits in social,
the classification Other Health vocational, and academic skills.
Impaired (OHI).This classification Without proper accommodations
acknowledges the biological nature within the academic program,
of the illness. An OHI classification these deficits lead to a high
recognizes that: dropout and school failure rate.

• Bipolar disorder impairs a child’s • An OHI classification clearly
ability to function effectively defines the child’s heightened
in school due to impairment levels of impulsivity,
in cognitive, emotional, and distractibility, sensory integration
physical functioning. deficiencies, and poor decision-
making skills as being due to this
• The behavioral and emotional neurological disorder.
problems of the student are
symptoms of a biological With appropriate program
brain disorder requiring supports, pharmacological treatment,
pharmacological and and environmental support, students
psychosocial intervention, not with bipolar disorder are more likely
primarily behavior modification. to successfully complete school and
become productive citizens.
• Behavioral outbursts, negative
peer relationships, and an The OHI classification is
inability to interpret social an essential building block of
situations are symptoms of vital support that students with
neurological instability.These bipolar disorder need in order
to succeed.

©2007 Child & Adolescent Bipolar Foundation.
Reproduction of this brochure is permissible for educational purposes only.

Child & Adolescent Bipolar Foundation
1000 Skokie Boulevard, Suite 570
Wilmette, Illinois 60091
847-256-8525

[email protected]
www.bpkids.org