EDUCATING THE CHILD WITH BIPOLAR DISORDER
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CHI LD & A D OL E S CEN T BIPOLAR FO UNDATI O N
DISORDER
BIPOLAR
WITH
THE CHILD
EDUCATING
Commonly What is Pediatric
Seen
Behaviors Bipolar Disorder?
• crying for no apparent Bipolar disorder is a biological brain disorder
reason
causing severe fluctuations in mood, energy,
• an expansive or irritable
thinking and behavior. It was previously known
mood
as manic depression, as it causes moods to shift
• depression
between mania and depression. Children—whose
• rapidly changing moods
lasting a few minutes to symptoms present differently than those of
a few days adults—can experience severe and sudden mood
• explosive, lengthy, and changes many times a day. Symptoms of mania
often destructive rages and depression can also occur simultaneously.
• separation anxiety Young people with this disorder are frequently
• defiance of authority anxious and have very low frustration tolerance.
• hyperactivity, agitation, At least one million American children and
and distractibility teenagers struggle with bipolar disorder, most
• sleeping too little or too of them undiagnosed and untreated. Children
much
with bipolar disorder are at risk for school
• night terrors
failure, substance abuse, and suicide. The
• strong and frequent
lifetime mortality rate for bipolar disorder (from
• cravings, often for suicide) is higher than some childhood cancers.
carbohydrates and
sweets
Yet children who are stable and have the right
• excessive involvement
support can thrive in school and develop
in multiple projects and satisfying peer relationships.
activities Depressed children may not appear to be sad.
• impaired judgment, Instead they may withdraw, not want to play, need
impulsivity, racing more sleep than usual, display chronic irritability,
thoughts, and pressure
or cry for no obvious reason. Children may
to keep talking
also talk of wishing to die and may need to be
• dare devil behaviors
hospitalized for harm to themselves or others.
• inappropriate or
precocious sexual Symptoms of mania may include elation,
behavior grandiose thinking, racing thoughts, pressured
• delusions and speech, hypersexuality, and decreased need for
hallucinations sleep. Since hyperactivity can be seen in both
• grandiose belief in bipolar disorder and ADHD, a growing number of
personal abilities that researchers believe that many children who are
defy the laws of logic diagnosed with “severe ADHD” may actually have
(ability to fly, knows
more than the teacher or
undiagnosed bipolar disorder.
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 Despite all these challenges, a
children are uncommonly bright student with bipolar disorder can
or creative, they often have co- succeed in the classroom with the
occurring learning disabilities. 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
classroom teacher successful with
typical students are essential when
working with children who have
bipolar disorder:
Flexibility to adapt assignments,
curriculum and presentation style as
needed.
Patience to ignore minor negative
behaviors, encourage positive
The ability to laugh at oneself and
behaviors, and provide positive
at situations.Teachers who can laugh
behavioral choices. Most important
at their own mistakes, and bring
is the ability to stay calm and be a
fun and humor into the classroom
model of desired behavior.
reduce the level of stress that
Good conflict management students feel.
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
have a mood disorder. Available on
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 At times of transition, the current
therapist, and the school nurse. 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
It is critical to work closely with neurological disorder.
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,
• Seating with few distractions, hunger, etc.)
providing buffer space and
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 5
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 These students are very forth to school with the child, or vulnerable to stress that can easily a daily chart or e-mail that records overwhelm their coping skills. successes, progress, difficulties, and Therefore, it is paramount to their mood information. Parents can then success in the classroom to reduce reinforce and support the teacher exposure to stressors and help them and the child. Parents can also spot build coping skills that they will trends in the child’s illness and need throughout their lives. More respond before problems reach a than anything else, these children crisis.They should inform teachers need structure and predictability of any unusual stressors at home and to frame the day, provided by changes in medication. 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 The most important factor in work consistently due to the these children’s success is the frequent mood shifts the students way adults respond to and work experience. Being prepared with with them.The teachers who a variety of approaches certainly work best with these students increases a teacher’s odds of dealing are resourceful, caring, and calm, successfully with their students’ and know how to work positively challenges. 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 At times all students are more
strategy that allow the children to demanding or just need a lot of
become more conscious of and attention. Greet them when they
better able to control their need for enter the classroom, seat them
movement. 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
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
7
Using Social Stories to Rehearse
New Situations
Like children with other
neurologically-based disorders,
children with bipolar disorder often
have difficulty in novel situations
and don’t know how to behave
appropriately. When given some sort
of structure or script, however, they
are far more successful. Social stories,
which have been used by children
with autism spectrum disorders,
prepare the child in advance for a
given situation so he can respond
appropriately when that situation
occurs.
Social stories can be simple, such
as talking through and role-playing
how to perceive that someone
else doesn’t want to be splashed.
They can also be longer, such as a
Carol Gray, noted expert on social
20-page book on going to a new
stories, provides the following
camp or school. It’s important to
guidelines* for writing your own
not only give the child information
social stories:
on the situation, but also to reassure
the child that he is capable of • Picture the goal
handling it.The story can also be • Gather information
a jumping off point for discussing
• Tailor the text
“what if”scenarios, so the child has
a chance to practice appropriate • Teach with the title
reactions for different outcomes. • * Additional Resources
Involving the child in creating the
www.thegraycenter.org/
story, either by coming up with what
socialstories.cfm
the child might say or by illustrating
it, is a great way to capture the www.polyxo.com/
child’s interest. socialstories/introduction.
html#needforintervention
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 Reward positive behavior with
these children have difficulty praise and privileges but don’t set
behaving appropriately in all up a reward system in advance.
situations. Although medication Programs that reward the child for
helps the children control their positive behavior, while punishing
behavior, they are highly influenced negative behaviors set the child up
by their impulses and surroundings for failure, raising stress. Punishing
even when moods are stable. 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
encourage them to behave
appropriately. Praise and key words
elicit positive behaviors, while
negativity helps the child spin out of
control. In fact, experts recommend
some praise at least once every 5
minutes, or 12 positive comments to
every negative comment.
In addition, the child’s team
should have a behavior intervention A child with bipolar disorder
plan. When a child is stable, the team often feels overwhelmed by the
needs to build the child’s skills that intensity of their emotions
lead to appropriate reactions and Experts recommend some praise
behavior, including emotion labeling, at least once every 5 minutes, or
empathy, anger management, social 12 positive comments to every
rules, nonverbal communication, one negative comment.
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 Discomfort from heat and light
disorder. Preferential seating near can be distracting. If you don’t have
model students, with few nearby control over the temperature in your
distractions, is critical. Some students classroom, suggest the child dress
do better near the teacher so that the in layers to ensure comfort. Children
teacher can unobtrusively check in who are tired or depressed may fall
and keep them on task, while others sleep if it’s too dark in the room.
need extra space to pace or move Others, if they’re sensitive to bright
around. 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 Some students, particularly
used for regaining composure or younger ones, may need one-on-one
collecting one’s thoughts, away from adult supervision, not only in the
peers or other staff. Sometimes the classroom, but at times of transition
student simply needs to take a walk. or unstructured activities full of peer
Make arrangements in advance that interaction, such as recess or lunch
do not call undue attention to the time.
student, but also consider policies on
Consider extending education
safety.
about diversity to include learning
Many children experience side differences and how individual minds
effects from medication, including can work differently.This information
can increase peer acceptance and
10 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 • more time for turning in
difficulties with sleep, concentration, homework or large projects
memory, and moods, plus medication
side effects and a tendency to hyper • extra time for tests
focus. Students with bipolar disorder • breaking tests or assignments
may need several or all of the into shorter segments with
following schedule accommodations: breaks
• permission to arrive later when • scheduling stimulating courses
necessary early in the day to get interest
• a shorter school day flowing
• scheduling difficult tasks for a • periodic checks on progress
time of day when the student is during an assignment to ensure
best able to perform the student is on schedule
Optimizing Testing Situations
Brain imaging shows that
people with bipolar disorder have
differences in their brains in the
areas that control memory. With
help, however, such as the following
testing accommodations, students
with bipolar disorder can succeed
in demonstrating their knowledge
more effectively:
• modified time constraints
• altered or simpler instructions
• oral testing or the use of a scribe • tools such as a calculator or
• an altered environment (such word bank
as a room with few or no other • offering an alternative type of
students) assignment to reduce the stress
• multiple-choice or matching of testing
rather than open-ended
questions 11Special 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 • Repeated episodes of bipolar
to classify the student’s special disorder cause deficits in social,
education needs. CABF advocates vocational, and academic skills.
the classification Other Health Without proper accommodations
Impaired (OHI).This classification within the academic program,
acknowledges the biological nature these deficits lead to a high
of the illness. An OHI classification dropout and school failure rate.
recognizes that:
• An OHI classification clearly
• Bipolar disorder impairs a child’s defines the child’s heightened
ability to function effectively levels of impulsivity,
in school due to impairment distractibility, sensory integration
in cognitive, emotional, and deficiencies, and poor decision-
physical functioning. making skills as being due to this
• The behavioral and emotional neurological disorder.
problems of the student are With appropriate program
symptoms of a biological supports, pharmacological treatment,
brain disorder requiring and environmental support, students
pharmacological and with bipolar disorder are more likely
psychosocial intervention, not to successfully complete school and
primarily behavior modification. become productive citizens.
• Behavioral outbursts, negative The OHI classification is
peer relationships, and an an essential building block of
inability to interpret social vital support that students with
situations are symptoms of bipolar disorder need in order
neurological instability.These 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
cabf@bpkids.org
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