Bipolar Disorder

 What is Bipolar Disorder?

 

Bipolar Disorder, sometimes referred to as manic-depression, is a mood disorder that causes radical emotional changes and mood swings from manic highs to depressive lows. Most with the disorder experience alternating episodes of mania (an abnormally elevated mood) and depression.

It has been estimated that 70-90% of children with Bipolar Disorder also have ADHD (Attention Deficit Hyperactivity Disorder). 

What Causes Bipolar Disorder?

 

  • Genes--because the illness runs in families, children with a parent or sibling with bipolar disorder are more likely to get the illness.
  • Abnormal brain structure and brain function
  • Anxiety disorders--children that have anxiety disorders are more likely to develop bipolar disorder.

How is Bipolar Disorder diagnosed?

A child can be diagnosed after being examind by a doctor. There are no blood tests or brain scans that can diagnose bipolar disorder. Instead, the doctor will ask questions about your child's mood and sleeping patterns. The doctor will also ask questions about your child's energy and behavior. Sometimes doctors need to know about medical problems in your family, such as depression or alcoholism. The doctor may use tests t see if an illness other than bipolar disorder is causing your child's symptoms.

Very Common Symptoms

 

  • Separation Anxiety
  • Rages & explosive temper tantrums (lasting up to several hours)
  • Marked irritability
  • Oppositional behavior
  • Frequent mood swings
  • Distractibility (Off-task frequently)
  • Hyperactivity
  • Impulsivity
  • Restlessness
  • fidgetiness
  • Silliness, goofiness, giddiness
  • Racing thoughts
  • Aggressive behavior
  • Grandiosity
  • Carbohydrate cravings
  • Risk-taking behaviors
  • Depressed mood
  • Lethargy
  • Low self-esteem
  • Difficulty getting up in the morning
  • Social anxiety
  • Oversensitivity to emotional or environmental triggers

 Common Symptoms

 

  • Bed-wetting (especially in boys)
  • Night terrors
  • Rapid or pressured speech
  • Obsessive behavior
  • Excessive daydreaming
  • Compulsive behavior
  • Motor & vocal tics
  • Learning disabilities
  • Poor short-term memory
  • Lack of organization
  • Fascination with gore or morbid topics
  • Hypersexuality
  • Manipulative behavior
  • Bossiness
  • Lying
  • Suicidal thoughts
  • Destruction of property
  • Paranoia
  • Hallucinations & delusions

Less Common Symptoms 

 

  • Migraine headaches
  • Binging
  • Self-mutilating behaviors
  • Cruelty to animals

Treatment Options  

There is currently no cure for Bipolar disorder. There are treaments that can help to control symptoms, and work best when used regularly not on and off.

1. Medication--Different types of medication can help. Children respond to medications in different ways, therefore the type of medication depends on the child. Some children may need more than one type of medication depending on the symptoms they experience. It is also possible that a few types of medication are tried before finding one that helps. Children should take the fewest number and smallest amounts of medications as possible.

*Parents, it is important to always tell your child's doctor about any problems or side effects.

*Do not stop giving the child medication without the help of a doctor. Stopping medication suddenly can be dangerous, and can worsen symptoms.

2. Therapy--Different kinds of psychotherapy, or "talk" therapy, can help children. Therapy can help children change their behavior and manage their routines. It can also help young people get along better with family and friends. Therapy may sometimes include family members.

Medications Used to Treat Bipolar Disorder 

Mood stabilizers--Lithium

Side Effects: loss of coordination, excessive thirst, frequent urination, blackouts, seizures, slurred speech, irregular heartbeat, fast heartbeat, slow heartbeat, pounding heartbeat, hallucinations, changes in vision, itching, rash, swelling

Anticonvulsant--Depokate

Side Effects: nausea, stomach pain, vomiting, anorexia, loss of appetite

Antidepresants-sometimes used to treat symptoms of depression in bipolar disorder. Those with bipolar disorder should not take an antidepressant on its own, doing so can cause the person to rapidly switch from depression to mania, which can be dangerous. To prevent this problem, doctors give patients a mood stabilizer or an antipsychotic along with an antidepressant.   

*A good treatment plan includes medication, close monitoring of symptoms, education about the illness, psychotherapy for the child and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support.

Tips for Teachers

Accomodations

 

  • small class size
  • seating with few distractions, providing a buffer space and model children
  • prior notice of transitions or changes in routine
  • back and forth communication between home and school
  • consistent scheduling that includes planned and unplanned breaks
  • scheduling the most challenging task at a time of day when the child is best able to perform, allowing for medication realted tiredness, hunger, etc.
  • homework reduced or excused and deadlines exended when energy is low
  • a safe place in the building where the child can retreat when overwhelmed
  • designated staff member to whom the child can go as needed
  • unlimited access to the bathroom
  • unlimited access to drinking water
  • annual in-sercive training for teachers by treatment professionals
  • set clear standards
  • expectations and explain why such standards are in place
  • use a 5:1 ratio of postive to negative reinforcements

Specific Recommendations 

  1. Find the child's strengths and point them out. This disorder takes a toll on a child's self-esteem.
  2. Notice whenthe child has low energy levels or high ones, and communicate these observations to parents and therapist. Sometimes a cycle may be begining and we miss the early warning signs.
  3. Notice when the child seems more irritable or giddy and communicate to parents and therapist. Again, this is critical to identifying any potential patterns of behavior in order to monitor the condition.
  4. Defiance and aggression are probaby the most challenging moods to manage. The best strategy for addressing these behaviors is to not take it personally. Keep your composure and do not get involved in power struggles. Remain a positive model. If the child says something rude, do not threaten to punish him/her. Try to hear this kind of response as a request for help. The child simply cannot verbalize that they cannot handle what is happening.
  5. Be firm and consistent whenever possible.
  6. Give the child choices and have the child participate in problem solving.
  7. Do not give ultimatums or threats. This can easily force the child into making poor decisions.
  8. When the child seems to want more attention, greet him as he enters the room, give him opportunities to work with other students and acknowledge him when he stays on task.
  9. Note that situations involving physical contact, competition, and perception of fairness, are triggers for many children to get aggressive.
  10. Monitor the child closely at recess.