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Bi-Polar Condition in Children Laura A. Riffel, Ph.D.

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Characteristics of Bi-Polar in Children Symptoms Which May Show Up ADHD Symptoms Distraction Hyperactivity (restless and fidgety) Impulsivity (risk taker) Overly gregarious Racing thoughts Pretentious

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Characteristics of Bi-Polar Condition in Children More Symptoms Crave Carbohydrates Binging

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Characteristics of Bi-Polar in Children More Symptoms Anxiety being separated from parents Irritable Oppositional behaviors Mood Swings Depressed Lethargic Low Self-Esteem Hard to get up in the morning Social anxiety Oversensitive Migraine headaches

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Characteristics of Bi-Polar in Children More Symptoms Meltdowns (long lasting tantrums) Compulsive behavior Bossiness

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Characteristics of Bi-Polar in Children Symptoms Rapid or pressured speech Motor & vocal tics Lack of organization Poor short term memory Destruction of Property Hallucinations and Delusions

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Characteristics of Bi-Polar in Children Extreme Symptoms Bed-wetting (especially in boys) Night terrors Learning disabilities Fascination with gore or morbid topics Hyper-sexuality Lying Suicidal

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Bi-polar Condition 4000% increase in diagnoses since the mid 1990s in childhood bi-polar condition.

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Is it Bi-polar???? Temper Dysregulation Disorder: (New DSM-V Diagnosis for Children) Brain based disorder or biological dysfunction Not necessarily life-long condition Children over 6- must begin before age of 10. Symptoms: Frequent temper outbursts when dealing with common stress Has to last for at least 12 months- can not be free of symptoms for more than 3 months at a time. Looks like: Yelling Physical aggression Over reacting Tantrums more than 3 times a week Tend to be negative daily

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Barometric Pressure I have found a correlation between barometric pressure and bi-polar condition in children and adults. Appears to be unique to each individual. "Barometric pressure, emergency psychiatric visits, and violent acts," Thomas J. Schory, Natasha Piecznski, Sunil Nair, and Rif S. El-Mallakh, Canadian Journal of Psychiatry, Vol. 48, October 2003, 624-7. Address: R. S. El-Mallakh, Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40292, rselma01@athena.louisville.edu.

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Schory et al. (2003) "The data suggest that total numbers of acts of violence and emergency psychiatry visits are significantly associated with low barometric pressure low barometric pressure is associated with impulsivity. low barometric pressure is associated with changes in cerebral blood flow, increased risk of rupture of intracranial aneurysms, premature labor, changes in the norepinephrine metabolite HMPG (at least in women), (adrenal gland hormone) and changes in cerebrospinal fluid concentrations of the serotonin metabolite 5-HIAA in people with depression. They also note that weather fluctuations are known to influence certain mental disorders, including seasonal affective disorder (SAD) and bipolar disorder. The researchers hypothesize that "barometric pressure may alter the propensity toward impulsive behavior through changes in brain monoamines or cerebral blood flow."

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http://www.wunderground.com/weatherstation/WXDailyHistory.asp?ID=KKSOVERL7 Type in your state and you will get a list of cities in that state Check the pressure for the city closest to you- it will tell you if its steady, rising, or falling Barometric Pressure is measured in inches. Graph it daily and watch for patterns: Website for graphing daily barometric pressure: http://tinyurl.com/bptemplate

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Parenting Tips

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Sleep Routines are of utmost concern- Go to bed like a farmer Sunset to Sunrise Do not vary unless absolutely necessary

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Exercise Exercise is a good counter to depression and stress Good for: Anger reduction Anxiety amelioration Tension reduction Releases endorphins which calms the body Ideas for exercise: Trampolines- outdoor or indoor Wii fit Treadmill Punching bag Dance video Kick boxing Martial Arts

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Active Listening Learn and use good listening and communication skills. Ask open ended questions- think Late Night Talk Show Host Whisper in right ear- the right ear is connected to the side of the brain that is more conducive to compliance.

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Choose your battles Is this the hill you want to die on?????

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Relaxation Practice and teach relaxation techniques to your child. Use: music, 60 bpm sound, headphones lighting, www.huelight.netwww.huelight.net Yoga breathing

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Relationship Narratives Help your child anticipate, and avoid or prepare for, stressful situations by developing strategies in advance. Make PowerPoint Relationship Narratives about possible barriers and how to handle them.

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Use PowerPoint as a visual schedule to help your child anticipate, and avoid or prepare for, stressful situations by developing strategies in advance. Learn safe ways to talk your child down from a rage fit. Do not restrain unless life is in danger. Talk to the school about implementing some stress reducing techniques. Engage your child's creativity through activities that express their gifts and strengths. Provide routine structure while allowing freedom within expressed limits.

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Classroom Ideas for Teachers of Students with Bi-Polar Information from: The Child and Adolescent Bipolar Foundation The Bipolar Child: The Definitive and Reassuring Guide to Childhoods Most Misunderstood Disorder The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children Understanding the Mind of Your Bipolar Child: The Complete Guide to the Development, Treatment and Parenting of Children with Bipolar Disorder

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Flexibility Flexibility to modify assignments, curriculum and teaching style as needed

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Patience 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.

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

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

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Humor The ability to laugh at oneself and at situations. Teachers who can laugh at their own mistakes, and bring fun and humor into the classroom reduce the level of stress that students feel.

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Teacher Characteristics The most important factor in these childrens success is the way adults respond to and work with them. The teachers who work best with these students are resourceful, caring, calm and know how to work positively with childrens shifting moods and cognitive weaknesses. Praise, encouragement, and key words elicit positive behaviors, while negativity helps the child spin out of control.

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Accommodations Suggested accommodations for children with bipolar disorder include: Back and forth communication between home and school Consistent scheduling that includes planned and unplanned breaks. Prior notice of change or disruptions in routine. Scheduling the students most challenging task at a time of day when the student is best able to perform, allowing for medication related tiredness, hunger etc. Seating with few distractions, providing a buffer space and model students. Small class size

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Accommodations Continued Annual in-service training for teachers by professionals Designated staff member to whom the child can go as needed (Preferred adult) Homework reduced or excused and deadlines extended when energy is low Safe place at school where the child can retreat when overwhelmed. Unlimited access to the restroom Unlimited access to water

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More teacher qualities Be resolved and consistent when possible. Continue to supervise the student closely at recess. Defiance and aggression are probably the most challenging moods to manage. The best strategy for addressing these behaviors is to get a Q-TIP (Quit Taking It Personally). Keep your poise and do not get involved in power struggles. Imprint calmness by modeling calmness. If the student says something rude, do not threaten to punish him or her. Hear this for what it is: A cry for help. The child is not capable of verbalizing that they cant handle what is happening.

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Teacher qualities continued Focus the students strengths and point them out to him/her privately. This disorder takes a toll on a childs self esteem. Use the 4Ps for raising self-esteem. Give the student equal choices and have him/her participate in problem solving. For example, the student might say, I dont want to go to music today. Show empathy by using an I statement, I hear you saying you dont want to participate in music today. Is that correct? You can then ask him/her simply Tell me more about that? He/she may say they just dont want to go to music and thats final. You then can tell him/her what your concern is i.e. the class is going to music and you dont want to leave them alone. Ask him/her how both of your concerns could be addressed. When you find a mutually agreeable solution to both of your concerns, go for it! Do not say, You can go to music or you can lose your recess. This is not a choice. You are giving him your choices and not hearing his/her concern.

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Teacher qualities continued If the student is becoming more ill-tempered, allow him/her to go to a predefined safe place. This should be done in a discrete way so as to not disrupt the class or make a scene. Limit those classes that are triggers, i.e. gym, music, recess. Note that circumstances involving physical contact, competition, and perception of fairness, are triggers for many children to become aggressive. Notice when the student has low energy levels or high ones and communicate these observations to parents and/or therapist. Its important to learn the signs of a cycle change.

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Teacher qualities continued Notice when the student seems more irritable or giddy and communicate to parents and/or therapist. Again, this is critical to identifying any potential patterns of behavior in order to monitor his/her condition. Notify the students parents of any changes in routines, group projects, known substitutes etc. When he/she seems to want more attention, greet him/her as he/she enters the room, give him/her opportunities to work with other students and acknowledge him/her when he/she stays on task.