Bipolar Disorder, specifically in children
Presented by : Ms. Regina Kaufmann
What is Bipolar Disorder?
• Mood disorder causing drastic emotional changes and mood swings
• Individual will experience “manic highs” and “depressive lows”
• An altered mood consists of three or more symptoms
• Generally occurs in teens and early twenties, but onset can initiate at any age
• May have impact on finances, employment and relationships---burden often falls on
family and friends
• Life-long condition
(BipolarDisorderSymptoms,2009; Lofthouse,Koons&Fristad,2004; Tylee &Goodwin,2006)
3 Forms of Bipolar Disorder:
• Bipolar I---is the archetypal form with incidents fluctuating from manic to depressive
• Bipolar II---characterized by depression alternating with milder forms of mania referred
to as "hypomania"
• Mixed Bipolar---simultaneous signs of mania and depression
• (World Federation for Mental Health, 2008; Strategies for Teaching.., 2007)
Characteristics of bipolar depression in general the population:
• Episodes last longer than mania
• Persistent sadness, irritability
• Enjoyment is lost in areas where past activities were experienced as pleasurable
• Low energy, perceived illness
• over-sleeping and eating (in regular depression, insomnia exists)
• Also, bipolar depressions seem to occur quickly than "typical" depression, and is
accompanied with fears.
(NIMH, 2008; American Academy of Child and Adolescent Psychiatry, 2008; Bipolar
Disorder Symptoms, 2009; WFMH, 2008; Lofthouse, Mackinaw-Koons & Fistad, 2004)
Characteristics of bipolar Mania in general the population:
• Inflated or short-tempered moods
• Diminished inhibitions
• Cognitively delusional
• Overly active, risky conduct
(National Institute of Mental Health, 2008; American Academy of Child and Adolescent
Psychiatry, 2008; Bipolar Disorder Symptoms, 2009; WFMH, 2008; Lofthouse
&Mackinaw-Koons, Fistad, 2004)
Characteristics of bipolar disorder in children:
• Tend to move rapidly from cycle to cycle (even within one day) with few perceived
“well” periods, may even experience both mania and depression simultaneously
• Most have “moody” and behavioral traits including being temperamental, exhibiting
rigidity and being oppositional, extreme irritability, may display episodic rage (these
tantrums may lead to damage to the home and threats toward people).
• May express extreme separation anxiety as a baby
• May require less sleep, experience very high energy, and become extremely talkative to
the point where they are not able to be interrupted.
• Teenagers may feel that they have unusually strong abilities (Superhero powers)
• Teens may be highly distractible with increased risk-taking translating into use of drugs
and alcohol, and sexual promiscuity.
• Complex in children and teens, and must be closely watched for extended time periods.
• Early onset Bipolar Disorder can be seen in very young children
• Surmised that 1/3 of all children diagnosed with ADHD will be re-diagnosed as being
• 3.4 million children diagnosed with depression later diagnosed with bipolar disorder
(Education.com, Inc., 2006; Harvard Health Publications, 2007)
The cause of this disorder is unknown, but believed to be:
• Imbalance of chemicals in the brain (neurotransmitters)
• Genetic or family history, however, studies involving identical twins (same genetic
make-up) show that one may have disorder and the other may not---hinting at
• Possible brain anomaly, indicated by fMRI (functional Magnetic Resonance Imaging)
and PET (Positron Emission Tomography) scans that show activity in brain while "on
task." Indicative of atypical brain development possibly leading to unstable dispositions
• Although there is no "cure," symptoms may be managed and their effects decreased
through a combination of effective medications, therapies and in-school interventions.
• Affecting equal proportions of men and women, but more women seem to be affected by
depression, while men are more likely to experience manic episodes.
(Bipolar Disorder Symptoms, 2009; NIMH, 2008; Lofthouse, Koons & Fristad, 2004)
History points to…
• Evidence surmises disorder to originated with beginning of humans species
• Genetically passed through generations
• Persons thought to be Bipolar: Isaac Newton, Beethoven, Van Gogh, Hemmingway,
Abraham Lincoln, Winston Churchill, and Teddy Roosevelt to name a few…
(Harvard Health Publications, 2007; Mental Health Ministries)
Seeking a diagnosis:
• Appointment with physician, including a physical assessment, consultation and lab tests
• Referral for mental health professional experienced with Bipolar Disorder
• Family history
( NIMH, 2008)
Pharmaceutical treatments currently used :
• Lithium used for more than fifty years, is effective for most individuals
• Antidepressants are not fully adequate for treatment, used alone they have been shown to
move the individual out of depression and into mania, or to keep the patient "cycling"
through the two polar moods.
• Anticonvulsants are believed stabilize dispositions, and may be an alternative to lithium
for those who do not tolerate the lithium.
• Antipsychotics are prescribed for treatment of both manic and depressive episodes.
• (Lofthouse, Koons & Fristad, 2004)
Reported alternative treatments are:
• Education about self, and illness. Individuals suffering for this disorder should know what
relapse signs are; be responsible for medicating regularly.
• Support groups and individual therapy are important for staying healthy---in mind and body.
• Active involvement of family and friends is imperative for support to stay strong, and focus
on being healthy.
• Electroconvulsive Therapies, previously known as "shock therapy," for relief for those whom
medication proves ineffective.
Is there a form of prevention known?
Possible Trigger: Action for avoiding episode:
• Inconsistent medication Take meds whether you feel like it or not (get
• Undergoing unnecessary stress Schedule time to relax each day, join support group
• Irregular sleep or not enough sleep set scheduled time to retire each night,
allow time for adequate sleep
• Drug or alcohol abuse Get professional help for substance use or abuse
• Inactive lifestyle Schedule daily exercise
(Bipolar Disorder Symptoms, 2009)
What about school, how will my child succeed?
• May have social-emotional, academic and behavioral problems in school, possibly
• May be identified as a "student with a disability, serious emotional disturbance, specific
Learning Disabilities and Other Health Impairments" therefore will be eligible for special
(Education.com, Inc., 2006; Lofthouse, Koons & Fristad, 2004)
Are there classroom recommendations?
• Organized classroom, the least distractions promotes greater "on-task" performance, and
• Behavior intervention plan uses the observations from a functional behavior assessment
(FBA), to determine the antecedent and the consequences of the targeted behavior, and
seeks to "replace" the problem behavior with a more appropriate one
• Clear expectations, therefore reducing any confusion as to the expected results
• Constructive discipline approach (positive); praise and encouragement work best.
• Flexibility when student is “cycling”
• Supportive teacher who is sensitive to child's emotional state; should be calm, optimistic,
patient, firm, reliable, and loving
• Calming music, or background music (nature sounds?); may be sensitive to noise, light
and also heat
• Social skills training, to increase peer acceptance, and social understanding
(Lofthouse, Koons & Fristad; "Educating the child with bipolar.."; Kauffman & Landrum, 59)
Specific Strategies for teaching students with behavior disorders:
• Consult previous teachers for interventions that has worked in the past
• Pre-established consequences for behavior, with immediate action taken after
• Know effects of medications and times that they will be given, structure strategies for
• Use breaks for cooling off periods, may be planned and "as needed."
• Acknowledge student’s input with group work, for peers to realize that they have positive
input and are contributing.
• Show respect and sensitivity (consider their situation)
• Highlight their strengths publically, and support their weaknesses, privately
• Encourage often, build their self-esteem
• Praise immediately upon positive or appropriate responses
• Realize that success will take time, smalls steps forward is still progress!
(Strategies for Teaching, 2007)
• Consistent scheduling should include scheduled breaks
• Preferential seating, enough space for comfort and near students who are good models,
also near teacher
• Advanced notice of transitions, especially unexpected events---may include social stories
to prepare student to respond appropriately.
• Shortened assignments (target quality not quantity)
• Scheduled “down time,” stress can overwhelm coping skills
• Schedule individualized for student’s ‘typical’ emotional cycle, keeping in mind the
student's best or most productive time of day for classes that are most challenging.
Links for Associations and Service Organizations:
• Depression and Bipolar Support Alliance
• Harbor of Refuge: Bipolar (Manic-Depression) Links Page http://harbor-of-
• Bipolar Focus http://www.pendulum.org/supportgroups.html
• Bipolar Disorder—Other places to get help… http://www.everydayhealth.com/health-
Bipolar Resource Materials:
• JOSSELYN Center for Mental Health (1-847-441-5600) For children and teens with
bipolar and other behavior disorders
• Learning about Bipolar Disorder: An Educational Packet of Information
• National Institute of Mental Health (NIMH) 6001 Executive Boulevard
Bethesda, MD 20892 USA www.nimh.nih.gov
• SAMHSA Mental Health Information Center PO Box 42557
Washington DC 20015, USA www.mentalhealth.samhsa.gov
• National Alliance on Mental Illness (NAMI) www.nami.org
2107 Wilson Boulevard, Suite 300, Arlington, VA 22201-3042 USA
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