Transcript CYCLONES

Bi-Polar Condition in Children
Laura A. Riffel, Ph.D.
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
Characteristics of Bi-Polar Condition in Children
• More Symptoms
– Crave Carbohydrates
– Binging
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
Characteristics of Bi-Polar in Children
• More Symptoms
– Meltdowns (long lasting tantrums)
– Compulsive behavior
– Bossiness
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
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
Bi-polar Condition
• 4000% increase in diagnoses since the mid 1990’s in
childhood bi-polar condition.
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
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, [email protected].
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
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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."
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 it’s 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
Parenting Tips
Sleep
• Routines are of utmost concern• Go to bed like a farmer
– Sunset to Sunrise
– Do not vary unless absolutely necessary
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:
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Trampolines- outdoor or indoor
Wii fit
Treadmill
Punching bag
Dance video
Kick boxing
Martial Arts
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.
Choose your battles
• Is this the hill you want to die on?????
Relaxation
• Practice and teach relaxation techniques to your
child.
• Use:
• music, 60 bpm
• sound, headphones
• lighting, www.huelight.net
• Yoga breathing
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.
• 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.
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 Childhood’s 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
Flexibility
• Flexibility to modify assignments, curriculum and
teaching style as needed
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.
Conflict Management
• Good conflict management skills to resolve
conflict in a non-confrontational, non-combative,
safe, and positive manner
Collaboration
• Receptivity to change and to working
collaboratively with the child’s parents, doctors,
and other professionals to best meet the needs
of the child.
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.
Teacher Characteristics
• The most important factor in these children’s
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 children’s
shifting moods and cognitive weaknesses.
• Praise, encouragement, and key words elicit
positive behaviors, while negativity helps the
child spin out of control.
Accommodations
• Suggested accommodations for children with
bipolar disorder include:
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Back and forth communication between home and
school
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Consistent scheduling that includes planned and
unplanned breaks.
– Prior notice of change or disruptions in routine.
– Scheduling the student’s 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
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
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Safe place at school where the child can retreat
when overwhelmed.
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Unlimited access to the restroom
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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 can’t
handle what is happening.
Teacher qualities continued…
• Focus the student’s strengths and point them out to him/her privately.
This disorder takes a toll on a child’s self esteem. Use the 4P’s for
raising self-esteem.
• Give the student equal choices and have him/her participate in
problem solving. For example, the student might say, “I don’t want to
go to music today.” Show empathy by using an “I” statement, “I hear
you saying you don’t 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 don’t want to go to music and that’s final.
You then can tell him/her what your concern is i.e. the class is going to
music and you don’t 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.
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. It’s important to learn the signs of a cycle change.
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 student’s 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.