How to Control Bipolar Behavior in Children

Bipolar disorder is a chronic neuro-developmental illness characterized by rapid fluctuations in mood, thinking, energy and behavior. Bipolar disorder typically emerges in adolescence or early adulthood. When it appears in childhood it is usually severe and highly disruptive. Early treatment can dramatically reduce symptoms and improve long- term outcomes. Utilization of a broad, multi-modal treatment program yields the greatest results. Treatment strategies you should incorporate into your child's program include medications, child therapy, parenting effectiveness training or family therapy, and use of behavioral management strategies such as clear limit setting, effective use of rewards, family rules and mood management training.

Instructions

Gain Control of Your Bipolar Child

• 1

  Consider using medication to control your child's bipolar moods and behavior. Medications can ameliorate symptoms and improve long-term outcomes. Talk with your child's psychiatrist or physician about medication options. Lithium, Risperdal and Abilify are all approved by the FDA to treat bipolar disorder in children. Other drugs that have been found to be helpful include mood stabilizers, atypical antipsychotics, and antidepressants prescribed along with a mood stabilizer. Your child's doctor should start your child on a low dosage, and slowly increase the dosage until she finds the lowest dose that is effective. It is important for the parents to monitor symptoms and report progress and problems to the prescribing physician.

• 2

  Start your child in therapy with a psychologist, counselor or therapist who is experienced in dealing with bipolar children.

• 3

  Consider participating in parenting or family therapy. Therapy can educate, enlighten, and empower parents to become more effective co-therapists in the treatment of the bipolar child.

• 4

  Set clear limits. Bipolar children need structure. When you give a command, specify what they have to do, what the time frame is, and what the consequences are. Bipolar children can become lawyer-like in dealing and debating. Do not engage in a power struggle. Focus on the positive behavior they need to do in order to obtain positive outcomes. For example, say "You need to clean up your toys before dinner. Once the toys are cleaned up, then you can watch T.V."

• 5

  Be generous in your use of rewards, and especially labeled praise, to encourage compliance. When you use labeled praise, you tell the child exactly what behavior, attitude, and so forth you are pleased with. For example, you might say, "Thanks for cleaning up your toys. I appreciate how you did it without complaining".

• 6

  Use "Time outs" as frequently as necessary, but use them as "cool down" periods, not as punishments. Bipolar children have difficulty modulating their mood, so a major socialization task for you will be to help them to learn how to gain self-control. When they are upset, disrespectful, angry, or noncompliant don't argue with them. Tell them they need to calm down. Tell them if they are unable to calm down and get control, then they need to take some alone time until they are calm enough to be in control of their words and behavior. Once they settle down and rejoin you, praise them for calming themselves down.

• 7

  Establish family rules. Discuss them. Post them. Be clear about consequences of repeated violations of rules. Elicit the child's input into what consequences should be. Go with consequences proportionate to the misbehavior. When they violate the rules, remind them that "we agreed that this is the consequence when you break the rule". It is harder for children to be indignant when they helped to develop the agreed-to consequence.

• 8

  Train your child in mood management strategies. Bipolar children have little self-awareness. They lack insight about the impact their mood has on their verbalization and behavior. Nor do they appreciate how their words, attitude and behavior affect others. Use "reflection" to help them to recognize and label their moods. For example, say, "You seem sad" or "I can see you are upset". Validate their feelings---this will help to calm them down---but don't validate their inappropriate behavioral responses to their feelings. Note to them how their mood is affecting their behavior and remind them of prior discussions of how to handle their intense feelings. For example, say "You are acting disrespectful because you are angry, and this will not help make things better. Go calm down, and when you're ready to talk about this reasonably, we'll talk about it." Reward them with labeled praise when they make positive steps toward self control.