I really appreciated, and related to, your posts about diagnosing a young child with bipolar disorder. In fact, your son’s diagnosis story is very similar to my daughter’s. She was diagnosed with bipolar II (along with ADHD & symptoms of anxiety) in kindergarten and is now 9. I noticed you also mentioned having a “very “bipolar-specific IEP” has been an important part of your son’s treatment. I was wondering if you could give some examples of the kinds of things you requested in his IEP. My daughter’s IEP meeting is coming up soon!
A “bipolar-specific” IEP is a very important tool to have implemented for a student with bipolar disorder. In the USA an IEP is an “Individualized Education Program” that is designed to aid a student with all aspects of schooling. In Canada and the UK an IEP is known as an “Individual Education Plan”. Although the name is slightly different an IEP is used in schools to help students with disabilities function at their best while at school. As the name suggests it is a plan that is individualized for a student’s particular needs, which include academic/emotional/social needs. IEP’s are tailored to meet the unique needs of a student. Goals and objectives are developed with input from parents/guardians, teachers, teacher’s aides, support workers, tutors, counsellors, school psychologists, social workers and anyone else who may be involved with the student’s care. The IEP takes into account how the student’s disability affects their learning. It carefully assesses the student in all areas. In addition an IEP needs to be regularly maintained and updated as the student’s needs change.
Students with bipolar disorder are often “highly gifted” but have difficulty with many of the aspects of a mainstream school environment. This was certainly the case for me. I was often described by my teachers as being a “bright student” who rushed through her work, made careless errors, was a class clown and was often giddy in class. My report card comments always stated, that I would have had much better grades if “I would have applied myself more” in all subjects. However with attending school in the 1970’s/80’s I went undiagnosed and was labelled as being a “behavior problem” by most teachers. I was never assessed for a disability or mental illness disorder.
It wasn’t until adulthood that the doctors began to see that something was not right. Initially I was diagnosed with depression, then ADHD along with Generalized Anxiety Disorder. It wasn’t until January 2011 that I was finally given a correct diagnosis of Bipolar II, with secondary diagnoses of ADHD and Generalized Anxiety Disorder being a close second. Now I know exactly why I struggled so badly throughout my school years! Unfortunately there was no such thing as an IEP when I went to school. If there was I am pretty certain I would have had one and I likely would have done much better. If there had been some sort of intervention for me I probably would have been quite successful and would have reached my full potential.
As an adult I became fairly familiar with how helpful an IEP could be for students while working at an outreach school where many of the students had an IEP in place. I was employed as a “student support worker” and worked with a girl who was diagnosed with ADHD. She was almost a “carbon copy” of me when I was a student. That was actually a good thing because I could identify with her very easily and that helped me help her. I worked mostly on a 1-1 basis with her and occasionally within small groups. I also worked with other students who had learning disabilities or other problems which made school extremely difficult for them. All of the students I had worked with all had IEP’s and needed extra support. These students were known as “coded students” within the school system, which meant that they had been assessed by the school psychologist and were identified as having some sort of disability that affects their learning ability.
If you have a child who continually struggles at school and/or at home it is important to have the child assessed. If you are concerned about your child’s behavior and overall well-being it would be a good idea to speak with your doctor about your concerns. Your doctor should be able to do a quick assessment of your child and determine whether further care or services are needed. A few other options would be to access a community mental health clinic or contact your child’s school principal or guidance counsellor and explain your concerns to them. Generally speaking these professionals should be able to either recommend an appropriate service for you to access or provide some sort of support to you and your child through the school system.
If your child has been through assessments and it has been determined that they have a disability then you may already be going through the IEP process or will be doing so soon. There are a few things to consider when you have a child on an IEP. If you have a child who qualifies for an IEP it will be helpful to think about “what will be the most important things to request for my child’s IEP?” Take a child with bipolar disorder for instance. A student with bipolar disorder will have an IEP which is much different than a child who is blind because each student has different individual needs. Here are some examples of some things that you could request in an IEP for a child who has bipolar disorder:
Accommodations such as:
- preferential seating (close to the teacher or teacher’s aide so the child’s mental status can be monitored frequently and more easily)
- oral tests instead of written, alternative or modified assignments
- use of a computer or other technology that may be helpful
- extended time on tests/assignments and a quiet space to work in such as a resource room or the library when required
- a special education teacher, specialized classes, a support worker or teacher’s aide to work 1-1 with the student, a tutor, peer support or a “study buddy”
- visits to the school counsellor when need be
- frequent breaks (especially if your child has focus problems, gets easily overwhelmed or irritable and frustrated), flexible schedule such as allowing the child to start school later in the day and/or give assignments and tests later in the day – (a time during the day when the child is at their best level of functioning)
- allow the child to have a water bottle and frequent bathroom breaks as some medications for bipolar disorder can create thirst and a frequent need for urination
- provide behavioral/crisis interventions and a “safe, private place” in case the child’s behavior becomes out of control and they are unable to settle
- allow the child to participate in “normal” regular school culture/academics as much as possible
- if appropriate allow the child to attend IEP meetings and help them understand the goals and objectives of the IEP
- provide not only academic support but emotional and social support as well
- designate someone that can teach and practice things like social skills, organizational skills, problem solving, anger management, calming and relaxation techniques to the child
Another strategy that my colleagues and I used was a “token reward system”. It is basically a tool that is used to help “reinforce positive behavior” in children/youth. It can be used with any child or adolescent and is usually quite effective. School personnel and parents can use this to help keep a child’s behavior in check. It also teaches them responsibility for their actions and rewards them in a way that keeps them motivated and interested. Every time a child is successful with a desired behavior (for example – counting to 10 when feeling irritated or angry, and repeat until the child can calm themselves) would earn them a “token”. I used poker chips and gave out clear boxes so that the child could see how many they collected over a week. At the end of the week the student would bring their box of tokens to me and share how many they had earned for that week. They would cash in their tokens and were then given a choice of rewards to pick from. The reward could be immediate (a package of hockey cards given to the student upon cashing in their tokens) or it could be a reward such as “play time on a computer” for 30 minutes on Monday. Other rewards could be going to the home economics room and cooking or baking something with their favorite teacher/aide/counsellor.
I would discuss ideas for “rewards” with the students and add whatever reasonable ideas they had to a “reward list”. This way they feel more involved in the process and stay motivated because they know what kind of rewards they can earn for any given week. Some parents use this system at home also to help motivate children to complete homework or chores around the house. It works well for any child but particularly well for children/youth that have disorders such as bipolar disorder.
You may think of other things that will be helpful to your child throughout the school day. If so don’t hesitate to make a request/s with your child’s school. Or if you suspect that part of the IEP is not working or some changes should be made communicate this to the school. You don’t have to wait for your child’s next IEP meeting to do so, just call the school and communicate your concerns. Keeping the lines of communication open with school personnel is vital in order for your child to have a good effective IEP.
In some instances a child with bipolar disorder may not be able to function well in a mainstream school. There can be various reasons for this but the important thing is to seek out other options if this is the case. For example some children with bipolar disorder can be extremely grumpy, agitated, and irritable for most of the day. Some children are too unstable and are susceptible to rages and unsafe behavior. They may also suffer from sleep disturbance and are often fatigued. That alone can make for a long difficult day.
In some cases it may be appropriate for the child to participate in home schooling. In cases that are more extreme some children may need to be placed in a “therapeutic school” or in a “residential treatment center”. It really just depends on the child’s level of functioning and mental status as to what will be the best option at any given time and for any given child. In any event there are many good services/programs these days as compared to when I went to school. The best thing a parent can do for their bipolar child is to keep your options open and recognize when you and your child may be in need of extra help and/or services. If you would like more information on IEP’s for children with bipolar disorder go to the Juvenile Bipolar Research Foundation website at www.jbrf.org . This is an excellent resource.
Thank you for submitting your question and please submit any comments or further questions that you may have on bipolar disorder to www.askabipolar.com