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Bipolar Disorder and it's Implications in the Classroom

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Jocelyn Kuksa

on 27 July 2014

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Transcript of Bipolar Disorder and it's Implications in the Classroom

Bipolar Disorder and it's Implications in the Classroom
What is an Emotional/Behavioral Disorder?
Currently, students with such disorders are categorized as having an emotional disturbance. Emotional Disturbance is defined under the Individuals with Disabilities Education Act (IDEA) as

"...a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance:

Bipolar Disorder
Bipolar disorder is also known as manic-depressive illness. The condition is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day to day tasks. Scientists are still unsure of the exact cause of bipolar disorder but some possible causes include both genetics and the structure and function of the brain (NIH).
Did you know?
Bipolar disorder often doesn't develop until an individual is in their late teens early adulthood years. Approximately half of the cases diagnosed are before an individual reaches the age of 25 (NIH).

So does this mean that children are immune to this disorder?
But wait, what does IDEA include?
Check out this quick informational video on IDEA!
What types of disorders are characterized as an EBD?
anxiety disorders
bipolar disorder
conduct disorders
eating disorders
obsessive-compulsive disorder
psychotic disorders
Children and Bipolar Disorder
Children who are diagnosed with this disorder are considered to have "early-onset bipolar disorder". When diagnosed, this type is usually more extreme then those diagnosed later in life. Individuals may experience episodes more frequently than an adult would (NIH).
Prevalence of Bipolar Disorder in Children
Although bipolar disorder is still more prevalent in adults than children, the rate of diagnosis has more than doubled in the last ten years in outpatient and inpatient settings (Youngstrom, 2006). Bipolar disorder has become the most common diagnosis in children under age 12 receiving psychiatric hospitalizations according to data from the Centers for Disease Control (Youngstrom, 2006).
An inability to learn that cannot be explained by intellectual, sensory, or health factors
An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
Inappropriate types of behavior or feelings under normal circumstances
A general pervasive mood of unhappiness or depression
A tendency to develop physical symptoms or fears associated with personal or school factors.
Laurent Clerc National Deaf Education Center (n.d.) Emotional and behavioral disorders.

Retrieved from http://www.gallaudet.edu/clerc_center/information_and_ resources/info_to_go/educate_children_(3_to_21)/students_with_disabilities/emotionalbehavioral_disorders.html
The following disorders are characterized as an Emotional/Behavioral Disorder:
Let's dive in and take a deeper look at bipolar disorder and it's implications in the classroom!
NICHCY (2010, June) Emotional Disturbance. Retrieved from http://nichcy.org/disability/specific/emotionaldisturbance#bipolar
Signs and Symptoms
Individuals with this disorder will experience intense "mood episodes". The first type of state is usually an overly joyful state called a manic episode. The second type is an extreme sad and hopeless state that is considered a depressive episode (NIH).
National Institute of Mental Health (NIH) (n.d.) Bipolar disorder. Retrieved from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
National Institute of Mental Health (NIH) (n.d.) Bipolar disorder in children and teens. Retrieved from http://www.nimh.nih.gov/health/publications/ bipolar-disorder-in-children-and-teens-easy-to-read/index.shtml
National Institute of Mental Health (NIH) (n.d.) Bipolar disorder in children and teens. Retrieved from http://www.nimh.nih.gov/health/publications/ bipolar-disorder-in-children-and-teens-easy-to-read/index.shtml
Let's take a closer look at an individual who
was diagnosed with this disorder at the age of 5!
Behavioral Implications in the Classroom
Treatment Beyond the Classroom
Youngstrom, E. (2006, July).

Pyschological science and bipolar disorder in children and adolescents
. American Psychological Association.
Retrieved from http://www.apa.org/science/about/psa/2006/07/youngstrom.aspx
In order to successfully teach a child with bipolar disorder, it is important as an educator, to know how this disorder affects a child and what strategies could help you as a teacher.
Pay attention
Remember and recall information
Think critically, categorize, and organize information
Employ problem-solving skills
Quickly coordinate eye-hand movements
Even when a child's mood may be stable, this disorder can cause cognitive deficits that affect the ability to:
Medications may help these symptoms in the classroom but may also have negative side effects that include:
cognitive dulling
slurring of speech
memory recall difficulties
physical discomfort such as nausea and excessive thirst.
Deficits in the Classroom
Although, these individuals will have a much more difficult time learning, there is no reason they cannot be successful in the classroom. Some simple tips for a teacher to be successful with these students include; flexibility, patience, good conflict management skills, receptivity, and the ability to laugh.
How to be Successful as a Teacher
A variety of factors need to be considered when dealing with a student in the classroom who has bipolar disorder. A student with this disorder will have issues building relationships, controlling their mood, and the ability and rate at which they learn.
Studies show...
Recent brain imaging studies show biological differences in those with bipolar disorder. The disorder affects
in a number of ways, ranging from:
Difficulties with sleep
School attendance
Executive function
What are the Academic Implications
*When looking at these biological differences, it can make sense why students with this disorder can become easily frustrated in the classroom on a daily basis*
Creating a Positive Student-Teacher Relationship
A primary underlying reason for problematic behavior in youth is the lack of adequate, sustained relationships with caring and concerned adult mentors during late childhood through the adolescent years (Allsopp et al., 2009).
Many of those students who usually need those positive relationships are the ones who try and reject the help. When a student rejects a teacher, it can then be hard to try and form a positive relationship without becoming frustrated.
Murray (2002), recommends emphasizing positive teacher–student relationships as a means for improving academic out-comes of early adolescents with EBD.
Creating a relationship that includes trust, patience and support through an academic journey can help set up a student for success in the classroom. The most important thing a teacher can do is get to know their student.
Accommodations for Students with Bipolar Disorder
Every students needs with bipolar disorder will be different, which means the accommodations that work for one child may not work for the next. Having a variety of options on hand as a teacher can help set both the teacher and student up for success.
Second set of books at home
Reduced class size
Extended time on tests
Reduced time of work during instability
Limiting sensory input like noise and light
Organizational assistance
A safe place to go during emotional distress
A child with BD can experience multiple behavioral disorders that can be subtle to extremely disruptive. Some common symptoms and behaviors include:
• An expansive or irritable mood
• Depression
• Explosive, lengthy, and often destructive rages
• Separation anxiety
• Defiance of authority
• Hyperactivity, agitation, and distractibility
• Excessive involvement in multiple projects and activities
• Impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
• Dare-devil behaviors
• Inappropriate or precocious sexual behavior
• Delusions and hallucinations
• Belief that one can defy the law
Managing Challenging Behavior
Bipolar disorder affects the areas of the brain that regulate memory, speech, thought, emotions, personality, planning, anxiety, frustration, aggression, and impulse control (CABF, 2007). This being said, even medication cannot always control the outbursts that a student with BD may experience. It is the teachers job to stay
calm, be patient, and praise
the student often to help keep the child under control and hopefully the episodes to a minimum.
Creating Behavioral Plans
Child & Adolescent Bipolar Foundation (CABF) (2007). Educating the child with bipolar disorder. Retrieved from http://www.thebalancedmind.org/sites/default/files/edbrochure.pdf
Minnesota Association for Children's Mental Health (MACMH) (n.d.) Disorders. Retrieved from http://www.cmhsreach.org/disorder_bipolar.html
For a child whose behavior impedes their learning, including the learning of others, the students IEP team needs to consider strategies to address that behavior. One of those strategies may include a positive behavior intervention plan.
Implementing Behavioral Intervention Plans (BIP) can:
Provides more intensive intervention and monitoring
Increases support around student
Provides an individualized plan for success
Addresses specific issues in a specific manner
Involves teachers, support staff, the student, and parents actively
Helps teachers to address behaviors and issues consistently across subjects, rooms, sessions, etc
PBIS World (2014). Behavior Intervention Plan. Retrieved from http://www.pbisworld.com/tier-2/behavior-intervention-plan-bip/
Implementing Behavioral Plans
Points to Consider
Teaching the child replacement behaviors
Rewarding the child for using socially acceptable behavior
Teaching the child to avoid the behavior "triggers"
Teaching the child to identify emotions
Changing the responses of the adults
Changing negative stimuli in the environment
Identify a caring adult to give positive time at school
Supporting the child at problematic times
In order for the plan to properly work, the student-teacher relationship is vital and must contain trust between the two individuals. Multiple support strategies may be in place to match each scenario the individual may encounter. Some examples of supports would include:
Each plan should focus on the child as a whole and teach them the correct coping skills.

Public Schools of North Carolina, (n.d.). Behavioral Intervention Plans. Retrieved from http://ec.ncpublicschools.gov/instructional-resources/behavior- support/resources/behavior-intervention-plan

Mood Stabilizers
Atypical Antipsychotics
is also an effective treatment to managing bipolar disorder. While therapy alone will not do the trick, it can help educate individuals on the disorder and be used as a support system.
Besides the interventions that can be done in the classroom, proper medication is
in order to limit and control the symptoms of those with bipolar disorder. The three most common forms of medications used are:
Why Become Educated on the Disorder?
With the diagnoses of bipolar disorder in children becoming more prevalent, and educational strategies for this disorder still being tested, it is only necessary for teachers and educators to become more knowledgeable on the disease. With increased knowledge, teachers can better manage their classrooms and help each student with bipolar disorder reach their potential.
National Institute of Mental Health (NIH) (n.d.) Bipolar disorder. Retrieved from http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
Child & Adolescent Bipolar Foundation (CABF) (2007). Educating the child with bipolar disorder. Retrieved from http://www.thebalancedmind.org/sites/default/files/edbrochure.pdf
Child & Adolescent Bipolar Foundation (CABF) (2007). Educating the child with bipolar disorder. Retrieved from http://www.thebalancedmind.org/sites/default/files/edbrochure.pdf
Murray, C. (2002). Supportive teacher-student relationships: Promoting the social and emotional health of early adolescents with high incidence disabilities

Childhood Education
285–290. Retrieved from http://www.thefreelibrary.com/Supportive+teacher- student+relationships%3A+promoting+the+social+and...-a088570977

Allsopp, D., McHatton, P., Mihalas, S. & Morse, W. (2009) Cultivating caring relationships between teachers and secondary students with emotional and behavioral disorders.
Remedial and Special Education, 30
, 108-125. doi: 10.1177/0741932508315950
Anglada, T. (2008). The student with bipolar disorder-An educator’s guide.
. Retrieved from http://www.bpchildren.org/files/Download/Educator.pdf
Once a plan is designed by both the teacher and the IEP team, the strategies and behavioral plan can start to be introduced to the student. Since most of these plans are based on a hypothesis, it is important to understand that not every strategy will work immediately.

The implementation of a student’s behavioral intervention plan must include regular progress monitoring of the frequency, duration and intensity of the behavioral interventions at scheduled intervals, as specified in the BIP and on the student's IEP (New York State Education Department, 2011).
New York State Education Department, (2011). Behavioral Intervention Plans. Retrieved from http://www.p12.nysed.gov/specialed/publications /topicalbriefs/BIP.htm
"Childhood bipolar disorder is potentially devastating, both to the child and his or her family. Little research has been conducted to date to develop empirical guidelines for treating these children (Fristad et al., 2003)."
Fristad, M., Gavazzi, S., Mackinaw-Koons, B. (2003). Family psychoeducation: An adjunctive intervention for children with bipolar disorder.
Society of Biological Psychiatry, 53
, 1000-1008. Retrieved from http://www.ideas4kid smentalhealth.org/uploads/7/8/5/3/7853050/fristad_et_al_2003.pdf
National Institute of Mental Health (NIH) (2012). Bipolar disorder in adults. Retrieved from http://www.nimh.nih.gov/health/publications/bipolar- disorder-in-adults/bipolar_disorder_adults_cl508.pdf
By: Jocelyn Sparks
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