In The News Bipolar Disorder: Pediatric/OT Perspectives
Bipolar Disorder: Pediatric/OT Perspectives
| 03 February 2009
ADVANCE Newsmagazines
Posted on: February 3, 2009 | By Susan N. Schriber Orloff, OTR/L
Bipolar Disorder: Pediatric/OT Perspectives
After my last column on bipolar disease in children ("Sensory Implications of Bipolar Disorder," Sept. 29, 2008), I have received many emails asking for more information. In response, this second column will address two major aspects: how to communicate this disorder as different from ADD, noting "red flags" for diagnosis, and activities and protocols that can best help these children.
No doubt that this is a difficult disorder to diagnose, but certain specific considerations should be acknowledged. Too often professionals label these children ADHD, ADD, behavior disordered, etc.; give them Ritalin or similar drugs without much relief of symptoms; and send the parents to "parenting classes."
The typical profile, if there is such a thing, may look something like this: The child is bright, learns easily and has advanced vocabulary and verbal expression. He may have a history of biting, demonstrate hyperactivity, fidgeting and lying (even when confronted with the truth); want to cuddle one moment and fly into a rage the next; display silliness, goofiness and giddiness; have racing thoughts; and is not easily calmed. He may have been dismissed from several preschools due to poor behavior/social skills. There may be a family history of depression/mood disorders or an adult in the family who is bipolar.
A diagnosis of bipolar disorder requires the intervention of a developmental pediatrician, as general pediatricians are often not as well trained in the subtleties of this and other discrete disabilities.
Parents of children with this disorder get advice such as "he needs a stronger hand," or "he will outgrow it," or "it is a sensory problem." None of these well-meaning words help at all! An excellent resource is The Bipolar Child by Demitri Papolos, MD, and Janice Papolos, which has been reviewed as a "shot in the arm" for parents of children with bipolar disorder.
School situations are often the most difficult to navigate. Teachers are "tuned in" to ADD and go there first whenever there are any behavioral concerns. It is important to guide these concerns so the most beneficial academic adaptations can be implemented.
The key in IEP meetings and similar teacher/administrator discussions is to ask the right questions. I have found that checklists are extremely helpful because they are specific and help the respondents organize thoughtful responses.
A sample checklist, adapted from the work of Papolos and Papolos, is available on the ADVANCE Web site at www.advanceweb.com/OT (see below). There you also will find extensive suggestions for adaptations and activities for children with bipolar disorder: environmental and behavioral considerations, activities to use both at home and in therapy sessions, and treatment suggestions for school-based occupational therapists. A list of resources for further investigation is provided as well.
Keep in mind that bipolar disorder does not "go away," children do not "outgrow" it, and most importantly, it is not anyone's fault. It is a lifelong disorder that will, on some level, always require medical (medication/psychiatric) and therapeutic management, accommodation and patience, for both the child and his family.
Susan N. Schriber Orloff, OTR/L, is the author of the Learning Re-enabled, a guide for parents, teachers and therapists. She also writes "Ask the Therapist," a column in Exceptional Parent magazine and is CEO and executive director of Children's Special Services, LLC, an occupational therapy service for children with developmental and learning delays in Atlanta, GA. She was named OT of the Year for 2006 by the Georgia Occupational Therapy Association. She can be reached on the Web at http://childrens-services.com or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
