In my classroom I have a number of children who have been diagnosed with Bi-Polar. One child has learned how to use the way he reacts when not in controll at times when he doesn't want to work or can not do what he wants. I have worked with him for more than a year and a half. I have had the children leave when he reacts strongly. Many times approximately 2 to 3 minutes after they left he would stop and get himself in control. I have observed that when he is not in control, he is fighting to control, his body reacts as well as the screaming and he rarely throws items as he does at other times. I have tried reward system after reward system, some work for a short while and then lose their effectiveness. The last thing I used was a card system which I called "Climbing the Rainbow" where each color earned a reward, however the rewards became higher as one climbed the rainbow. With this child I used a plus and minus process to get the card turned up. He helped develop the list of behaviors that would earn pluses. He was able to turn his card up twice for three days and then it seem to stop working. Does anyone have any ideas for what can work with children with Bi-Polar?
Other specific problems:· Anxiety Problems -
· Organizational Skills -
· Shifting Skills -
· Initating Skills -
· Social Skills -
· Sleep/Wake problems and Medication problems-
· Distractions - Staying on Task
Auditory and visual field/ground problems means that noise and visually stimulating walls may be too much. These students prefer a quiet environment with little movement in the room. Sucking on hard candy or chewing gum may actually help them focus better and remember skills taught. They stay attentive if they are interested in the subject, it is broken down into small parts and clearly presented. Check frequently for understanding.
One of the important goals will be to teach and reinforce self-worth, and then self-discipline. Medication compliance with teens may be a big issue as some of the medications may also cause weight gain and nauseousness. The child and teen will have their self-esteem shaken by the depression/manic episode/s. Building self-worth is important. Developing self-care and then self-discipline is a slow process. At times it may seem there is little or no progress or there is only baby steps. Be patient and encouraging because your role is so important in the well being of the bipolar student.
The Child and Adolescent Bipolar Foundation suggest the following strategies for teaching a child with bipolar disorder:· Flexibility to adapt assignments, curriculum and presentation style as needed. · 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.· Good conflict management skills to resolve conflict in a non-confrontational, non-combative, safe, and positive manner. · Receptivity to change and to working collaboratively with the child’s parents, doctors, and other professionals to best meet the needs of the child. · The ability to laugh at oneself and at situations. Teachers who can laugh at their own mistakes, and bring fun and Suggested accommodations for children with bipolar include:· Small class size · Seating with few distractions, providing a buffer space and model children. · Prior notice of transitions or changes in routine. · Back and forth communication between home and school · Consistent scheduling that includes planned and unplanned breaks. · Scheduling the student’s most challenging task at a time of day when the child is best able to perform, allowing for medication related tiredness, hunger etc. · Homework reduced or excused and deadlines extended when energy is low · A safe place at school where the child can retreat when overwhelmed. · A designated staff member to whom the child can go as needed · Unlimited access to the bathroom · Unlimited access to drinking water · Annual in-service training for teachers by child’s treatment professionals Specifics recommendations for some children: 1. Find the child’s strengths and point them out to him. This disorder takes a toll on a child’s self esteem. 2. Notice when the child has low energy levels or high ones and communicate these observations to parents and therapist. Sometimes a cycle may be beginning and we miss the early warning signs. 3. Notice when the child seems more irritable or giddy and communicate to parents and therapist. Again, this is critical to identifying any potential patterns of behavior in order to monitor his condition. 4. Defiance and aggression are probably the most challenging moods to manage. The best strategy for addressing these behaviors is to not take it personally. Keep your composure and do not get involved in power struggles. Remain a positive model. If the child says something rude, do not threaten to punish him or her. Try to hear this kind of response as a request for help. The child just cannot verbalize that they can’t handle what is happening. 5. Be firm and consistent when possible. 6. Give the child choices and have him participate in problem solving. For example, the child might say, “I don’t want to go to gym today.” Let him know you heard him (empathy) and reassure him that you are not going to say “no.” You can then ask him simply “What’s up?” He may say he just doesn’t want to go to gym and that’s final. You then can tell him what your concern is i.e. the class is going to gym and you don’t want to leave him alone. Ask him how both of your concerns could be addressed. When you find a mutually agreeable solution to both of your concerns, go for it! Please note, asking a child if he wants to sit in the class or go to gym is not collaborative problem solving. You are giving him your choices and not hearing his concern. 7. Do not give ultimatums or threats. This can easily force a child to make poor choices. 8. When he seems to want more attention, greet him as he enters the room, give him opportunities to work with other students and acknowledge him when he stays on task. 9. If the child is becoming more irritable, allow him 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. 10. Note that situations involving physical contact, competition, and perception of fairness, are triggers for many children to get aggressive. 11. Limit those classes that are triggers, i.e. gym, music, recess. 12. Notify the parents of any changes in routines, class projects, etc. 13. Continue to monitor the child closely at recess.
Bipolar disorder involves big changes in mood and energy. A child may exhibit extreme elation or agitation accompanied by high energy levels and possible destructive tantrums in the manic state. They may have persistent states of extreme sadness or irritability, being whiny, hard on oneself, swearing, disrespectful, threatening, and low energy in the depressed state.
Children can go through severe and sudden mood changes many times a day. Symptoms of mania and depression can also occur at the same time. Children with the disorder are frequently anxious and have a very low tolerance for frustration. Proper treatment can reduce the severity and frequency of the episodes.
One of the most important things for someone with bipolar disorder is medication. It would be good to know if the child is medicated. Either way, let the parents know on a regular basis what you are seeing in terms of energy levels, aggressive levels, etc. Try to see if there is a cycle to the moods or specific times of day or specific subjects when these behaviors occur. Children with bipolar disorder often have a greater sensitivity to light, noise, and stress. Motivation and energy levels may fluctuate often.
I would be curious as to the age of your bi-polar student. I would suggest, depending on the age, to use several other methods in addition to the rewards. First, have a behavior analysis completed on the student to identify triggers and reinforcers. Any special education teacher should be able to do this. Once reinforcers are identified, work with parents and other teachers to identify reinforcers of appropriate behaviors and create your reinforcer menu. Secondly, incorporate social stories with the students in your class. I have included a site on how to write social stories, but you can also search for books already written on the topic. http://www.ehow.com/how_2255108_write-social-story.html And finally, use self monitoring techniques with the student. Here is a site with ideas: http://www.iidc.indiana.edu/irca/behavior/selfmgt.html Remember, that although it seems intentional, the student may not be able to control and predict his behavior consistently. Make sure he has tools to identify when he is starting to feel out of sorts and that he has an appropriate plan to deal with his emotions and subsequent behaviors, and if necessary, an escape plan (chill zone, another teacher's room, etc.).
This is an interesting situation. I did a little research and found the following. Hope you can find something in these articles and sites that will help. Good Luck!
What have you been using for rewards? These children need to be working toward something that is INCREDIBLY reinforcing for them. In the case of the one child who acts out until the other students leave the room, it is most likely that the fuction of his behavior is attention-seeking. Therefore, he should be working to receive peer attention (eg working with a friend, etc), and he needs to be given a more appropriate way to attain attention than "acting-out" behavior. For instance, you can tell him that for every 30 minutes (or however long he is capable of) that he can go without acting out, he can have five minutes to work with a peer (as mentioned before) or present something to the class.
Keep in mind that bipolar children are challenging by definition; they are constantly changing so you need to be very creative in finding reinforcement that is meaningful to them at the various stages of their bipolar cycles.
It can be very challenging to work with a student with Bi-Polar disorder to help him/her to decrease a bad behavior. You should work on targeting the behavior small steps at a time. For example, I once had a Bi-Polar student, who would throw tantrums. She would yell and cuss and throw things each time she had a tantrum. I would discuss with her the things that I wanted her to stop doing. Then, I would let her choose one for us to work on. She may choose to work on not yelling or not throwing things. Then, I would help her come up with a behavior to replace the bad one. For example, we might choose to replace throwing things with using a stress relief ball. Once you have targeted the behavior to reduce and the behavior to replace it with, then it is time to discuss awards and consequences. You should let the student help decide on an effective reward that he/she would work for. However, it should also be one that you feel is reasonable and that you agree with. Do the same for the consequence. Put all of this in writing in a behavior contract. Each of you should sign it. If you would like to stress the importance of the contract to the student, then have the student present the contract to the principal and ask them to sign it, also.
First of all, I think it is great for the other students to leave when he begins his fits. You have to think of the safety of others. Not only that, many times these outburts are to gain attention, and removing the others takes some of that attention away.
I do think rewards are good. I would start very small though. I would pick 1 behavior that is particuarly bad. Work on eliminating this. Target the behavior, and what happens when he does this or does not do this. Make sure and be consistant.....I know this is hard, but it will not be effective if the same thing is not done every time. After one behavior begins to subside, then you can add others to work on.
Also, no matter how bad it gets, just try to stay positive. I do not know your child's situation, but sometimes a good word can help a lot!