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Section 23
Implications for School-Based Intervention for Bipolar Children

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When faced with a child who presents with severe behavioral problems, counselors’ primary roles center around the ASCA’s National Standards in academic development and personal/social development. The following recommendations are based on the ASCA position on ADHD (ASCA) and recommended interventions for children with behavioral disorders. The school counselor may participate in the implementation of the following: (a) making referrals for appropriate assessment and treatment; (b) developing a collaborative relationship with parents and teachers so as to facilitate a multimodal delivery of services to children with bipolar disorder; (c) helping teachers design appropriate programs for students that include opportunities to learn appropriate social skills and self-management skills; (d) providing students with activities to improve their self-esteem and self-concept and to promote the safety of self and others; (e) and serving as a consultant and resource to parents, teachers, and other school personnel on the characteristics and problems of students with bipolar disorder. Counselors need to be aware that children who present with severe behavioral concerns need to be thoroughly assessed and treated by a child psychiatrist and/or child psychologist. In these situations, the role of the school counselor is to encourage parents to have the child assessed so that appropriate provisions may be made at the school level to accommodate the child’s needs. It is recommended that school counselors and teachers document dates and severity of behaviors that are a cause for concern in order to help appropriate health-care providers arrive at an accurate diagnosis. Continued documentation of behaviors after diagnosis and during treatment is important to monitor progress and to help fine-tune treatment requirements.

The development of a collaborative relationship among the counselor, parents, and teachers is important for a plan for working with the bipolar child. Counselors may play a role in helping teachers give the child a sense of consistency throughout his or her day by maintaining open communication with parents to identify effective strategies to be used at both home and school. Working with parents and teachers to identify inciting events that may set off a child’s negative behavior may be helpful in both the home and school setting. For example, the child in the case example became easily frustrated when doing timed math facts at both home and school. When given the opportunity to complete math facts without the pressure of being timed, his frustration level dropped and he experienced success. A daily home-school communication log may become an important tool to ensure that everyone receives the same information and adjusts the child’s schedule or work expectations accordingly. For example, if a child had a difficult time sleeping the previous night, it may be expected that he or she may not be functioning at an optimal level at school the next day. Therefore, providing the child with a quiet space to work, opportunities to take more breaks, or a reduced workload may be appropriate.

Children with bipolar disorder may be defiant and resistant to suggestions from adults, resulting in conflict. Greene has recommended that parents and teachers prioritize items into three “baskets” in order to reduce behavioral difficulties. The purpose of the baskets is to identify behaviors that are non-negotiable, negotiable, and not worth addressing. “Basket A” consists of non-negotiable items that parents and teachers should insist upon, such as unsafe behaviors that could be harmful to the child, other people, animals, or property (e.g., anything that requires a firm “No”). “Basket B” consists of items that are negotiable, that are important to teach the child how to stay calm in the midst of frustration, and that require the adult to work with the child to arrive at a mutually satisfactory resolution. Greene suggests using the question “Can you think of a way to work that out?” to encourage children to think about possible solutions, rather than overreacting to the problem. For example, completing timed math facts is not a safety issue (Basket A), therefore, it is negotiable (Basket B). The adult would calmly and rationally identify the reason for not wanting to complete timed math facts and negotiate with the child an appropriate manner in which to complete the math facts. “Basket C” consists of items that are not worth fighting about (e.g., no-win situations). For example, for some children in certain mood states, completing math facts may be a no-win situation, and therefore, the adult would not even address the situation until a later time.

Counselors need to recognize that the bipolar child’s behaviors are stimulated by internal rather than external factors but may be easily set off by external cues (Papolos & Papolos). Therefore, children with bipolar disorder require special accommodations at school, specifically in regard to over-stimulation, transitions, and social interactions (Papolos & Papolos). By developing a collaborative working relationship with parents and teachers, counselors may be able to work with the classroom teacher to make accommodations for the child with bipolar disorder. Counselors may need to provide rationales for teachers for them to make necessary accommodations in their classrooms (explaining about internal and external factors that influence the student’s behavior). For example, children who become overstimulated may require a place to calm down when their moods are variable. It is recommended that the child be given the opportunity to choose the times when he or she would prefer to work alone, or the child and teacher may develop a signal for use when either of them recognizes that difficulties may occur. Children who have difficulty making transitions may benefit from the use of a written plan for the day so they are aware of the transitions in advance. Children who have difficulty with social interactions may benefit from practicing skills such as staying calm in the midst of frustration, collaborative problem solving, and seeing situations from alternative viewpoints (Greene). Personal safety and the safety of others is always an issue. Collaboration with administration, teachers, and parents is necessary to determine where a child will be taken if he or she is in a rage. Removing the child from the classroom or playground and into a space that is safe may be necessary. Some children respond well to being physically restrained by an individual trained in child restraints, whereas other children become more panicky. A child who is raging likely will not respond to verbal intervention by adults, and that child requires space and time to regain control and calm down (Papolos & Papolos). It is highly recommended to have a space reserved for children who may experience rages at school, such as a room with no stimulation and no access to materials that may become weapons (Greene; Papolos & Papolos).

It is difficult to know how seriously to take a child’s threat of suicide (Papolos & Papolos). It is a myth that individuals who threaten suicide never actually go through with it, so any threat of suicide from a child of any age needs to be taken seriously. Suicide is often an impulsive act and may be triggered by a variety of events (e.g., relationship problems, difficulty with schoolwork, hurt feelings), so children who threaten suicide need to be closely monitored. By developing a broad base of knowledge of bipolar disorder in children, the counselor may act as a consultant or resource person for parents, teachers, and school personnel. Knowing the signs and symptoms associated with early-onset bipolar disorder would lead to appropriate referrals, assessment, and treatment. As a result, collaborative programming may ensue for children with academic, behavioral, and/or social problems associated with early-onset bipolar disorder.

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Personal Reflection Exercise #9
The preceding section contained information about school-based interventions for bipolar children.  Write three case study examples regarding how you might use the content of this section in your practice.

QUESTION 23
What is one technique that Greene suggests for reducing behavioral difficulties and conflict? Record the letter of the correct answer the Answer Booklet.