My Child Has Bipolar Disorder!

 I write to parents because words have power.  They are imbued with a magic that can weave a splendid future for your child. But, only if the words are true and you listen to them.  My words today tell of the little we know of the neuropsychology of bipolar disorder.  I communicate with you about this disorder so that in hearing your might better understand your child’s unique challenges, and in understanding you might be able to better support them in their life’s journey.

 

What is Bipolar Disorder?

 

Bipolar disorder in children has received increased attention from the scientific community and general public over the last ten years.  Still, it is often misdiagnosed and little understood by the first line of defense:  pediatricians.   Sometimes children’s depressive episodes are not taken seriously and are considered a simple phase.  Alternatively, their euphoric moods are written off as childish elation, and the patterns over time are missed. That is what parents must look for. Their eyes must scan the years and see whether there is a pattern of episodes of mania and depression.  By mania I refer to a period of elevated mood where a child is unrealistically happier than the circumstances demand or a period of excessive irritability that is disproportionate to the event triggering the temper tantrum or rage.

 

When you are looking for a pattern of altered mood you need to be looking for multiple incidents of mania (about four) where your child evidences inflated self-esteem believing they are smarter or stronger than others when they are not, grandiosity or belief that they are able to do unrealistic things, decreased need for sleep popping up energetic after three or four hours, speaking loudly and rapidly or non-stop, reporting that their thoughts are going nonstop, and increased distractibility.  You may even see increased psychomotor activity that isn’t recognized as a symptom. For instance, my own daughter will suddenly begin emptying out her closets and reorganizing things in the middle of the night when she can’t sleep and has too much energy, alternatively, she may just pick up a mop and start cleaning the floors.  Some children will evidence excessive interest in dangerous activities.

 

Depressed mood may be apparent in terms of feelings of sadness that don’t appear to be related to anything going on in your child’s life.  Or, it may be manifest as irritability or decreased pleasure from activities your child normally enjoys.   There may also be an increased need for sleep, insomnia,  a change in appetite, restlessness,  or slowed movement, fatigue, excessive worry or feelings of guilt, impaired concentration, and thoughts of worthlessness, death or suicide. 

 

What Symptoms Should I Be Aware Of?

 

One of the problems with early onset or childhood Bipolar Disorder is that it is often mistaken for ADHD.  But, this is a disorder with broader impairments than ADHD.  Here are some of the characteristics you want to be aware of:

 

Very Common

 ·         Separation Anxiety

 ·         Rages & Explosive Temper Tantrums (lasting up to several hours)

 ·         Marked Irritability

 ·         Oppositional Behavior

 ·         Frequent Mood Swings

 ·         Distractibility

 ·         Hyperactivity

 ·         Impulsivity

 ·         Restlessness/ Fidgetiness

 ·         Silliness, Goofiness, Giddiness

 ·         Racing Thoughts

 ·         Aggressive Behavior

 ·         Grandiosity

 ·         Carbohydrate Cravings

 ·         Risk-Taking Behaviors

 ·         Depressed Mood

 ·         Lethargy

 ·         Low Self-Esteem

 ·         Difficulty Getting Up in the Morning

 ·         Social Anxiety

 ·         Oversensitivity to Emotional or Environmental Triggers

          

 Common

 

 ·         Bed-Wetting (especially in boys)

 ·         Night Terrors

 ·         Rapid or Pressured Speech

 ·         Obsessional Behavior

 ·         Excessive Daydreaming

 ·         Compulsive Behavior

 ·         Motor & Vocal Tics

 ·         Learning Disabilities

 ·         Poor Short-Term Memory

 ·         Lack of Organization

 ·         Fascination with Gore or Morbid Topics

 ·         Hypersexuality

 ·         Manipulative Behavior

 ·         Bossiness

 ·         Lying

 ·         Suicidal Thoughts

 ·         Destruction of Property

 ·         Paranoia

 ·         Hallucinations & Delusions

 Less Common

 ·         Migraine Headaches

 ·         Bingeing

 ·         Self-Mutilating Behaviors

 ·         Cruelty to Animals

 

 

My child has many of these symptoms, but not all the time

 Symptoms will wax and wane, alternating from one pattern to another.  The hallmark, however, is that it seems as if your child’s speedometer appears to be broken. The cruise control may be set at 55, but sometimes your child crawls along at 15 miles an hour and other times he speeds along at 110 miles per hour.  When things get really child, your child can become paranoid (believing someone is after him), or delusional (thinking a flood was his fault) or experience hallucinations (hearing or seeing things that aren’t really there in the external world).  These severe symptoms usually disappear when the mood improves.  Unlike adults, however, children can exhibit both manic and depressive symptoms simultaneously or within the same day.  This is one of the characteristics that may it hard for pediatricians to identify. You may have a child talking about killing himself in the morning, who is completely chipper by the time you get a 3pm pediatrician’s appointment.

 So, is your child thinking clearly during either the manic or depressive episodes?  Neuropsychology tells us the answer is a definitive: no!  During the depressive stage there are deficits in cognitive functioning, motor, perception and communication. Your child experiences both memory and executive function difficulties, that is problems recalling things both recent information and things that have been stored in long term memory, as well as problems reasoning about things.  While in the manic stage, other deficits are present.   Visual pattern and spatial memory functions are impaired during this time. There is also evidence of over inclusive and idiosyncratic memories with difficulty filtering environmental stimuli and over generalization (which in turn leads to over reactions). Basically, there seem to be some form of dysexecutive syndrome occurring where during a manic state social behavior and decision making is impaired. 

 While your child will appear to improve and relapse, research is showing that even in the euthymic (apparently normal stage) there are residual neuropsychological deficits.  These include continued psychological and social difficulties associated with continuing deficits in executive functions, attention and visual processing.

 

Life-long Illness requires life-long skills

 

Being a parent of a child with bipolar disorder, I realize that the main thing a parent wants to take away from an article about bipolar disorder in children is how to help them cope.  First and foremost, I am saddened to share that there is no cure, no medication that will correct the neuropsychological dysfunction our children must deal with.  Nor, is there any medication specifically targeted to address bipolar disorder.  At the current stage of medicine, Bipolar Disorder is a chronic life-long illness that needs to be approached from that perspective. 

 Whenever a child suffers from a chronic illness, we need to treat them as normally as possible. This means being matter of fact about the illness when discussing it with the child.  It also means maintaining as much as we can normal age-appropriate expectations for school and home responsibilities.  You have to be careful not to permit the illness to take over your child or your marriage.  Teach your child about their illness and educate them about ways to help modulate their own moods.  For instance, you may teach your child to turn on their own depression light daily when they are experiencing feelings of sadness or irritability. Likewise, you may encourage them to play a selection of their favorite upbeat music during these periods, and to excuse themselves from activities with friends when they feel irritable.  You might also teach your child to use transcranial electrotherapy each morning to help minimize potential mood swings. During manic phases, you might want to help your child direct excess energy in constructive directions – housecleaning, bike riding, jumping on a trampoline.  I encourage children to make their own “stress kits” that they fill with things they find soothing when they are irritable. For my own child this includes some of her favorite music, certain Game Boy games, oils with favored scents, particularly soft and cuddly stuffed animals, pieces of soft material, bubbles and a journal.  She also keeps an iPod and a noise cancelling headset available for when she finds herself oversensitive to sounds.  Your child will know what to include in their own kit. We keep a kit handy in my daughter’s bedroom and a portable one in the car, so she can access it easily whenever she feels a need.  This gives her a sense of control and helps avoid mood swings from going too far in one direction before the pendulum begins to swing back. 

 Another key issue is teaching your child to self-advocate in positive ways. For example, my daughter had a tremendous difficulty all year dealing with a classmate who for her own reasons talked nonstop and followed my daughter around. To my child, this was over-stimulating and could easily trigger an over-reaction.  When she started saying she hated going to school because of this child, we discussed how she could handle the situation, and agreed that she would tell this child:  “I feel like I need some private time now” and if the child didn’t give her personal space, she would then go to the teacher and repeat:  “I need some private time now, can you ask Andrea to leave me be”.  This worked well in avoiding arguments and outbursts.   The situation you and your child need to role play will be unique to your child.  But, doing so following a single incident of difficulty can add to your child’s repertoire of automatic adaptive responses when the situation reoccurs and your child is not thinking clearly.

 Therapeutic Parenting

 These parenting techniques can help your child deal with their disorder when symptomatic and assist in preventing and containing instances of relapse.  

 1.     Help your child build on strengths.  Encourage and embellish upon whatever your child has a passion for and can do with some facility. This will legitimately increase self-confidence and help modulate the negative feelings that come along with a depressive mood. 

 2.     Teach game-playing skills that emphasis deductive and inductive reasoning; that is reasoning from the part to the whole and from the whole to the part. The habit of playing old fashion family games – Scrabble, Chess, Checker, Monopoly, Cribbage, Mancala – not only builds cognitive skills, but they also help to keep your child engaged during depressive episodes.

 3.     Encourage non competitive sports. Sports are critical during the manic stage because they provide a constructive outlet for tension and energy, but they need to be non competitive – i.e., gymnastics, swimming, karate, tai chi – in order to minimize self-recrimination when your child has a downward mood swing.

 4.     Because of their irritability and mood swings it is hard for other children to maintain friendship with your Bipolar Child. To help counter this trend of withdrawing from your child, directly and consistently instruct your child in friendship skills.  When friends have birthdays, gather supplies and have your child make a card and perhaps a cake.  Plan play dates and agree with your child on a range of specific activities to engage in with friends before their arrival; so that your child will feel more in control and less likely to abruptly switch moods.  When you hear your child being bossy or dominating. Step in and model the correct way to make requests. When you child is being critical, suggest a way to give a legitimate compliment.  For instance, if your child criticizes a peer for not wanting to jump on the trampoline and say something like “You’re gonna get fat because you never want to do anything.”  You might say:  “You’re right exercise keeps us healthy, but I notice that Carolyn does like to swim since we haven’t a pool, perhaps you too could run through the sprinkler”.  This type of constant verbal mediation is critical to helping your child maintain perspective and avoid swinging further to the extreme of a mood.

 5.     Children with Bipolar disorder also benefit from a predictable routine. They need to know what is coming in order to prepare for it.  But, they also need flexibility built into their lives to accommodate their mood swings.  For instance, I require that my daughter go to Sylvan Learning Center or summer, so she maintains the routine of getting up, having breakfast, getting dressed and heading off to an educational setting.    This summer, however, she has been in a depressed mood and requiring more than the usual amount of sleep. Therefore, at her request,  we agreed that she’d attend Sylvan from 11 till 2 rather than 9 to 12 so she could have more sleep This greatly improved her mood. Still, because Sylvan was focusing on the area of her greatest weakness (writing), she found five days a week too stressful and had trouble holding back her melt downs into bouts of crying. Again, at her initiation, we agreed that she would only attend three days a week so that she had a day off in between each session to build up her reserves for dealing with a very difficult skill.  So, routine needs to be tempered with flexibility. Some of you might be asking, what happens when schools in session. Well, we apply the same principles.  Clothes are set out the night before, lunch packed, and book bag prepared and put in the car, and she begins the day with transcranial electrotherapy. Some days when all of that is not enough, she goes to school late and has to own the responsibility to negotiate with her teacher when and how she will make up the missed work.  The same holds true if she feels compelled to take a day off. Since she is responsible to negotiate when and how to make up the work, though, she seldom takes a day off unless she is truly at her limit.

 6.     Teach your child relaxation techniques such as progressive muscle relaxation and deep breathing and practice these with your child on a regular basis to help maintain mood stability.

 7.     Prioritize your battles, let go of less important matters so there are fewer situations that are likely to push your child either into mania or depression.

 8.     Reduce the overall level of stress in your home.  This may even include arranging for all homework and projects to be completed at school after school so that the stress is not brought home.  It also means consistently employing good communication and listening skills. 

 9.     Help your child anticipate and avoid stressful situations. For instance, my daughter was reluctant to attend her school’s end of the year pool party because she knew certain boys would tease her about her figure.  We discussed this and agreed in advance that she’d wear shorts, but, not a bathing suit and engage in other activities besides swimming. She went, and enjoyed the party that she otherwise would have completely avoided.

 10.                        Remove from your home objects that your child could use to hurt themselves or others during a rage; especially guns and knives.

 11.                         Involve your child with animals in a positive way. Animals can help soothe children and help maintain their emotional stability. Towards this end therapeutic horseback riding or dolphin therapy, or canine therapy can be very beneficial.  You might even consider getting a trained therapy dog as a full-time companion for your child.

 Therapeutic Interventions

 Given the cognitive deficits your child may have, you might also want to consider pursuing cognitive rehabilitation for your child in order to remediate or at least mitigate some of these symptoms. To do this, you can either contact a good neuropsychologist for Neuroremediation (cognitive rehabilitation) or you can consider doing the cognitive training at home.  In this case you may want to consider Captains Log or SoundSmart.  Captain’s Log.    This program offers over 2000 hours of cognitive training and is a researched based intervention to improve brain functioning.  Just as research shows that regular exercise boosts physical fitness, so cognitive exercise books mental fitness.  Captain’s Log includes 40 different program that stimulate the areas of the brain that are responsible for learning abilities such as listening skills, self control, reasoning, hand-eye coordination, listening skills and memory. This computerized cognitive rehabilitation program includes lively graphics, instant feedback and exciting, entertaining tasks to motivate children while they learn.  I used this program in my practice working with patients with TBI and ADHD and learning disorders for 20 years, and highly recommend it.  Parents can lease this program through www.Able2learn@clubspaces.com for $495.00 per year and work with their children at home to develop these skills at their own pace.

 

For children with auditory processing problem, you may want to look into SoundSmart... This program consists of three modules:  This program was designed by a clinical psychologist in collaboration with a psychiatrist to improve listening skills, following directions, phonemic awareness, working memory, mental processing speed and impulse control. These are all crucial skills for progressing academically. The auditory attention coach that progresses from beginner through intermediate to advanced levels with spoken instructions becoming increasingly complex.  Math and Memory Coach which works to improve memory by learning to do math in one’s head, and covers elementary school math curriculum from K through 4, thought it has training all the way to the adult level; and Sound Discrimination Coach which  provides challenging phonemic awareness drills to train the player to listen well under all types of conditions.  If you are interested in trying this program out, email me at able2learn@live.com and I can send you a demo disk for a home trail for $25.00.

 

"I highly recommend this software as an auditory cognitive training tool."
-Dr. Muriel Prince Warren

 

 If our child’s problems lie in the area of visual processing, then you may want to explore SmartDriver Visual Attention Builder. This is a stimulating and entertaining, non violent driving game.  It builds both cognitive skills and self-esteem in individuals ages 5 through adult who have problems with visual processing, learning disabilities, Bipolar Disorder, TBI or ADHD.  It is a game situation where in order to win; you have to drive your car successfully through progressively more difficult roads and driving situations.  It plays like a video game while developing important skills.  For teenager approaching driving age, it may even serve as a good transition preparation tool.  For those who need it, you can even use it with the USB Steering Wheel with brake and accelerator pedals so they feel more like they are really driving.  Meanwhile, they will be improving visual attention and perception, visual tracing and self-control as they progress through 90 progressive levels of difficulty; and you have automatic detailed record-keeping of their current level of performance. Since driving defensively is the only way to win the game, children develop the ability to anticipate problems and to connect cause and effect.  If you feel this might be a good fit for your child, I have a demo disks for $25 each that will permit you to try the program out.

 

If the attentional impairments associated with Bipolar Disorder are a significant handicap for your child, you may wish to also explore neurofeedback with a properly qualified biofeedback practitioner.  In this case, you can obtain appropriate referrals through the Biofeedback Certification Institute of America at bcia.org.  Alternatively, you may wish to pursue home feedback based attention training.  In this case, you may wish to look into  Play Attention is based on the work of Joel Lubar, Professor Emeritus Ph.D. from the University of Tennessee.  He found that training children to increase the fast brainwaves (beta) and decrease the slow brainwaves (theta) over the sensory motor cortex improved attention, concentration, impulse control and memory.  His system requires that a child work two to three times a week with a trained biofeedback technician certified in EEG biofeedback or neurofeedback.

 

Unique Logic has used this principal to develop an educational system that is designed to be used by parents or teachers in that it is simple to use and it focuses on improving specific skills that affect academic performance:  the ability to attend for longer periods of time, the ability to concentrate on a moving target – like a teacher walking around the room, the ability to initiate focus quickly and sustain it until a task is complete, the ability to remember both auditory or visual sequences long enough to copy them, and the ability to process information selectively so you ignore the irrelevant stuff and focus on the critical stuff.  Though this is based on the same principal as Joel Lubar’s work, with Play Attention the child’s experience is simply that they are controlling games by using their focus.  The helmet transmits your child’s brainwaves to the computer, which gives your child a concrete visual referent for improved attention through the various characters in the games they are playing.  It basically makes their attention tangible for them so they can learn to control it.

 

From my perspective, there are two primary benefits of this system.  First (according to the research) you get improvement that is equal to or better than improvement with medication in terms of success rate, but, with much greater longevity of benefit.  Research shows that those who take medication are no better off after three years than those who were never treated with medication, but, with attention training of this type, it is like riding a bicycle:  once you learn the skill, you can always use it.  Second, there are no medication side effects, no medication rebounds after school, and no worry about medication interactions.  Other benefits include the reduced cost of treatment versus a lifetime of medication; as well as the child’s improve ability to benefit from their program of general or special education.

 

For my clients, during the school year, the parent works two afternoons a week with the Play Attention (5 levels of 5 minutes each), and they consult with me once a month so we can make any necessary protocol adjustments as the child progresses, and so they can learn effective behavior shaping techniques to eliminate undesirable behaviors as their child’s capacity for self-control improves.

 

Personally, I really like to see this intervention done intensely over the summer. This avoid the problem of trying to fit it in around baseball, soccer, dance, church and everything else that goes on during the school year.  During the summer, I suggest that parents consider feedback based attention training first thing in the morning every morning. While it is true that after the honeymoon period of seeing that their mind can control the screen, children begin to show resistance; but the summer is a perfect time to deal with this because parents can easily use the Premack Principal.  “Before you do any fun activities, you have to do Play Attention.”  You simply have to make doing anything the child likes (TV, Computer, playing with friends) contingent completing Play Attention. Since this only takes 40 minutes from start to finish this can be done right after breakfast and then the rest of the day is free.  If you have a typical 10 week summer break, you can get 70 sessions done in one summer, and your child will almost be done with their feedback based attention training by the end of the summer.  In my practice, I often had children do the training 2x per day, once in the morning and once after lunch so they could complete the entire program over the summer and return to school ready to pay attention to their academics.

 

 

If you are interested in learning about this intervention, click on the link above to register for the free webinar.   In the meanwhile, if you’d like to request a free demonstration CD, please visit:  http://www.playattention.com/ABOUT-US/contact-us/?refid=drcrum

 

 

 If you sign up for the webinar or order the free CD, please drop me an email at able2learn@live.com, so I can follow up with you in a few days to answer any lingering questions, and send you an annotated bibliography on this type of biofeedback.

 

 

Another intervention that might be explored is transcranial electrotherapy as research is beginning to document a greater efficacy for depression than medication; and in my personal experience, my daughter has found this nonpharmacological intervention very helpful in modulating her moods.  We are not certain of the mechanism for transcranial therapy’s efficacy. It is believed that the Alpha-Stim microcurrent waveform activates particular groups of nerve cells that are located at the brainstem. These groups of nerve cells produce   serotonin and acetylcholine which  affect the  activity of nerve cells situated to control the activity of nerve pathways that run  into the brain from the spinal cord and back down into the spinal cord. As it alters the electrical and chemical activity of certain nerve cells in the brainstem, transcranial electrotherapy appears to modulate brain activity by amplifying  activity in some neurological systems, while decreasing  activity in others. This modulation appears to occur as a result of the production of alpha waves as measured on   Qeeg’s .  Alpha rhythms are associated with by feelings of calmness, relaxation and increased mental focus and decreased levels of stress, agitation and emotional Lability

 

 

Some patients experiences  effects can be produced after a single treatment, and repeated treatments have been shown to increase the relative strength and duration of these effects. In some cases, effects have been stable and permanent, suggesting that the electrical and chemical changes evoked by Alpha-Stim have led to a durable re-tuning back to normal function

 

Medication

 Now, you may be wondering why I haven’t spoken much about medication for children struggling with the challenges inherent in Bipolar Disorder.  The problem with the medications that are prescribed to manage bipolar disorder is that the trial and error phase to find a medication that “works” well for a child can take weeks or sometimes months.  More importantly, some children don’t respond to the medication at all and others experience distasteful side effects such as weight gain, rashes, sleepiness, fatigue or a flattening of emotion.  The fact is that the longer a person uses medication, the more risks there are in terms of toxic side effects upon sensitive organs such as a the liver or the kidneys.  Research; however is beginning to suggest that those with Bipolar Disorder can stabilize their moods through neurofeedback rather than medication. The advantage to this is that there are no negative side effects and gains are long-term.  Some children do not achieve a good level of mood stability with medication alone. In that case, neurofeedback can be an important adjunctive therapy.  Others don’t achieve complete stability with neurofeedback, in which case medication can supplement neurotherapy (but, perhaps with lower dosages than if used in isolation). In short, psychopharmacological and electrophysiological approaches to the treatment of mood and behavioral disorders are not intrinsically contradictory. Neurofeedback and transcranial electrotherapy are perhaps best viewed not as an alternative to conventional psychopharmacological agents, but rather as one component of a multimodal approach. When used as an adjunctive treatment in combination with standard medication, neurofeedback may improve certain clinical outcomes in some psychiatric patients.

 

 

A Cautionary Note on Antidepressants and Stimulants from the National Institute of Mental Health

 

Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat attention deficit hyperactivity disorder (ADHD) or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.

 From:
Child and Adolescent Bipolar Disorder:[NL]An Update from the National Institute of Mental Health

 

 

Emergency Intervention Plan

 

Parents also need to have an emergency intervention plan in case their children should engage in suicidal talk or gestures. Every significant adult in the child’s life should be informed that if this occurs, the child is to be immediately evaluated by a professional familiar with the symptoms and treatment of early-onset bipolar disorder. Do some investigation a head of time, know who you will bring your child to if the need arises, how to contact them and how to get to them.  Make certain that you find a board-certified child psychiatrist to diagnose and treat your child.  You need a doctor who:

 

 

  • is knowledgeable about mood disorders, has a solid current background in psychopharmacology, and stays up-to-date on the latest research in the field

     

  • recognizes that he or she does not have all the answers and welcomes information discovered by the parents

     

  • explains medical matters to you clearly, listens well, and returns phone calls promptly

     

  • offers to work closely with parents and values their input

     

  • has a good rapport with the child and makes your child feel heard and understood

     

  • understands how traumatic a hospitalization is for both child and parents, and keeps in touch with the family during this period  should it become necessary

     

  • advocates for the child with your insurer as needed  

     

  • Advocates for your child with the school to make sure the he or she receives services appropriate to the child's educational needs and mental health needs.

     

 

What about school and my Bipolar Child?

 

 

Bipolar Disorder is one of those invisible disorders (in contrast to a missing leg, or Down’ Syndrome) which schools are particularly inept at dealing with.  Staff routinely blames children with Bipolar disorder for their misbehavior because they consider their behaviors to be necessarily voluntary and intentional. This constant blame and negative feedback which may even escalate to time outs, in school suspension, out of school suspensions and expulsions, becomes another major stressor escalating your child’s symptoms.  Consequently it is critical to get an Individualized Education Plan and a Behavioral Intervention Plan with Positive Supports in place as soon as you have a confirmed diagnosis. You also need to have a medical contingency plan in place in case your child becomes a danger to themselves or others.  When looking at your child’s educational needs you may wish to consider:

 

 

  • preschool special education testing and services; including sensory integration training to help reduce your child’s hypersensitivity to environmental stimuli

     

  • Small class size (with children of similar intelligence) or preferably not a self-contained classroom with other emotionally fragile (and certainly not a class for children who are considered "behavior disorder") children for part or all of the day.  Placement in a private or parochial school may be beneficial if it provides consistency and small classes.

     

  • one-on-one or shared special education aide to assist child in class

     

  • a daily email communication to and from teachers to facilitate  communication

     

  • homework deadlines flexibility when energy is low

     

  • late start to school day if fatigued in morning

     

  • Recorded books as alternative to self-reading when concentration is low. requesting that text books be provided on tape and your child provided with a laptop computer that can read the books to your child will increase the likelihood of task completion

     

  • Designation of a "safe place" at school where child can retreat when overwhelmed.  This should not be a detention classroom. But, rather a place that is comforting. Perhaps the school garden or the library.

     

  • designation of a staff member to whom the child can go as needed

     

  • unlimited access to drinking water and the bathroom  so that these small issues do not trigger a mood swing

     

  • art therapy and music therapy top provide your child with a way to express the feelings they don’t understand and can’t put into words

     

  • extended time on tests

     

  • use of calculator for math

     

  • extra set of books on disks and laptop at home

     

  • use of keyboard or dictation for writing assignments along with specific training in touch typing so that this becomes an automatic skill

     

  • Periodic sessions with a social worker or school psychologist.  This might be only once a month during good periods, and twice a week during stressful periods.

     

  • Social skills groups and peer support groups which should be as non-medicalized as possible. In other words, Boy Scouts or Girl Scouts, 4H and church youth groups all give your child opportunities to learn from nondisabled peers or model appropriate social interaction skills

     

  • Annual in-service training for teachers by child's treatment professionals (sponsored by school). Make certain this is written into your child’s IEP.

     

  • enriched art, music, or other areas of particular strength

     

  • Curriculum that engages creativity and reduces boredom (for highly creative children). Programs such as those offered by Montessori schools or Waldorf schools may be appropriate

     

  • a provision in the IEP for home bound instruction whenever mood issues cause your child to be absent three or more consecutive days from school

     

  • Goals set each week with rewards for achievement that can be purchase through tokens that are earned on a variable ratio schedule during each school day.

     

  • summer services such as day camps and special education summer school

     

  • placement in a day hospital treatment program for periods of acute illness that can be managed without inpatient hospitalization

     

  • placement in a therapeutic day school during extended relapses or to provide a period of extra support after hospitalization and before returning to regular school

     

  • placement in a residential treatment center during extended periods of illness if a therapeutic day school near the family's home is not available or is unable to meet the child's needs

     

What do I do when the district wouldn’t work with us?

 

 

Bring your team: psychiatrist, pediatrician, neuropsychologist, friends, and family members to the IEP and advocate as a powerful pact.  If the issues aren’t resolved, ask for a second meeting and be certain to provide the agenda and your supporting evidence prior to the meeting. If this doesn’t work proceed immediately to mediation, and if this is fruitless go directly to due process. If due process fails, proceed to federal district court pro se.

 Meanwhile, if the educational complaint system is not generating positive results complain outside of the special education system at every corner.

 

 

1.     If your child is bullied, teased or harassed for his or her disability, file an OCR complaint. Contact the police and file charges against the perpetrators, if the police wouldn’t intervene, try the Sheriff’s Department or the State Troopers. Send the parents formal notice of intent to hold them responsible for any damages, pain or suffering your child sustains, and notify the principal in writing that since s/he is in loco parentis, and permitting this persistent and pervasive harassment to continue you will be pursuing monetary damages under ADA if they don’t rectify the situation immediately.

 

 

2.     If your child is denied homebound instruction call Child Protective Services and report the school district for educational neglect.  Be certain to provide the CPS worker copies of the relevant sections of IDEA

 

 

3.     If an IEP team member without a medical license disputes or overrides the diagnosis or medical recommendations from your psychiatrist or pediatrician, file with the Medical License Board against them for practicing medicine without a license.

 

 

4.     Get hold of the ethical standards for any OT’s, PT’s, SLT’s or Psychologists on the team.  Read them careful and then document any violations and file against their licenses/certifications.

 

 

5.     Use public records access to determine whether school district attorneys or consulting experts are in violation of the law because of receipt of employee benefits such as pension.  If so, contact the district attorney

 

 

6.     Investigate whether mediators or hearing officers have any relationship with school employees (check the payments they receive by accessing public records); and if so, file against them for ethical violations of their licensure.

 

 

7.     File with the teacher certification board for ethical violations when teachers fail to advocate for your child or fail to provide you accurate information about ADA, IDEA, or NCLB.

 

 

8.     Call Child Protective Services if your child is punished for a manifestation of their disability and ask Child Protective Services to protect your child from the offending individual in the school system.

 

 

9.     Send copies of tape recordings where staff lied along with copies of what the law actually says to local radio and TV stations.

 

 

10.                        If school attorneys provide you misinformation file against them with the bar association for practicing outside their field of specialty for which they should be appropriately trained since they knew or should have known the correct information and intentionally or out of ignorance provided you misinformation.

 

 

11.                        Write your senators and congressmen with specific issues.  Provide documentation and ask for them to take specific actions to protect your child.  If you don’t like their responses, copy them and send them to their opponents and ask how they can help you; and indicate that you and the other special needs parents in your district will only support representatives who actively intervene on the behalf of disabled children.

 

 

12.                        Don’t forget the Federal Department of Education!  Write, call, blog if they don’t respond.

 

 

What do I do if I believe my child is being abused by school personnel because of his disability?

 

Because of their irritability and tantrums, school staff may find it hard to deal with your child. This makes them potential victims for abuse.  Consequently, you need to know what to look for.  If your child comes home with cuts and bruises in unusual places, hard to believe stories about how accidents occurred at school, frequent or repeated injuries,  begins to evidence school phobia, call Child Protective Services and ask them to investigate the adults who routinely interact with your child in school.  Then, call for an IEP meeting and ask that:  each staff person working with your child receiving anger management and relaxation training because you feel there is cause to suspect that someone is over reacting to your child in a hostile fashion.  Then, spend quality time with your child each day. Listen to what they tell you and if they are expressing stress, take them to see a therapist who has experience dealing with abused children.  Whatever you do, don’t isolate yourself or your child. Don’t hide the problem, if anyone is being verbally or physically abusive to your child; let it be known so that action can be taken to protect your child.  Meanwhile, make certain that you, your spouse, your special needs coach, your neuropsychologist, your play therapist, your speech therapist, your occupational therapist, your parents and anyone else who knows and cares about your child either volunteers in their class or visits to conduct observations.  This way they can serve as a deterrent to abuse and gather information about who the culprit may be. Remember, school staff are suppose to teach your child how to behavior appropriately through modeling and administration of meaningful moderate consequences. They are not suppose to punish your child physical or emotionally. They are not suppose to embarrass your child, or to belittle your child.  They are not to instill unreasonable fear. Any of these things constitute abuse and require your immediate action.

 

 

Presented as a community service by :

 Susan L. Crum, B.S., M.S., Ph.D

 Special Needs Coach

 Able2Learn

 Email:  Able2learn@live.com

 Website:  www.specialeducationsupport.org