Monday, November 24, 2014
Bipolar Disorder (Children and Adolescents)
Educating Children with Bipolar Disorder
My 16 yr. old daughter had been mainstream and doing very well until she developed tardive distonia and had her Risperdal discontinued. She is now limited to Lamictal.
Due to total school refusal, we have sent her to Hyde School-Woodstock, however, she seems to be getting more angry and agitated, particularly with the punitive nature of school policy. Any advice?
Hello and thank you for your excellent question. Sounds like a difficult situation for all.
My first piece of advice is to talk with your prescribing physician regarding either a lower dose of Risperdal, which may not cause tardive dystonia. or an alternative to Risperdal (e.g., Depakote, Ability, Lithium, Seroquel etc.).
Regarding her school placement, although I haven't heard about Hyde-School Woodstock, my first thought is how well are the school personnel trained in educating teens with bipolar disorder? Most schools do not have this background. I'd suggest looking at the education section of the Child and Bipolar Foundation website, which has numerous resources for educating children-teens with bipolar disorder. (See link below.)
Second, as a psychologist I'd be very interested in learning more about the particular difficulties your daughter is currently having at this school and their specific triggers and trying to problem-solve those. Triggers can be academic, mood-related, situational, person-specific, sensory, medication induced and/or sleep/diet related.
Third, is the punishment system effective in reducing unwanted behaviors? If not, I'd suggest modifying it.
Fourth, is the punishment system balanced by a reward system that is effective (i.e., it increases desired behavior)?
Fifth, in addition to the "tool" of effective pharmacology, does your daughter have the necessary tools to manage her "unhelpful" moods, feelings, thoughts and behaviors, and are any of these unhelpful psychological phenomenon functional/meaningful to your daughter?
My last thought is if the primary reason for her refusing school in the first place as been identified and resolved; otherwise, her current school difficulties could also be related to that, too.
I hope my thoughts and questions lead to more solutions for you and your daughter.
Best wishes and take care.
Nicholas Lofthouse, PhD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University