Sensory Implications for Bi-Polar Disorder

While Autism is very much in the current spotlight, the rate of children being diagnosed with Bi-Polar Disorder is even higher.

According to the National Institute of Mental Health over 1.5 million children under the age of 15 are severely depressed. And one major study (Child and Adolescent Bipolar Foundation) states that nearly half of those children who exhibit depression before puberty will be diagnosed with Bi-Polar Disorder before they are 20 years of age. Another study projects that there are at least 1 million children who are suffering with this condition who are “uncounted”. Symptoms can emerge at any time in the life cycle, cases have even been diagnosed in preschoolers.

Unfortunately, according to Dr. Terrence Ketter, director of the bipolar disorder clinic at Stanford University, “at least half of the people that have this disorder do not get treated”. Getting it treated early on is essential. Dr. Demitri Papolos, research director of the Juvenile Bipolar foundation says that the disorder grows “like a tumor” and that heaping the torment of this disorder on an adult is “bad enough, but loading it on a child it is tragic”.

The cause of the rise in the diagnosis of this disorder appears to be related to stresses in school and at home. The Centers for Disease Control note a 20% increase in (presumed bi-polar-related) suicides in children over the past ten years.

A child with one bipolar parent has a 10%-30% chance of becoming bipolar, and if both parents are bipolar the odds reach 75%. In the general population, 90% of all those diagnosed with bipolar disorder have at least one close relative with a mood disorder.

Treatment in the past has often been by trial and error. Protocols include drug regimens, lifestyle changes, individual and family therapy. Occupational therapists can play a major role in helping families with the necessary lifestyle changes as well as helping the child develop behaviors that allow them to gain some measure of self-control. OT’s can also help with parenting techniques and helping families develop routines that can help the bipolar child relate more successfully with unaffected siblings.

Learning to balance sleep, meals, play as well as school demands is extremely important for not only these children but also the whole family. The child can be taught to seek out their siblings and to use them as a sounding board, “trusted eyes and ears” for when their perceptions become distorted.

Often these children are also diagnosed with ADHD, and the very nature of the affects of bipolar disorder creates sensory distortions and unstable sensory processing abilities.
With the above in mind the occupational therapist can help provide assistance by:

1. Helping to create fixed family schedules for bedtime, wake-up times, meals, etc., as well as helping families understand that “drug holidays” are both dangerous to the child as well negatively impacting therapy progress.
2. Providing avenues for families to discuss, on a regular basis, problems within the home and at school to help resolve issues before they reach the crisis stage.
3. Helping the family to find ways to reduce family and inter-sibling/parent bickering.
4. Education for the family about the behaviors associated with the disorder.
5. Participating with the psychologist in family therapy meetings.
6. Increasing transitional tolerance when unexpected changes in routines occur by role-playing and other techniques.
7. Providing evidence of successful completion of specific task demand situations and activities. (ADL’s, etc.)
8. Provide routines that promote self-monitoring, behavior training, and daily structure that helps the child organize and monitor their behavioral reactions.
9. Increasing gross and sensory motor proficiency in novel (supported) situations (such as the S.H.I.N.E. Sensory Program © (Socialization, Hiking, Integrative, Neuro-muscular Experience© part of Children’s Special Services, LLC)
10. Supporting the parents and helping them understand that they can be active participants in the therapy programs, but most of all, as one parent put it, “..at least now I know I am not a bad mother”.
11. Administer assessments that can realistically help set goals for self-care and community and academic situations.
12. Increase self-esteem through relaxation and other techniques that reduce feelings of helplessness and inadequacy. These can include but are not be limited to:

• •  breathing techniques
• •  visualizations
• •  journaling about moods; thoughts, ideas and feelings
• •  utilizing structured and unstructured activities such as crafts, cooking, music, and drawing, to express moods constructively.
• •  preventing further impairment through or loss of function through related activity based interventions.

While recent pharmacological advances have greatly increased the management of this disorder, OT’s working as a team member in conjunction with the physician can greatly contribute, by providing tangible task/activity/function-based successes, creating hope for the possibility of a normal life.

Susan N. Schriber Orloff, OTR/L, is the author of the book Learning RE-Enabled, a guide for parents, teachers, and therapists (and a National Education Association featured book), and the Handwriting on the Wall Program. Children’s Special Services, LLC is the exclusive provider of P.O.P.tm Personal Options and Preferences, tm social skills programs. She was the 2006 Georgia OT of the Year and the CEO/executive director of Children’s Special Services, LLC, which provides occupational therapy services for children with developmental and learning delays in Atlanta. She can be reached through her Web site at www.childrens-services.com or at sorloffotr@aol.com.