On the last track, we discussed three self-destructive behaviors commonly practiced by bipolar child clients, which were eating disorders; self-mutilation; and substance abuse.
I have found that triggers can differ from child to child. Often, a bipolar child might be more sensitive to a trigger than normal or he or she might be subject to kindling, which we will discuss later in this track. Sometimes, a mood may augment a trigger’s effect or a trigger might augment a mood swing’s effect.
On this track, we will examine the effects of two triggers on bipolar children. These triggers are kindling; and seasonal affective disorder. Also, we will include three techniques on how to predict these triggers, which are by developing a "Trauma History", a "Trigger List", and also tactics for when a trigger occurs.
2 BPD Triggers
The first trigger topic we will discuss is kindling. As you know, kindling occurs when a trigger has such an effect on a client that they become much more vulnerable later in their life. This is especially the case in children with early onset bipolar disorder. Because their condition has already made them so sensitive in their early life, they are more susceptible to experiencing a traumatizing trigger.
Case Study: Caddy's Kindling
Caddy, a 7 year old bipolar client, was exposed to kindling early in her life. When she was five, a dog had growled at her. Although she was in no danger and her mother had been quick to save Caddy from this perilous situation, the stress caused by this encounter was so great that it remained imprinted on her mind. After the incident, Caddy became depressed, napping for hours a day. When she became manic, she would have frequent night terrors of dogs attacking her which greatly increased her stress. In the short span of two years, Caddy’s kindling had so taken root that even something as simple as a broken toy would throw her into depression.
Technique: Trauma History
Do you have a bipolar child client that seems oversensitive to triggers? In such cases, I recommend talking to his or her parents and getting a "Trauma History". I ask the parents of the bipolar client to write down any time in the child’s past in which he or she was exposed to a frightening, angering, or depressing situation. Most importantly, I ask the parents to detail the reaction of the child after the incident.
Caddy’s father Carl explained, "Well, the dog was a large one and so of course she probably felt vulnerable just because of that. But when he growled at her, she went into a fit. After that, she slept most of the day, I guess that’s when she was in her depressed stage. When she became hyper, she grew attached to me and wouldn’t let me go. Again, I think this was a result of the dog incident." As you can see, the early trauma Caddy experienced also increased her separation anxiety. Think of your Caddy. Do you think asking his or her parents for a Trauma History could shed some light onto an oversensitive client?
2. Seasonal Affective Disorder
The second trigger topic we will discuss is seasonal affective disorder or SAD. As you know, SAD can affect even a mentally stable person, but I have found that bipolar children are much more sensitive to this disorder. During the winter months, with a decrease in light and temperature, the bipolar child client will be susceptible to depression whereas in spring and summer comes the mania.
Caddy, in addition to being a victim of kindling, was also subject to SAD. Carla, her mother, stated, "During the months of May to August, she just won’t slow down. She has so many more nightmares during those months, too. Every once in a while, a low mood will set in, but it doesn’t last for nearly as long as a manic mood. But when it starts to get colder, she can’t play outside, she sleeps for long periods. I can’t get her to do anything, even watch her favorite TV shows or listen to her favorite music. When we try to play games, she doesn’t even look like she’s having fun."
Caddy, as you can see, is an extreme case. Because of her early kindling, her triggers were unpredictable and erratic. Other clients, however, may have very predictable triggers.
Grant was a 9-year-old client who had early onset bipolar disorder. When he first was referred to me, his mother Carol asked me, "What sets him off? Once it was a balloon popping. Another time, he missed the stupid purple dinosaur show. His LEGO did not do what he wanted it to do. I wouldn’t get him French fries."
Although Carol could not see what set her son off, it was fairly clear to me that Grant had specific triggers. What I explained to Carol was that these triggers were not specific incidents but situations that incited common emotions in Grant. All the incidences that Carol related to me all induced a feeling of disempowerment in Grant.
Technique: Trigger List
If he does not feel in control of his environment, he becomes frightened and his body reacts in a rage. However, I told Carol that every child needs boundaries and there was no reason to adhere to his every whim. In fact, that might make his situation later on in life worse. I asked Carol to compile a "Trigger List". Her list included: "A teacher saying "no"; he couldn’t get a second helping of ice cream; I wouldn’t let him watch another hour of TV; it was raining so he couldn’t go outside."
Do you see the connection? Unfortunately, there is no way to prevent many of these triggers. However, with medications and a sense of preparedness, Grant and Carol could be ready for another tantrum.
Technique: Survival Tactics
In addition to kindling and seasonal affective disorder, we will now present tactics for when a trigger occurs. There is no reasoning with a child when they are in a depressive or manic state. However, there are a few tactics that can help a parent reduce the intensity of an episode. I gave Carol a list of these tactics which included the following:
1. Let the child define his or her own mood. What a parent perceives as sadness in a child might be expressed as "indecisiveness" or just plain "feeling bad". Letting him or her know that you are interested in what he or she is feeling will give them a sense of understanding.
Learn your child’s code words and actions. This will help you interpret and communicate the mood cycles to therapists and psychiatrists.
3. Anticipate triggers when you can. Plan to deal with them before they happen. If you know that something is likely to trigger your child (i.e. time of day, candy at the checkout counter of the supermarket), schedule the shopping trip for another time or find a way to bypass the counter with the candy.
Don’t let your child’s mood... trigger an automatic reaction in yourself. Wait until you know what you are dealing with before you act.
Obviously, there is no way to prevent a tantrum from occurring, but with the help of the Trigger List, parents like Carol can be prepared for a mood swing when it occurs. Think of the parents of your early onset bipolar disorder client. Could they use helpful tactics like these to reduce the intensity of a mood swing?
On this track, we discussed effects of two triggers on bipolar children. These triggers were kindling and seasonal affective disorder. Also, we included three techniques on how to predict these triggers, which were by developing a "Trauma History", a "Trigger List", and also some "Tactics for when a trigger occurs."
On the next track, we will examine steps to cope with a raging bipolar child client, which are Creating a safe environment; disengaging the child; knowing your comfort zone; and rechanneling. We will also include techniques parents can use when their child begins to rage at home.
Online Continuing Education QUESTION 6
What are two effects of triggers on bipolar children?
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