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Section 12
Tensions regarding Children with Bipolar Disorder

CEU Question 12 | CE Test | Table of Contents | Bipolar
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed three non-medicinal treatments for depression.  These treatments included:  electroconvulsive therapy; light therapy; and repeated transcranial magnetic stimulation.

On this track, we will examine the three key aspects of stress on bipolar child clients. These three key aspcts are biological processes; social factors; and transitions.  We will also include three techniques to reduce these stresses, namely Acclimation, Point System and Transition Form.

3 Key Aspects of Stress

1.  Biological Processes
First, we will discuss the biological processes unique to bipolar clients.  As you know, the hypothalamus works with the limbic system in the genesis of emotion.  Together, they are involved in the control of hormone secretion and the regulation of the autonomic nervous system.  Researchers today have found that many of the clinical features of depression and mania as well as the physiological findings suggest some dysfunction in the limbic-hypothalamic circuit. 

One consistent finding is that the interval between sleep onset and the beginning of the first period of REM is shortened.  The hypothalamus also regulates the pituitary gland, which also activates the adrenal gland to release cortisol, inducing the stress response.  If this stress response is continually tripped for the wrong reason or if it cannot be turned off, it could be potentially damaging to the client.  Such dangers as unhealthy weight gain, heart disease, and hypertension can all be caused by excessive stress.

2. Social Factors
Secondly, we will discuss the way social factors affect the stress response.  Interestingly, social factors directly influence the intensity of the stress response.  When an infant is separated from its mother, his or her body responds by producing the stress inducing hormone cortisol.  However, the levels of cortisol can also correlate with the level of social support the infant has during separation. 

For instance, the most dramatic levels of cortisol occur when infants are completely isolated in a new environment.  However, separated infants who remain in familiar surroundings with other mothers and infants show minimal signs of distress and minimal increases in adrenocortical activity.  I have found that bipolar children with separation anxiety can buffer their fears if they have at least one or two figures of social support. 

Technique:  Acclimation
Carolyn was a young mother of nine year old Jacob.  Jacob had extreme separation anxiety and hated to be left with any new babysitter.  To help Carolyn with Jacob’s separation anxiety, I asked her to acclimate young Jacob to any new babysitter.  For instance, when Carolyn needed to hire a new babysitter, she asked the young girl over during weekends when Carolyn was still at home. 

While Carolyn was in the room, the babysitter would play with Jacob and until Jacob became used to her and even friendly.  Once this bond of friendship was established, I asked Carolyn to leave the room.  If Jacob began to show signs of stress, the babysitter would cope with him by distracting him with toys and by holding him in her lap.  This extra support during mild separation built to a level in which the babysitter could almost completely dissuade Jacob from his separation anxiety and Carolyn could leave him alone for a couple of hours.  Think of your "Jacob" who has separation anxiety.  Could he or she benefit from babysitter acclimation?

3. Transitions
Common stressors for bipolar children are the same for any child, but the reaction and intensity of the stress is much more severe for bipolar child clients.  For instance, one of the main stressors for any bipolar child client is a transition in any daily schedule or routine, such as a move or a new school.  These transitions will trigger the stress hormone and the client may fly into a rage or depression, depending on their reaction.  Often, in the first few sessions with a new client, he or she is going through a transition. 

Technique: The Point System
To help children in their early sessions, I use "The Point System" which has been reported to work in and out of therapy sessions.  For instance, Jacob was irritated and isolated his first few sessions.  To help him speak to me, I stated that he would receive points when he answered my questions.  When he reached five points, he would receive a prize

We kept score on a small chalkboard in my office and every time he reached five points, I let him pick out a toy to play with.  Sometimes, I would have candy on hand, but only when a manic episode was far from occurring.  The extra sugar may put an already jittery client over the edge into mania.  Think of your transitioning client.  Would he or she respond to "The Point System"?

Technique:  a 10 Category Transition Form
Because transitions also occur in the home, I suggest that parents of bipolar children fill out a "Transition Form" when any change to the current environment is imminent.  This form is meant to aid parents in monitoring their child’s moods and activities.  The transition form had several blank spaces with categories to fill.  These categories included the following:
1. Expected transition
2. Date transition will begin
3. Date transition will end
4. Beginning preparations date
5. Tactics:  (i.e. reading books about transition, talking about transition, work with child to design schedule for transition period)
6. Mood observations pretransition
7. Mood observations day before transition
8. Mood observations day of transition
9. Mood observations posttransition
10. Mood observations two weeks posttransition
These categories are specially designed to help parents monitor their children during transitions and their ensuing mood cycles.  Think of your transitioning clients.  Could his or her family benefit from the "Transition Form"?

On this track, we discussed three key aspects of stress on bipolar child clients, which were biological processes; social factors; and transitions. We also included three techniques to reduce these stresses, which were Acclimation, Point System and Transition Form.

On the next track, we will examine three difficulties bipolar children have in relating to other children.  These difficulties include impulsiveness; defiant attitudes; and disempowerment.

Peer-Reviewed Journal Article References:
 Boyers, G. B., & Simpson Rowe, L. (2018). Social support and relationship satisfaction in bipolar disorder. Journal of Family Psychology, 32(4), 538–543.

Goldberg, S. G. (2019). Narratives of bipolar disorder: Tensions in definitional thresholds. The Humanistic Psychologist, 47(4), 359–380.

Greenberg, J., Hilton, E. C., Li, J. J., Lu, Q., & Mailick, M. R. (2021). The impact of parenting a child with serious mental illness: Accounting for the parent’s genetic vulnerability to mental illness. Journal of Family Psychology, 35(3), 417–422.

Hardin, T. (2010). Review of Treatment of bipolar disorder in children and adolescents [Review of the book Treatment of bipolar disorder in children and adolescents, by B. Geller & M. P. DelBello, Eds.]. Psychiatric Rehabilitation Journal, 33(4), 335–336.

Online Continuing Education QUESTION 12
What are three key aspects of stress on bipolar child clients? To select and enter your answer go to CE Test


CE Test for this course | Bipolar
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