During manic episodes, children with bipolar disorder will feel anger and rage—and with greater intensity—rather than elation or euphoria that is common in adults. Bipolar in children combine the depressive and manic states together to form ‘aggressive depression.’ However, because they lack the emotional maturity to manage these outbursts, they require personalized help. Here’s a look into bipolar rage and the best strategies for parents and caregivers:
#1 What is rage in children with bipolar?
The nerve centers responsible for rage are located in the limbic system or “animal brain” that contains structures essential to our survival through the “fight or flight” response, explains George T. Lynn, MA, a Licensed Mental Health Counselor in Bellevue, Washington. “To the child in rage, it is a life and death struggle. As the limbic system flares on, adrenaline spikes, the child becomes stronger, and the thinking brain shuts down.”
#2 Know what you’re dealing with
These temper tantrums can turn into rages lasting for hours. Children with bipolar are often intentionally “dare-devilish” and tend to be risk-takers. In addition to severe anger episodes, irritability is common, especially when first waking up in the morning. Also, these kids don’t have a normally developed emotional regulation so they may be constantly anxious, irritable, have trouble sleeping, have fear issues and are are rarely in a calm state.
#3 Understand the disease
“Children with bipolar-like problems with rage and violence do have personal boundaries,” believes Lynn, who has pioneered the use of psychotherapy for adults and children with neuropsychological issues such as bipolar disorder. “Many children with bipolar challenges punch holes in walls, but few will put their fists through a window. This behavior suggests that these children are able to control themselves somewhat. But given the limitations they possess in terms of ability to see the big picture, to form valid conclusions about it, and to manage their own stress and mood swing, it takes enormous strength to exercise this control.”
#4 How to view the behavior…
Think of it as reacting to a child with diabetes and is in a state of high blood sugar level. You would accept that his off-behavior agitation or temper is due to something medical and you would treat it with medication or food. It’s important to remember that because your child has a brain disorder, it is the chemistry of their brain that drives their rage. That doesn’t preclude setting boundaries, but it’s an important distinction to make, especially when there are other children in the household without bipolar symptoms and require different parenting techniques.
#5 Get proper medication
Rage in children who have bipolar is actually closer to a seizure than an emotional event and in fact the National Institute of Mental Health is studying whether bipolar and seizure disorders are directly related. In the meantime, this anger and other symptoms of the disorder are usually effectively treated with anti-seizure medication, or mood stabilizers. Medication can balance brain chemicals that control emotions and stabilize the child.
#6 Monitor meds and chart the moods
Mood-stabilizing medications can restore the brain to a more normal level, reducing the likelihood of chemicals flooding to cause the anger and fury. However, sometimes it takes some trial and error to find the precise dosage for success in stabilizing the child. In order to properly communicate the effects of the meds to your child’s health professional, it’s important to keep an accurate and detailed mood and behavioral chart so you can monitor the effects.
#7 Seek family-focused therapy
Family-focused therapy and individual psychotherapy tailored for children can also help bipolar children control feelings of rage. “These therapies help bipolar children tolerate frustration and express angry thoughts and feelings in ways that are less disruptive and destructive,” says David Fassler, MD, clinical professor of psychiatry at the University of Vermont College of Medicine. Additionally, family therapy sessions teach parents how to implement techniques at home that can reinforce positive behavior and reduce the frequency of these angry outbursts.
#8 Control stress
Anger in children with bipolar is often triggered by stress. “It’s known that bipolar children and teens have more rapid mood changes than adults with bipolar disorder,” says Fassler. These mood changes often manifest themselves as anger episodes. It’s extremely beneficial for parents to first control stress in themselves and this will naturally transfer to their children. Better yet, have your child participate in your own mindfulness strategies together, such as yoga and meditation.
#9 Instill and enforce boundaries
It’s essential for parents to establish the most appropriate boundaries and consequences for these children and then stick to it. By letting the kids run the house or manipulate them, because at times, it’s just easier to give in, is actually doing these kids a disservice as future adults, explains Lynn. Children with bipolar will benefit from strong, but loving parents who don’t let the child spin free because there are no consistent consequences.
#10 Consequences, not punishment
Punishment of a furious child with bipolar is more delicate. They should certainly be taught, while in a calm state, there are specific consequences for certain behavior. Talk with your child about rules that cannot be broken regardless of their brain illness i.e. it is unacceptable behavior to harm others or destroy property. Explain what the consequence will be so he knows prior to any meltdown what will happen. Remember to wait until your child is stable and calm before delivering the consequence.
#11 Reinforce positive behaviors
“Parents help the child to the degree that they reward even little gestures of moderation and reasonable behavior,” Lynn writes in his book: ‘Survival Strategies for Parenting Children with Bipolar Disorder.’ “They help her develop character strength when they note and affirm every time she is able to put boundaries around her own wild emotional reaction. And they stick to their consequences. They require her to repair the wall and compliment her for doing a good job for it.”
#12 Check your emotions
It’s crucial to master techniques to manage your own stress first. Children with bipolar are sensitive to the emotions of others around them, especially stress, so it’s important to practice stress management. If you are stressed and you are irritable and frustrated, you will make things worse. Also, remember that timing is everything; it’s important to wait until your child is calm before dealing with the consequences of the negative behavior.
#13 Don’t argue back
Arguing or even trying to reason with a child when he is unstable or during a manic phase is pointless and will likely end up causing further frustration for both sides. Lynn describes this mindset: “Children with bipolar disorder seem incapable of seeing the other’s perspective in a situation. They will argue incessantly or deliberately twist an argument to justify their position on any issue.”
#14 Listen with your heart and your head
Lynn writes that your best bet is to get on problems early, keep your cool, and take your child’s bipolar-related challenges seriously. Try and do what you need to keep your heart open and see the soul of a very young child in her. She is disabled for the time being. “One must be ‘very quiet’ in one’s heart so as to allow the child to express the pain she feels inside. Try to approach the situation with this sense of peace and presence while you maintain the proper boundaries and consequences for violence.”
#15 Sibling communication
Communication is key for the siblings of a child with bipolar. While they may grasp their brother or sister has a brain illness, it may still be confusing as to why they are being treated differently for their anger issues or the punishment and consequences aren’t the same. They will be required to understand this so as to help calm down their sibling. It may be beneficial for them to talk with a therapist as well for help adjusting.
via bpHope – bp Magazine Community