Bipolar Children and Outbursts at School

The child: "I felt like I could explode inside. I don't know what made me do it. He did it to me on purpose."

It's every parent's dreaded moment. The cell phone rings. You recognize the school's number on the screen. They've called to say that Tom had an "episode" in the lunchroom. He thought that another child deliberately spilled milk on him. Tom responded by hurling his lunch tray across the room—with the food still on it. You'll need to come pick him up—now. As we've seen before, bipolar children seem to have what are known as "affective storms," reactions that are out of proportion to the factors that precipitated them. These may be brought on by stress, anxiety, problems with medication, hearing the word no, or any number of real or imagined stressors.

Ways to Help

Perhaps the most important remedy for such episodes at school begins with identifying the triggers that cause them. For example, if you know that your child is upset by the noise and commotion of the school lunchroom, you may want to ask the teacher to seat him in a quiet place or to allow him to eat in a quiet room with a teacher present. Of course, frustrating situations are inevitable in life, and your child needs to learn in advance how to prepare for them—and prevent his behavior from getting out of control. Many therapeutic schools, that is, schools that focus on helping children with emotional and/or behavioral issues, employ what they call a "level system," based on positive reinforcement for good behavior.

Through a system of points awarded during each period of the day on the basis of good behavior and academic standards, students can earn recess time, items from the school store, and other privileges. The point system can be a powerful tool for preventing or curtailing meltdowns. Kids learn to identify what is happening in their minds and bodies when a "storm" overtakes them and to come up with strategies, such as deep breathing and talking themselves through it, that can help them defuse their anger and maintain their self-control.

When the inevitable happens and a child blows a gasket, it's important to talk to him about what happened and how such outbursts can be prevented in the future. At the Newmark School, Regina Peter has instituted a schoolwide "debriefing" system to deal with students when they lose control. Rather than focusing on what the child wants or has done, the debriefing focuses on the child's reaction to the situation that has just occurred and on what can be done if the same thing happens in the future. "Keep calm is the first message we send," says the school's director. "Then, without judgment, we walk the child to a quiet debriefing room and ask him to work with us to fill out a form that describes what happened, how he felt, and what strategies he can use to prevent the same sort of thing from happening again. We try to send kids back to the classroom with coping skills—and a resolve that they can do better next time."

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