Bipolar Transitions

Clinicians sometimes refer to a child's emotional rigidity as the inability to "shift set." This rigidity often comes into play when getting a child ready to transition to a different activity or begin a new routine. For example, every week, Mark and his mother went to karate class. And every week, getting out of the house was an ordeal. Mark's mom often spent at least half an hour begging and cajoling him to go to class. Yet once there, he consistently had a great time. Nonetheless, the memory of the week's positive experience didn't carry over to the next time he had to go to lessons, and his mother's begging and arguing would begin anew.

Over the years, I've found that a definite correlation exists between a child's rigidity and his mood. When a bipolar child is depressed, everything becomes more difficult. Certainly, it's true that all children, even those without disabilities, can sometimes have trouble transitioning from one activity to another. Any child may protest being called to dinner when he's playing a video game or watching television. He probably doesn't like being interrupted while he's having fun, and he might say, "Just one more minute. I've got to do it. I'm about to get the fifth level on the game." But once his mom restates the rules—"I told you five minutes ago that it's going to be time to stop. You got the warning. Enough is enough. If you don't come to the table right now, you won't be able to watch that program you like on Animal Planet"—the nonbiopolar child might seem annoyed but will eventually go to the table for dinner.

The same scenario with a bipolar child might look much different. His mom gives him the same warning, "Look, Joseph, this is the last time I'm telling you this. If you don't come to the dinner table, you won't be able to watch that show on Animal Planet before bedtime."

"I don't care. You're mean. You probably weren't going to let me watch it anyway. You always promise things and then change your mind. You don't listen to me, so why should I listen to you?"

With that, Dad walks in. "What is going on here? Joseph, why were you yelling at your mother?"

"She won't let me just finish my game. She wants me to go eat now. I can't. She's mean. I know she hates me!"

"You know your mother doesn't hate you. You know she loves you. But it's dinnertime. So let's go."

Joseph doesn't move. His father then proceeds to turn off the video game. Joseph gets angry and pushes him backward, and Dad lands on the couch.

"That's enough!" Dad says and holds Joseph securely, to restrain him. In doing so, he accidentally taps the boy's chin, ever so slightly. Then Joseph starts screaming, "That's child abuse! I'm calling the police."

Many people who don't have a bipolar child find such a situation incredible. They assume that the parent handled the situation in the wrong way. But parenting techniques that are good enough for most kids simply don't work with many bipolar kids. Here, you have two reasonable people attempting to reason with an unreasonable one. There is little room for progress.

This kind of rigidity plays a role in any number of situations in which a transition is required for a bipolar child. It may be the teacher saying, "OK, let's move on to the next subject" or "Gym is over; it's time to go back to class."

Transitions can be hard enough for bipolar kids in the best of times. But an onset of depression can make their rigidity even worse, or it can cause them to think that a change has occurred even when nothing has changed. Mom can make the same tuna sandwich every day for lunch (with the crusts taken off and the sandwich cut diagonally), then one day, the child becomes depressed and starts screaming, "This isn't the same tuna, it tastes different. I can't eat this! Why did you change it?" Nothing the mother does is different, but the child is more depressed, so to her, it's as if nothing is right.

Dealing with these situations is understandably difficult. Again, I often suggest to parents that they should give themselves a time-out to recoup their sanity and impulse control before attempting any kind of intervention.