May 27, 2005

Bipolar Patterns in Children

There is a good article in this month's "The Brown University Child and Adolescent Behavior Letter" that focuses on new perspectives on development, prevention and treatment of Bipolar patterns in children.

In the article by Drs. Greenspan and Glovinsky it is suggested that in their book, "Bipolar Patterns in Children: New Perspectives on Developmental Pathways and a Comprehensive Approach to Prevention and Treatment" (Greenspan and Glovinsky, 2002) they describe bipolar disorder as bipolar pattern -- using the word patterns rather than disorder in discussing bipolarity in children.

"Because of the variability in the presentation of the disorder, we now know that we are not dealing with a single disorder, but rather with patterns of behavior marked by severe emotional dysregulation and difficulties in executive functioning that involve interrelated features, including genetic and biological, psychological, interactive, and family patterns."

In their Treatment Plan they describe Home, psychosocial, medication, educational approaches to dealing with children who have "bipolar patterns".

Specifically, they suggest that:

"The most important component is the home program where parents and child work on learning affective signaling, including more effective and sensitive patterns of up- and down-regulating cues. They do this as part of spontaneous play or conversations (a special type of Floor Time or "hang out time").

Parents also engage in daily problem-solving discussions where they help the child think about tomorrow and visualize and describe feelings associated with anticipated positive and negative expectations. The goal in their discussions is to help the child use more differentiated and subtle rather than polarized descriptions of feelings.

The home program also focuses on providing stable, nurturing caregiver relationships and firm, persistent, but not punitive limits and guidance. The close relationship with the same sexed parent is also important. In addition, the specific processing weaknesses need to be identified--e.g., motor planning or sequencing, or executive functioning ability--and a program to strengthen these capacities must considered.

Many children will also require psychotherapy, which has the same goals as the home program, and enables the therapist to support the family in the implementation of the home program. For some children, medication will need to be considered to help the child stabilize his or her mood and participate in the home or psychotherapeutic program. ...

The educational program needs to collaborate closely with parents and the therapeutic program. In the educational setting, the same goal of co-regulated affective interaction, firm but gentle guidance and limit-setting, and subtle differentiated (gray-area) thinking needs to be supported, while pursuing the age-expected academic goals.

If there are areas of processing challenges, the school program should work on these and also create opportunities for extra practice interacting with peers, including work with the school mental health counselor and lots of projects solving problems working with other students.

For more information go to or

For a complete version of this article and a full list of references, go to 2newsletters/newsletters/CABL/CABL.htm.

* For a more detailed description of the developmental pathway leading to bipolar patterns, please see the new Interdisciplinary Council for Developmental Learning Disorders Diagnostic Manual for Infancy and Early Childhood, Mental Health, Developmental, Regulatory-Sensory Processing, Language and Learning Disorders in Infancy and Early Childhood (ICDL-DMIC). You can order a copy at


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