While many children with bipolar disorder don’t act out in school (but rather tend to save their pent up frustration and upset for home and mother), some do. The school may try to discipline, suspend, or expel the student due to unruly or oppositional behaviors without understanding that many of the behaviors are a result of the student’s condition. If you or the child psychiatrist believe that these behaviors are sequellae of bipolar symptoms, you should request that the school conduct a Functional Behavioral Analysis (an FBA). Based on the findings of the FBA, the school must write a Behavior Intervention Plan (BIP) into the IEP. This is now mandated by law.
The FBA/BIP Process
The FBA (Functional Behavioral Analysis) is a formal assessment which can identify problem behaviors a student is exhibiting, where they are having them, when they are having them, and with whom they are having them. The data is analyzed and a Behavioral Intervention Plan is developed which provides goals to replace problem behaviors with positive behaviors.
Only trained professionals such as psychologists or special education teachers with specialized training are qualified to conduct a Functional Behavioral Analysis. We cannot stress strongly enough that parents need to investigate the level of experience of the people assigned to conduct the FBA. If it becomes obvious that experienced professionals are not available, then the parents are going to have to insist that the school district bring in such professionals from the outside. Otherwise school districts will continue developing BIPs which are inherently flawed and subject to failure.
The data from the FBA is used by the BIP team (school psychologist, teachers, support teachers and any other professionals who work with the child) to develop an appropriate intervention plan that will:
- Describe the behavior
- Determine the functions of behavior
- Develop interventions that will replace untoward behaviors with new behaviors.
- Develop a timeline for reviewing the plan
The school will implement the plan and, over time, evaluate the outcomes as outlined in the plan.
It is important when observing a child with bipolar disorder to differentiate between behaviors that can be modified, and symptoms of the illness. For example a child may be refusing to work because he is overwhelmed by the stimulation in the room, does not understand the assignment, and/or feels lethargic from the meds and/or the illness (or a combination of these factors). Therefore, he is simply not able to perform to the teacher’s expectations at that time, as opposed to being defiant to earn the respect of his peers, or some other outcome (known as a function) of the behavior.
It may be necessary for the team to receive training in childhood bipolar disorder before the team is able to create an effective and appropriate Behavioral Intervention Plan–one intended to identify the antecedents of the problem behaviors and modify them with positive behaviors.
The Behavior Intervention Plan should:
- Identify the antecedents to the problem behavior
- Focus on positive supports
- Teach replacement behaviors
- Manipulate antecedents
- Manipulate consequences
- Change curriculum or instruction
- Monitor and evaluate effectiveness and modify if necessary
Some examples of these interventions are:
For more information about FBAs and BIPs, contact the Center for Effective Collaboration and Practice. This is a national organization that helps students with emotional and behavioral problems in school. Go to http://cecp.air.org.
Two other helpful sites are:
Where Can The Student’s Needs Best be Accommodated?
Because federal guidelines call for placing any child with a disability in the least restrictive environment, most public schools begin providing services in the regular classroom. If the child continues to struggle or does not make progress in the general education classroom, the team may decide (with the parents’ agreement) to place the child in a self-contained classroom within the public school setting. Here the class size will be reduced and there will be more accountability to the individual student. There are typically one or two special education teachers and a trained aide or two working with the student in the self-contained classroom. Depending on the student and the special ed program, the child may be “mainstreamed” into regular education classes for some academic subjects and for elective periods such as music, art, gym, computer, etc.
The time may come, however, when it becomes clear that a small, therapeutic program in a private or public school would be a more appropriate placement for the student. When a student’s illness negatively impacts his or her learning and no progress is being made academically, socially and/or emotionally, the parents and school team should begin to discuss a therapeutic day school. This is a separate school, usually with a small number of students, a small class size (six to eight children), in a classroom with a trained special education teacher and a trained aide. The child receives academic instruction along with group therapy, individual therapy, social skills classes, and art and music therapies.
Some schools will make recommendations of therapeutic day schools, but some will tell parents only about programs that are inexpensive for the school district and which may serve more as a warehousing situation than an appropriate place for education. Nor will all communities have any kind of therapeutic day school—good or bad.
In these situations, parents will want to contact an educational consultant (and may have to secure the services of an educational attorney). The Independent Educational Consultant Association has a list of reputable consultants in all areas of the country. Go to http://www.iecaonline.com or call 703-591-4860 to obtain names and phone numbers. Educational consultants are trained experts who possess comprehensive knowledge of placement options. Many consultants specialize in crisis-intervention and have extensive experience advising families with children who have emotional and behavioral difficulties. This expertise is used to advise you on the most suitable placement for your child.
Parents can also contact their Department of Education’s Special Education Division. Most states list their approved therapeutic day schools so you can at least get started. Go to: http://wdcrobcolp01.ed.gov/Programs/EROD/org_list.cfm?category_ID=SSE.