Intensive Outpatient Program for Children,
Teenagers and Young Adults with Bipolar Disorder
Many children and teenagers who suffer from bipolar disorder have not been diagnosed appropriately. These children experience a wide range of symptoms ranging from frequent tantrums to inability to control impulses. Many of these children have received diagnoses such as attention deficit, oppositional defiance, or obsessive-compulsive disorders. Although bipolar children may exhibit symptoms of those conditions, an inaccurate diagnosis can lead to ineffective and at times detrimental treatment. For example, children with attentional deficits are often treated with psychostimulant medication; however that same medication is contraindicated for bipolar disorder and can trigger mania and psychosis.
Fair Oaks Therapeuticum offers assessment and diagnosis for families who suspect loved ones may suffer from bipolar disorder. We use an integrative, non-medication-based approach for bipolar children and teenagers (although medication may need to be necessary, especially during times of crisis). Our therapeutic approach incorporates education, social skills training, psychotherapy, nutrition, therapeutic movement, parent education, and an understanding that this lifelong conditions requires professional intervention until a patient is stabilized and has found meaning through both the gifts and the liabilities of the illness. Our program incorporates treatment guidelines established by the American Academy of Child & Adolescent Psychiatry for childhood-onset bipolar disorder.
Treatment is most effective when children receive multiple treatments each week and the entire family is included in the therapeutic process. Both the family and patient receive hands-on tools to manage relationships, school, and home life more successfully.
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Who is this treatment for?
The intensive treatment program is for children (starting at age 4), teenagers and young adults with a diagnosis or suspected diagnosis of bipolar disorder. Patients with similar constellations of symptoms are accepted for treatment when assessment suggests they will benefit from our program.
Often, children and teenagers are referred to our clinic because their parents and teachers notice that their mood fluctuates, sometimes several times within a day or week. Tantrums and "meltdowns" are common. These children may be gifted or exceptional in certain areas but have problems relating to others or fitting in with classmates or social groups. They are often anxious and struggle with racing thoughts and many fears. They may be unusually sensitive to sound, touch, and temperature. They may have problems eating and sleeping. As teenagers, they may abuse drugs and alcohol. Early intervention and treatment can transform the experience of growing up for our young patients and their families.
Our program in more detail:
Initial consultation and interview
- Review questionnaire; interview family.
- Educate family about the program, its components, the anticipated time and financial commitment, and its limitations.
- Assess appropriateness of the child and family for the program.
Psychological assessment
- Diagnosis of bipolar disorder using the following tests: the Wechsler Intelligence Scale for Children (WISC III), Developmental Profile-II (DP-II), Bipolar Questionnaire, Mood Charts, Measures of Psychosocial Development (MPD).
- Diagnosis of depression, using the Children's Depression Inventory (CDI).
- Diagnosis of attentional problems, using Conners' Continuous Performance Test (CPT).
- Additional tests for differential diagnosis: House, Tree, Person Test, Child Bipolar Questionnaire (CBQ) and Mood-Rating Chart, Trails A & B, and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) test.
- Additional tests may be necessary to support or disprove diagnostic impressions and will require additional time and resources not included in the basic assessment. These tests may include: the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) test, the Millon Clinical Multiaxial Inventory, or other psychological tests.
Other assessment tools
- Evaluation of current medical treatment and medication/medicinal consultation.
- Feedback session with parents to review assessment and treatment plan.
- Parents receive a comprehensive assessment and treatment plan.
- Identify potential barriers and support services to assist in program implementation.
- Evaluative report and treatment recommendations.
Treatment for bipolar disorders: Our approach
The program provides ongoing week-based treatment with several treatment sessions per week, including group and individual therapy sessions for the patient and family members. Over the course of the program, patients and their families receive a full spectrum of treatments, including:
Interventions
Individual and/or group psychotherapy, focusing on key questions and issues related to bipolar disorder:
- Understanding the disorder: How am I different?
- Strengthening esteem.
- Learning to cope with fears.
- Learning to cope with nightmares and sleep dysregulation.
- Learning to cope with attentional deficits; learning attentional strategies when in a group.
- Focusing on connections to and genuine care for others; focusing on connections to other
- Experiencing joy and satisfaction in belonging, giving and receiving
- Anger management.
Family Treatment, focusing on understanding our treatment approach and exploring family issues related to the patient's illness.
- Exploring any family history of bipolar disorder.
- Supporting parents in their child-rearing efforts.
- Teaching anger management techniques.
- Helping create meaningful rhythms in the family's home life.
- Supporting and increasing child's effort at self-regulation.
- Hands-on interventions for parents, including providing interactive parent coaching and behavior modeling.
Medicinal Interventions
- Complementary medicinal treatment, either alone or in conjunction with conventional medication.
- Dietary consultation and exploration of food intolerance.
Therapeutic Yoga to help integrate other forms of treatment. Focuses include:
- Breathing, relaxation and self-awareness.
- Integration of hemispheric processing through movement.
- Building awareness of one's presence in time and space.
- Strength and flexibility training.
- Esteem building.
Therapeutic Listening to further integrate benefits of treatment.
- Supports attentional processes.
- Desensitizes auditory stimuli.
- Increases auditory discrimination
- Supports healthy eating habits and other self-regulatory processes
- Supports social competence.
Home Program, focusing on several areas:
- Sensory integration intervention.
- Peace massage before bedtime to increase relaxation.
- Homework assignments for practicing new behavior.
School Interventions
- Consultation with a patient's teachers and other school officials.
- Consultation with parents and teachers on a patient's individual educational plan (IEP).
- For young adults, we offer supportive interventions to assist at school and work
Consultation with community mental health professionals
Periodic Reassessment
Timing for reassessment varies depending on a patient's progress. Generally, reassessment is helpful between 12 and 18 months after our initial treatment and on an annual basis thereafter. Reassessment is also indicated when a patient experiences sudden changes in functioning. Assessments can also be of great benefit to determine appropriate accommodations and objectives in school.
Contact us
If you have questions about any aspect of our program, please contact Dr. Ursula Stehle at (916) 962-0222, ext 1#, or email her at drstehle@therapeuticum.org
Last modified on 01.13.10
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