MGH Home SchoolPsychiatry Home Page
School-Based Interventions : Bipolar Disorder (Manic Depression)
 
Interventions for Manic Mood (Mania)

Accommodations
  1. Allow the student to complete schoolwork or tests in a less stimulating environment

    Example:
    Identify a calm, comfortable area (with limited distractions, noise, and sensory stimuli) where the student can complete work/tests.
  2. Assist the student in prioritizing work

    Example:
    Designate times during the day (lunch, end of day) to check the student's assignment folder so that he/she understands tasks, and the order for completing them.
  3. Seat the student where the teacher can monitor, but not where the student is the focal "center of attention"

    Example:
    Determine a seat within the classroom where an effective balance of teacher monitoring yet not over stimulation can occur.
  4. Identify subtle signals for the student to gracefully exit if activated

    Example:
    Devise with the student hand signals (touch head) or non- disruptive verbal signals ("get a drink of water") if the student gets overwhelmed in class, and identify specific places or staff the student can go to.
  5. Develop a simple explanation that the student and staff can use with peers and teachers

    Example:
    With the student and/or parents, devise an explanation for the student's missing school, leaving class, or crying, that the student and staff can consistently use if others comment.
  6. Provide the student extra opportunities to remedy medicine side effects

    Example:
    Anticipate that the student may have dry mouth or need to go to the bathroom, so devise signals with the student, and provide multiple opportunities (for example, every few hours).
  7. Provide the student with alternatives to repeating questions and comments

    Example:
    If the student is perseverating, redirect the student to count to five or do another task while waiting for the teacher's attention; periodically reinforce the student for employing delaying strategies when he/she is not being called on.
  8. Provide the student alternative modes of expression for completion of projects

    Example:
    Allow the student to use a laptop computer if tremor/medication side effects limit handwriting.
  9. Adjust time for the student to complete assignments or projects

    Example:
    Allow the student extra time before, during, or after class to finish assignments; the student may need to catch up during summer school. top

Modifications

  • Provide alternative physical activities if team activities are not well tolerated

    Example:
    Provide alternatives to team sports (yoga, biking) to avoid the student's revving up or becoming the target of criticism by students/staff.
  • Provide creative, safe content activities to allow the student to express his/her ideas

    Example:
    Modulate content to fit with the student's mood; when excitable, avoid open-ended, fantasy activities and instead use structured, repetitive activities. If necessary, provide sentence starters or connectors to limit student digressions.
  • Allow the student alternative modes of expression if he/she cannot verbalize in a useful way or is speaking too rapidly

    Example:
    Provide the student with an opportunity to write, dictate, or draw ideas.
  • Limit homework to a feasible amount during manic periods

    Example:
    When the student is manic and has a hard time focusing, limit or diminish homework requirements.
  • If concentration cannot be sustained, allow the student to use appropriate device aids

    Example:
    Allow the student to use a dictionary or calculator during testing.
  • Provide extra-credit opportunities, particularly following deteriorations

    Example:
    Allow the student to read additional books, and/or retake tests during or following crisis/manic intervals. top

Specialized Instruction

  • Allow the student to have homebound instruction during manic periods

    Example:
    Determine the conditions that warrant homebound instruction (for example, the student is sleeping during the school day while awake at night; the student's fears or delusions are causing conflicts in the classroom; or the student is unable to benefit from being in the school setting to accomplish tasks). Home instruction may need to be provided by specialized (therapeutically trained) staff. top

Behavioral Planning

  • When the student's behavior is inappropriate, provide acceptable behavior choices

    Example:
    If the student is moving around the classroom, specify acceptable forms of movement ("can stand," "can move these books and alphabetize in this shelf," "can walk around the room three times then start math").
  • Give reinforcement preferentially for appropriate behaviors

    Example:
    Focus positive comments on what the student does correctly to reinforce desirable behaviors ("I really like how you are standing in line with a quiet voice, hands to your side and with good space between you and your friends"). top
 
 
    ©2010 Massachusetts General Hospital, School Psychiatry Program and MADI Resource Center
    Copyright | Disclaimer | Privacy Policy | Department of Psychiatry  | Site Map