The following excerpt is taken from Chapter
8 of Bipolar Disorders: A Guide to Helping Children and Adolescents
by Mitzi Walsh, copyright 2000 by O'Reilly & Associates, Inc. For book
orders/information, call (800) 998-9938. Permission is granted to print and
distribute this excerpt for noncommercial use as long as the above source is
included. The information in this article is meant to educate and
should not be used as an alternative for professional medical care.
It is very rare for a child to be diagnosed with bipolar disorder as a
preschooler. However, if your child falls into this category, or if she has
another disabling condition that emerges in early childhood, she should be
eligible for Early Intervention (EI) services.
EI service offerings vary widely according to where you live. They should,
however, be determined by the child's needs, not just what happens to be
available or customary in your area. Evaluation is the first, and sometimes the
most important, service provided through EI programs. Once an evaluation has
been carried out, if your child is found to have bipolar disorder or another
disability an Individual Family Service Plan (IFSP) is developed. The IFSP
spells out the needs of the child and the family, and the services that will be
provided to meet those needs.
The Individual Family Service Plan
This document should be created at an IFSP meeting, which you will be
invited to attend and contribute to. Although it's a good idea for both parents
and practitioners to write down their ideas for goals and interventions in
advance, the IFSP itself should not be written in advance and simply handed to
the parents to sign.
The cover page of the IFSP summarizes what's known about the child and his
diagnosis, and lists the team members present at the IFSP meeting. It also
lists the services to be provided, who will provide them, how often they will
be provided, and where they will be delivered. Further details about these
services are entered on goals and objectives pages, later in the IFSP.
Accordingly, the cover page should be mostly blank until the goals and
objectives pages have been filled out.
Goals and objectives will be developed by the team at the IFSP meeting. They
can be written to cover any area where your child has a deficit, including
cognition, behavior, coping strategies, fine and gross motor development,
communication, social skills, and self-help skills. Goals should be finite,
observable items rather than general concepts. For example, "Kim will
learn to use counting to ten and breathing deeply as a response to
frustration," is a workable goal, while "Kim will learn to deal with
frustration," is not.
One or more pages of the IFSP describe your child's evaluation. These pages
should cover medical information, psychiatric diagnosis, and the results of
hearing, vision, and developmental screening, if any.
The IFSP can also include services needed by the whole family to help you
care for your child. For example, these services might include parent education
classes, the services of a behavior expert who can help you with home
discipline problems, psychiatric consultation, and assistance in finding and
accessing community resources.
The goals set in your child's IFSP will dictate what kind of setting
services should be delivered in. Typical EI settings include:
- Home-based services. For very young children, home-based services
often make the most sense. Home-based programs may include direct therapeutic
and educational services, training and supervision for parents and volunteers
working with the child, and assistance with medical procedures and care needed
to allow education to take place.
- Direct services. This category includes all types of professional
services, such as psychological therapy, that are delivered in a school setting
(but not as part of the preschool program itself), clinic, or other setting
outside the home. For example, the IFSP might specify that your child is to
receive 45 minutes of play therapy twice a week at a nearby university's
clinic. These services may be delivered by professionals or facilities under
contract with Early Intervention, or by practitioners working directly for the
- School-based services. This category includes all services delivered
as part of a public or private preschool program, at the school site.
Therapeutic services may be integrated into a special or typical preschool
program, or may be delivered as pull-out services for which your child leaves
the class for one-on-one or small-group work.
A primarily home-based program goes the furthest to build a strong
relationship between the child and his parents. It takes place in a familiar,
non-distracting environment that has probably already been made appropriate for
the child's sensory and safety needs. It eliminates lost time and problems
related to transporting a preschool child to school (many EI programs actually
bus infants and toddlers across town). It also provides the best stage for
intensive, one-on-one intervention, such as floor-time play therapy.
It can also be extraordinarily difficult to get approval for. One tool that
may help you win this battle is a thorough and accurate financial appraisal
that compares the cost of an intensive home-based program in the early years to
twelve years of residential or private placement. If your child has been
diagnosed with a bipolar disorder at this early an age, it is likely that his
symptoms are already very severe. That makes early, intensive intervention the
most cost-effective solution, no matter how you cut it.
Early Intervention classrooms
A preschool setting with other children is often considered the best
placement for a young child with a psychiatric condition, because it provides
the child with the greatest number of opportunities to relate to others, play,
and learn. Spending time with other children in a structured setting can be
very beneficial for developing social skills. However, attention must be paid
to your child's special needs, deficits, strengths, and so on--just any
preschool class won't do.
Early Intervention preschools come in four basic flavors:
- Regular preschool classroom, with or without special support. Also
called a full integration setting or mainstreaming, this might be a Head Start
or similar preschool classroom. Your child would attend preschool with
therapeutic services, classroom adaptations, and personal support, such as an
aide, as needed. These services, adaptations, and supports must be written into
- Supported integrated preschool classroom. Also called a reverse
integration setting, because it's the nondisabled students who are integrated
into a special program rather than the other way around. This is a specially
created preschool setting that brings together a small group of children with
disabilities and children without disabilities. Therapeutic services, classroom
adaptations, and personal support are provided to each child with a disability
as per his IFSP. Children in a supported integrated classroom may have a
variety of different disabilities, such as autism, Down syndrome, or mental
- Special preschool classroom. This is a specially created preschool
setting for children with disabilities only. The children may have a mix of
various physical or emotional disabilities, or a mix of different behavior
disorders only. The classroom may be part of a larger school with other types
- Special preschool. This is an entire preschool program created
specifically to work with children who have disabilities. It may be within a
larger school program that also educates school-age children. It may be owned
and run by a public school district, or it may be a private school that
contracts with the Early Intervention program to provide services. If it is
private, EI and/or the school district should pay the full cost of tuition if
it is judged to be the most appropriate setting for your child.
There are positive aspects to each of these typical settings. For children
who can handle full, supported inclusion in a regular preschool classroom,
there are ample opportunities to model the behavior of less-challenged
Supported integrated classrooms offer similar benefits, with a daily program
and structure that's more geared toward the child with special needs.
Special classrooms and schools generally have the most services, but provide
few opportunities to interact with nondisabled peers. Your child's needs,
abilities, and difficulties will dictate the right placement, as there is no
workable one-size-fits-all approach.