Mood Disorder Tips: How to Help a Child Through Manic and Depressive Episodes

I had such a hard time sleeping last night thinking about Sunshine, her most recent behaviors, strong emotions, and mood disorder struggles.

Sunshine is transitioning from mania to the depressive episode in her mood disorder cycle.

I feel so helpless as her mom, when she's in this state away from home in residential, because I can't be with her to help her.

So, in an effort to help myself feel better, I wanted to be sure to share with all of you what we've learned actually does help Sunshine during her mania and depressive episodes

It's my hope that these tips can help others, including those working with Sunshine now. (This post is an actual e-mail I sent to Sunshine's team in her RTC, modified to fit the blog.)

Here are our best mood disorder tips and how to help a child through manic and depressive episodes.

10 Ways to Help a Child Experiencing Manic or Depressive Episodes

1. Lower Expectations

Sunshine's IQ drops about 20 points when she is in her manic and depressive episodes. This is not just specific to Sunshine, but has been proven  in many who struggle with bi-polar disorder.

When Sunshine is manic or depressed, she can not function the way she does when she's stable.

Sunshine experiences such an overwhelm of emotions during her manic and depressive episodes over the littlest things. She literally can't put thoughts and ideas together like she can when she's table.

The overwhelm of emotions she feels during her manic and depressive episodes are so quick to turn into behaviors.

When choosing to interact with Sunshine while manic or depressed, it's best to simplify things as much as possible, shortening up sentences as much as you can.

The goal is to always help Sunshine remain calm. Confrontations do not go well. If Sunshine feels the slightest threat, behaviors sky rocket in seconds.

Lowering expectations can make such a huge difference when your child is manic or depressed. It can really make or break the day, especially when it comes to safety.

2. Extra Support

Due to the drop in IQ and emotional overwhelm, Sunshine has a really hard time thinking through scenarios she can usually handle.

We have found visual schedules, a one-to-one, and assistance in as many tasks as she requires, during this time to be incredibly helpful in curbing behaviors.

We try to always focus on the goal of our requests. If the goal is to have Sunshine's hair brushed, and it's just too much for her during this time of her cycle, we help in whatever ways she needs.

We know when she's feeling better about herself and more stable, she'll go back to doing it on her own, without any added negative experiences.

The IQ drop and emotional overwhelm is not just specific to Sunshine. Do your best to provide as much extra support as possible, being patient and understanding when your child can not function as they usually do.

3. As Much Outside Time as Possible

Sunshine's happy place is outside. She loves nature, sun, running, climbing, and so much more. (It's usually peer interactions that make outside time hard.) 

The more time Sunshine spends outside in the sun, the fewer behaviors she has and the clearer she thinks.

I love that Sunshine's response to outside time matches medical and scientific studies about how to help mood disorders. 

Outside time makes such a difference for all those who suffer from mood disorders, especially when in a depressive episode.

4. Exercise, especially Swimming

The one thing that stops Sunshine's behaviors related to her manic and depressive episodes more than anything else is swimming.

Anytime you can get her into the water, or playing a water sport, it will calm her like nothing else. She loves to swim and will do so for hours.

Last summer, as we had to spend six weeks in a hotel with Sunshine waiting for a new residential placement, Sunshine swam almost every day for at least an hour, usually two. She only had two incidents of aggression towards people and one out of area incident the entire six weeks. 

Exercise, especially swimming, calms her that much.

If your child responds to swimming or another type of exercise like Sunshine does, be sure to provide that opportunity each and every day!

5. Hands Off and Provide Sensory Support

Sunshine's sensory systems are on fire when she is manic and in her depressive episodes. Nothing but swimming seems to calm this.

The minute Sunshine is touched, her behaviors will escalate immediately. We avoid needing to touch Sunshine at all costs, unless she's asking for hugs, etc.

We provide as many calming sensory experiences as possible for Sunshine during this time. Most often Sunshine's go-to sensory experience is wrapping up in a blanket and squeezing a stuffed animal. She'll sometimes want to wear multiple layers of clothing. (Dress up works great during those times.)

Basically anything that helps with her cravings of proprioceptive input seems to calm.

A hands off approach encourages independence and promotes safety. 

Providing sensory support helps calm the body and the mind, which in turn soothes the mind and body.

6. Multiple Emotional Check-ins

Sunshine has A LOT going on in her head during her mania and depressive episodes. Constant emotional check-ins throughout the day when she's feeling safe and comfortable help immensely.

Sunshine's behavior seizures don't disappear during mania and depressive episodes. They get worse. Once the behavior starts, they will not stop until the behavior seizure is done. 

During manic and depressive episodes, Sunshine can go from 0 to 10 in seconds, which is must faster than usual. She also shows crazy strength during this time.

Check-ins minimize the possibilities of emotions becoming too big and overwhelming, which then minimizes behaviors.

Be prepared to hear some pretty intense thoughts without judgement as you do emotional check ins during mania and depressive episodes. Try to understand that the brain isn't okay. It's not the child's fault. 

The goal is to take the thoughts out of the brain and into the open where they can be discussed and talked about.

7. Food and Water

When Sunshine is in her manic and depressive episodes, even her taste preferences change. It's yet another sensory experience on fire. Battles over food can be much worse during this time, especially if Sunshine is craving oral stimuli.

During her mania and depressive episodes we always try to have unlimited fruits and vegetables on hand for Sunshine to eat when she needs something.

We carry water bottles with us everywhere. Drinking water helps Sunshine stay hydrated when she's on go go go mode. It also helps her remember to take deep breaths as she's drinking.

The goal is to ensure Sunshine isn't hungry as she refuses food she usually likes or forgets to eat, to prevent more behaviors.

Many people struggle with sensory experiences related to food during mania and depressive episodes for a mood disorder. The more help we can give in this area the better.

8. Lean into Rituals and Routines

Sunshine LOVES her rituals and routines, especially when they are positive. During her manic and depressive episodes, she relies on those rituals and routines so much, especially as her senses are on fire and emotions out of control.

When things are changed up, her mania and depressive episodes become much worse and harder to handle. This always results in more behaviors.

Mania and depressive episodes can cause so much upheaval and overwhelm in the brain. Clinging to anything that's the same and typical can help those struggling so much!

9. Eliminate Incentives and other Behavioral Approaches

Incentives cause anxiety for Sunshine. Even if she seems really excited and motivated, emotions are still intensifying beneath the surface and will eventually explode.

Either she'll self-sabotage because trying to earn something is just too much for her to handle, or she'll hold everything in to receive the reward, and then explode on others afterwards.

Manic and depressive episodes cause emotions related to incentives to be ten times bigger, especially in go go go mode, or when she's spiraling with negative self-talk left and right.

In our experience, Sunshine's behaviors improve when she feels good about herself, accomplishing tasks successfully. The more success she feels, the happier she is, and the more independent she becomes.

One of the best ways to sooth a manic or depressive brain is to help the child understand they are good enough now.

10. Take Breaks and Share the Load

Sunshine is intense when she is manic and in her depressive episodes. She wears on you. She's really physical and extremely demanding. 

It seems like every situation can spiral in a matter of seconds and you're left thinking, "What the heck?!" if you're not watching the calendar.

You're doing all you can do to think straight, stay calm, and not let emotions get the best of you, while you try to keep her, yourself, and everyone else safe. This is especially hard as Sunshine talks incessantly and is so loud during her mania.

Both my husband and I work from home because of Sunshine. We understand that we need to be there to support each other during behaviors.

We are constantly tag teaming, taking turns, or using a united approach with Sunshine, because we know we can't do it all alone. No one can.

Switch out staff and/or caregivers as often as possible, BEFORE her behaviors get the best of you.

You are not weak when you ask for help.

Sunshine is only ten years old. She is developmentally six years old.

When she's in her manic and depressive episodes, she's like a three or four year old.

No professional or caregiver can ever expect a child that young to do the work that has to be done on their own during manic and depressive episodes.

Just think of the daily functioning level of a three or four year old. They need help with so much!

When we keep all of this in mind during mania and depression, life becomes so much easier.

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