The Balanced Mind Foundation Live Event Transcript

Did you miss our chat with Leslie E. Packer? Read the transcript of this exciting and informative chat. The Balanced Mind Foundation will be hosting several more expert chats this Summer. Watch your email for more details.  

Biography
Leslie E. Packer, Ph.D., is a New York State licensed psychologist in private practice, specializing in children and adolescents with neurological disorders such as Mood Disorders, Attention Deficit Hyperactivity Disorder, Tourette Syndrome, Obsessive-Compulsive Disorder, and Asperger's Disorder. In addition to her treatment services, she also serves as a consulting psychologist to school districts to provide staff developments and to assist school teams in developing appropriate educational programs, behavior plans, and accommodations for students with neurological disorders.

She is the author of two web sites, School Behavior and Tourette Syndrome "Plus", for parents, educators, and clinicians. Her new book, Find a Way or Make a Way, provides helpful school accommodations for a variety of disorders.

Nanci - The Balanced Mind Foundation 
Please join me in welcoming today’s guest, Leslie Packer, Ph.D., to our monthly expert chat session.

Leslie Packer PhD   
Hi, everyone! I’m delighted to be here. Thanks to The Balanced Mind Foundation for inviting me, and Nanci for all she’s done to get this chat organized.   
 
Nanci - The Balanced Mind Foundation 
You’re very welcome - we have our first question so let's jump right in.

Carolyn   
My daughter is starting high school this year. I'd like advice about how much information to give to her teachers about her BP.

Leslie Packer PhD   
That's a great question. At the beginning, I would give them only enough to get them off on a good footing. That means: don't throw diagnoses at them and a list of problems, but focus on one or two things that they need to know immediately. I've learned that teachers want practical tips. So what can you tell them about how to get off on a positive note with your child?

And you can let them know that you'd like to talk to them in about two weeks after they've had a chance to start to get to know your child. That's when you can fill in more details.    

Carolyn   
Would you recommend an email or a request for a face to face meeting? Or some other format?

Leslie Packer PhD   
I tell the parents of my patients to send a letter to the teachers now that they will get when they come in to set up their classrooms. Keep the letter short (1-2 pages at most), focus on the immediate stuff, and be sure to tell them about your child's strengths and interests that they can use to form a bond with your child. They'll have more time to process it if it is before school starts.    

Carolyn
Ok, thank you. I had no idea where to start. Middle school was much easier!

shaeNY   
My daughter is showing a lot of anxiety about the start of the school year. What can I do to help her get off on a positive note?

Leslie Packer PhD   
Wow, that's another great question! For one thing, you can remind her that all kids are a bit anxious. Everyone worries about whether they'll make a friend, whether their teacher will like them, whether they'll get lost trying to find their classrooms, etc. Some kids need a walking tour of the school before the year begins so they can map out how to get from class to class, what stairs to use, etc. Others need a "cheat sheet," like teaching them that classrooms that begin with 1 are on the first floor, and classrooms that begin with 2 are on the second floor. One of my kids went all of the way through high school without ever realizing that there is actually a scheme to room numbers.

You can also reassure your child that most kids do not make friends on the first day, and that you will consider the first day a success if she can come home and tell you the names of two teachers! Helping your child set realistic expectations for the first day of school may help reduce anxiety.    

ladybug   
My son is starting high school this year and recently diagnosed BP. He just came off an IEP for dyslexia. Not sure he wants to be put on another IEP. His concern is that will make him graduate with the minimum requirements which will affect his college entrance. Is this true and what do you recommend?

Leslie Packer PhD   
An IEP is not supposed to lower standards for graduation. It is intended to help students with special needs achieve the higher, usual standards. Colleges do NOT know whether students had an IEP or not. It is not supposed to be on their high school transcript. So keep the expectations high and if he needs the services to help him succeed in high school to increase his chances of getting into college, explain to him how an IEP can help him build towards his future.    

ladybug   
Sounds good. Thanks.

Leslie Packer PhD   
You're welcome.  
  
bella   
Prior to being diagnosed bipolar last year, my 13 yr old son was kicked out of the only middle school in our community. We now have a 504 in place for next year, but his placement is being changed to a different teacher/hall and he already is expressing anxiety about returning. This is the first year in his life that he is NOT looking forward to going back to school. Any suggestions as to how to make this transition any easier?

Leslie Packer PhD   
One thing that helps some students (and of course, I don't really know your son) is to contact the school's psychologist in advance and ask about arranging a private tour/meeting/walk around in the building. If a student can meet teachers in advance, that may also help reduce anxiety. I've had a few patients where we arranged for the student to go in during August and help the teacher set up the classroom. That way, the child felt more comfortable in the room and with the teacher.   
 
jdcmom   
my daughter is 9 - ADHD/BP. She functions well at school for the most part, but has some behavior issue- academically she's done well. Should I consider an IEP or other intervention to protect her in spite of good grades?

Leslie Packer PhD   
There are many intellectually gifted children and teens who need accommodation programs or IEPs. If a child is doing well academically and doesn't require special education services such as related services, then they may not need an IEP, but they may need an accommodation plan, also known as a 504 Plan.

If her behavior is likely to get her into disciplinary problems, then does she need a behavior intervention plan? If so, then you may want to contact the district about that. They will usually recommend a more informal approach first, but as a parent, you want to create a written record alerting them so that if her symptoms get her in trouble, you can protect her somewhat.

ladybug   
Do you feel a child with BP would do better in a private setting? Are there schools that specialize in BP?

Leslie Packer PhD   
I tend to be a strong proponent of public education for a few reasons: (1) the public schools have more funding and more resources, (2) the public district has legal responsibilities and mandates that private schools don't have, and (3) I wanted my own kids to be exposed to their peers in the community that they would see on the street, etc.

I do not know of any schools that specialize in BP, but perhaps The Balanced Mind Foundation's resources could be of help to you on that.  
  
ShaeNY 
Our kids have been on the typical “stay up late, sleep late” summer schedule. When should we start switching them over to a “school” sleep and wake time?  I hate to spoil the last few days of their summer.

Leslie Packer PhD   
Spoil it. :)
If your child suffers from the "Don't Even THINK About Waking Me Up in the Morning Syndrome," you need to start easing them back into the wake-up time that they'll need for school. Depending on how late they're sleeping, you may need to start now, by waking them up 15 minutes earlier tomorrow, another 15 minutes earlier the next day, etc.
Don't count on switching them over two days before school re-opens. Their bodies and sleep cycles really need time to adjust. One thing that may help now is that when you do get them (or preferably, if they wake up to an alarm clock that is set), be sure to have something planned for them to do so that they don't go back to bed.   

Nanci - The Balanced Mind Foundation  
I have a child that falls into this category. What do you recommend in the way of incentives, vs. just saying “this is the way it is, we expect this of you”?

Leslie Packer PhD   
That's a great question. It's easy to give book-based answers, but having lived with one of these kids myself, I think the house could have burnt down and no incentive in the world would have made a difference.

Nanci - The Balanced Mind Foundation 
Oh, our kids must be twins separated at birth!

Leslie Packer PhD   
When I dealt with my own kid, we really focused on the self-management and responsibility issue, but if the child is younger, you can try some "cooperation rewards" that include getting up when asked to. Twins? LOL!

Leslie Packer PhD   
While there's a lull let me toss one thing out.... If your child gets their medication adjusted for school, remember to consult with the physician about when to start the change-over.    

Nanci - The Balanced Mind Foundation 
Not to belabor this issue but it does speak to a more general challenge. To what degree do we allow natural consequences to guide our kids (detention or poor grades for being late or missing school) and to what degree do we interfere or “helicopter” to prevent those consequences? Particularly at the middle or high school age?

Leslie Packer PhD   
My friend and colleague, Sheryl Pruitt, had a great quote on that; "Prepare the child for the path, not the path for the child." It's understandable — and necessary — that we have to advocate for our children and prepare the way a bit, but we also do need to let them fall on their face sometimes so that they learn how to pick themselves back up and try again.

So I might not let my kid oversleep so much that they miss school, but by the same token, if they oversleep and miss some place that they wanted to go, I might let that happen and then use that situation to problem-solve with them about what they could do in the future to prevent that from happening again.

I also encouraged my children to advocate for themselves by working with them on how they could explain things to their teachers and peers without using their conditions as an excuse. Sometimes, though, I would still have to step in and educate the school or advocate more strongly for my children because even bright, articulate children will be unable to handle some of what school personnel may throw at them.   
 
JohnT   
My 12 year old son suffers from school refusal. He wants to go to school right up to the point we arrive in the parking lot, then simply cannot go in. Any suggestions to help him get past this point?

Leslie Packer PhD   
School refusal is a really tough challenge, but the key to coming up with a good intervention plan is back in the assessment stage, i.e., "Why is the child refusing to go to school?" We've learned that there are a number of causes. Some kids are highly anxious, while other kids may be refusing to go to school or have school phobia due to a medication side effect.

Yet other kids who have ADHD+ may refuse to go to school or be truant because school isn't a reinforcing place and they'd rather seek excitement elsewhere. If it seems like the school refusal is anxiety-driven, the school psychologist can help develop a behavior plan to ease his entry to school. It may involve a "check-in" ritual whereby he's asked to come see her or someone in the office. A plan might involve having him help a teacher before school doing something he enjoys. One thing that helps some anxious refusers is to have a non-parent take the child to school so that the separation issues are minimized.    

bella   
Can you elaborate on your comment from the previous question? How do we explain to their teachers and peers without using their condition as an excuse.

Leslie Packer PhD   
Great question! Some kids that I've treated or represented (or even parented) over the years seem to get to the position or view of "I can't help this .... I have (insert diagnosis here)." I worry that we're teaching kids to feel helpless about their conditions.

So, let me give you an example of the difference:
If a child has a compulsion to turn a light switch on and off exactly 21 times when they enter the classroom, that is a symptom, yes, but it impinges on others, who even if they are educated about OCD, may be annoyed or frustrated. So the child can explain to peers, "I'm sorry about that... it's a compulsion, and I'm working on it. I realize it's frustrating for you and it's frustrating for me, too, but I'm trying to make it better."

If a child "loses their cool" and is really abrasive to peers, "explaining" "I have bipolar disorder" is only going to count for so much. After a while, peers generally get to the point of "I don't care what your problem is, don't take it out on me!" So we teach kids to recognize the impact of their symptoms on others and to take some responsibility for trying to protect others from their symptoms.

Does that answer your question?    

bella   
Yes, thank you.

Nanci - The Balanced Mind Foundation   
I'm going to backtrack again to put through a question about something you said earlier about the timing of medication changes.

jdcmom   
Our pdoc just changed my child’s meds and school starts in a week. Could you elaborate?

Leslie Packer PhD   
Some medications are quick-acting, while others have to build up in the system over days, weeks, months. And of course, if you just changed meds, there's always that "wait and see" period in terms of side-effects.  It's important — for your child's safety and image — that someone in the school building know what they are taking and that they are undergoing a medication change — particularly since some medications can have behavioral side effects that might be misinterpreted by school personnel.

I often ask the prescribing physician to send a note to the school nurse (with written consent, of course) to let the school know what medications the child is on, any known side effects for that child, and under what conditions the physician wants the school to contact him or her.

One of the biggest shocks I ever got as a parent was when I learned that many schools do NOT have a current PDR for their school nurse. So if your child is taking a new or new-ish medication, you may want to think about sending in some information for the school nurse about the medication. Ask the pharmacy for the package insert, even.    

Nanci - The Balanced Mind Foundation 
And, some schools don't even have a nurse on staff, so the medications are being handled by the school secretaries.

Leslie Packer PhD   
Ugh. Sadly, that's all too common.

ciao_bella   
Do you have any creative suggestions for educating a high school student with bipolar? It seems no matter what, the student with BP is easily overwhelmed and frustrated. Any thoughts beyond the normal, frequently recommended accommodations? For example: independent study in combination with reduced class load, and maybe even a class at a community college, etc. I'm constantly trying to think outside the box for ways he can be successful. I'm open to anything!

Leslie Packer PhD   
One of the things I do in educational planning for children and teens includes asking THEM what they think will work for them. I often use a "magic wand" question like, "If I had a magic wand and could make one thing better for you in school, what would it be?"

There's no one strategy that will work for all high school students with bipolar. I'm not even sure what you mean by "normal accommodations," because I would bet that most kids with BP are not getting all of the accommodations they really need. If a student is getting easily overwhelmed and frustrated, that suggests to me that they are NOT getting the right accommodations or enough of them.   
 
joanfisher   
Many families seem to have trouble getting their schools to listen to them, or to their doctors, or even to residential treatment center transition plans. How can you communicate with the home school that services are needed if they just say, "we can't do that because we don't have the money."

Leslie Packer PhD   
If you are in the U.S., my understanding is that it is flatly illegal for them to use that as a reason not to provide needed services. That said, they are probably telling the truth — that they need to watch the budget. One of the strategies I have used over the years is to have the M.D. on the case write a letter of "medical necessity." We have trained physicians not to write "It would be helpful," but to write, "It is medically necessary." Some schools still will try to ignore a physician's letter, but it makes it harder for them. And of course, parents always have due process rights, which includes the right to written notice for any service or request they are denying.    

Carolyn   
My daughter has always been a target of bullies. The usual suggestions about how to cope don't help/work for her. Do you have any ideas?

Leslie Packer PhD   
She shouldn't have to cope with bullying. The school needs to meet their responsibility to provide a safe environment for all students. Sometimes bullying can be reduced by peer education, but if there is a climate of bullying, then the approach needs to be building-wide. Has the school implemented an anti-bullying program?

One of the things I do is to document the problem and send it up the chain. Creating a written record of the problems may cause some administrator to realize that they could be in legal jeopardy of a lawsuit if they do not address the problem, but the bottom line for me is that it is the adults' responsibility — not your child's — to deal with the bullying.
Carolyn   
Oh yes, and they have been receptive to my input. Often the bullying is very sneaky or she doesn't want to say anything because of fear of repercussions.

Nanci - The Balanced Mind Foundation  
I think that's pretty common, so many of our families say that their kids are afraid to speak up or ask for interventions because they don't want to be viewed as a tattletale.

Leslie Packer PhD   
That's not specific to BP, either, Nanci.

Nanci - The Balanced Mind Foundation
Good point.

Nanci - The Balanced Mind Foundation
We have just a few minutes left, Dr. Packer are there any points you would like to share with our members that haven't been addressed in the questions so far?

Leslie Packer PhD   
Lets see.... OK, tip from Life's Little Lessons:

Leslie Packer PhD   
All those new clothes we love to buy our kids for the new school year? Forget it. On the first day of school, let your child go to school in older clothes that are comfortable and soft or well-worn. Unless they want to go in new clothes, of course!

Structure, routine, structure. Rinse. Repeat. If we keep lowering the bar or moving it, our children tend to do worse. Keep the bar and expectations high and help them get there.

I hope your children all have a great school year. :)  
  
Nanci - The Balanced Mind Foundation
Thank you so much for sharing your time and expertise with all of us this afternoon/evening (depending on your time zone). Just a reminder that you can submit general questions to Dr. Packer through her website  and watch for her book coming out shortly.

Leslie Packer PhD   
Thanks, everyone, and good luck.