Chat With Tracy Anglada and Sheryl Hakala M.D.
The Balanced Mind Foundation Live Event Transcript

Did you miss our chat withTracy Anglada and Sheryl Hakala? 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

Tracy Anglada

Tracy Anglada is the founder and president of BPChildren (http://www.bpchildren.com/), an organization dedicated to providing information and resources to children with bipolar disorder and their families.

Dr. Hakala is a child and adult psychiatrist providing psychotherapy and pharmacotherapy. Most recently, Ms. Anglada and Dr. Hakala co-authored The Childhood Bipolar Answer Book: Practical Answers to the Top 300 Questions Parents Ask.                                  

Nanci-The Balanced Mind Foundation
We are delighted to welcome Tracy Anglada and Sheryl Hakala, MD as our guests for today’s chat. Dr. Hakala and Ms. Anglada, would you like to make any opening remarks?

Tracy Anglada  
Thank you for inviting us to chat with the community today. It’s very nice to be here with you.

Sheryl Hakala MD  
We are very excited to participate in this chat today. Thank you for having us.

Nanci-The Balanced Mind Foundation  
Could you start out by telling us a little about your latest book, how you came up with the 300 questions, what areas of the book you feel would be of most interest to our members?

Tracy Anglada  
Frankly it was no problem to come up with 300 questions. As a parent and doctor team we really are on the front lines of dealing with this illness daily.

Sheryl Hakala MD  
Yes, we could have written two whole books on this topic. I think this book offers very practical hands on information for the reader.

Chrisa_H  
Like many others, we have had more med changes over the past three years than I can count. What ways can you help manage the stress - on the child and the parent - of the swings in mood, side effects, etc. during medication changes?

Tracy Anglada  
Medication changes can be very stressful. To reduce stress having support is really vital.
Organizations such as The Balanced Mind Foundation and support groups such as NAMI can be helpful but also using a therapist of your own can help you deal with these bumps in the road.

Sheryl Hakala MD  
Yes, I agree. It is also important to make sure that you do monitor your stress so that there is no push to make any unnecessary changes.

SunWillShine  
I've read that the teen years presents some unique challenges for families of bipolar children, as well as for the kids themselves! How can I prepare for my child's teens (and what can I do to help my child be ready for the changes she'll go through)?

Tracy Anglada  
It's never too early to start. First off not hiding the diagnosis early on and being very open and honest can give you a good basis before you ever get to those teen years

Sheryl Hakala MD  
I think it is important to provide as many avenues as possible for your child to feel normal. Involve your child in organizations or youth groups if possible. Also, it is important to make sure you have regular checkups with your pediatrician to make sure you stay informed about hormonal changes that can occur.

Tracy Anglada
Also not overly worrying about the teen years. Every child is different and with growth sometimes come maturity.

Nanci-The Balanced Mind Foundation  
Can you expand a little on the hormonal changes? Often it's hard to know what is normal 'teen' behavior and what is BP. Also, do things settle down a bit after puberty?

Tracy Anglada  
It can be hard to tease out the difference between a teenager pushing limits and symptoms of bipolar disorder. The thing with the teen years is a teen with bp still has all the same issues except multiplied over.

Sheryl Hakala MD  
Girls sometimes will have increased moodiness as they are closer to time of menarche and will sometimes have increased risk for exacerbations of mood with monthly hormonal changes. Hormonal changes sometimes can cause mood exacerbations in boys as well.

tiredmom  
One of the things I struggle with is staying patient and supportive during the really difficult behavior periods with my child. What advice do you have for getting through the relentless screaming, indecision, mission mode, etc.? It completely wears us down.

Tracy Anglada  
Tiredmom, you are not alone. We all have those times where it is really difficult. So first give yourself a big pat on the back and know that you are human.

Sheryl Hakala MD  
I think it is important to keep in mind that your child is not doing this because of anything you did. There is no need to feel guilty although as a parent this is a hard thing to do. It is important to develop your own relaxation techniques so that you find your own calmness in the midst of the storm.

Tracy Anglada  
I agree 100% with Dr. Hakala. Some parents have found using positive statements over and over again in their head like a mantra is helpful or even envisioning yourself like a lighthouse of strength giving guidance to your child.

Sheryl Hakala MD  
It is also important to consider seeking out professional help for yourself. Even if you are just questioning whether or not you should do this, it would probably be a good idea to follow through, take some time and make your own appointment. The worst that can happen is that the therapist or mental health professional would give you a pat on the back and let you know you are doing your best.

Sandy  
What is the earliest age to suspect bipolar in a child? And if a child is gifted, can they be confused with Bipolar?

Sheryl Hakala MD  
Some clinicians are diagnosing as early as one year old. The youngest I have been able to diagnose in my practice is 5 years old. Certainly the symptoms can start younger than five.

Tracy Anglada  
Many children with bipolar disorder are gifted and sometimes both gifted and learning disabled at the same time. There are varying responses to this situation based on the level of knowledge that teachers have. Some actually deny that a gifted child can have bipolar disorder.

Sheryl Hakala MD  
I think that a gifted child can be confused with Bipolar because both may very creative and a gifted child may be irritable at times because they feel the weight of the world because they understand more than other children. The difference would be that the bipolar child's irritability will be more impairing than a child who is gifted without bipolar.

Tracy Anglada  
This is where you really need a trained professional to sort things out as well as educational testing so you know exactly how to address your child's needs.

Nanci-The Balanced Mind Foundation  
You make a good point about people denying that a gifted child can have bipolar disorder. I've heard comments such as "how can your child be in special education, she's smart". Not everyone realizes that special education services are for kids of all ranges of intelligence.

Tracy Anglada  
Nanci you are so right and many people fail to realize the impact that bipolar disorder has on cognitive functioning.

lizzee  
Can you recommend any books for parents on techniques for parenting a young (6 yrs old) child with bipolar disorder? In this case the mother is also bipolar - but fairly stable. Her daughter is defiant and "just won't take no for an answer”? Thanks.

Sheryl Hakala MD  
I do think that our new book is very helpful with parenting techniques. Also consider, The Explosive Child.

Tracy Anglada  
One thing it's really important for parents to recognize is the need to parent differently according to their child's mood states. In our book, we broke down the parenting differences in each mood state and how each state requires a different focus in order to move the child forward.

Nanci  
I really liked the chart you put together, it illustrates so well the need to use different techniques depending on the severity of your child's illness, and gives guidelines for what's important at each stage.

Sheryl Hakala MD  
It is not uncommon for children with bipolar disorder to be defiant. It is important to give them consistent, loving, stable limits and realize that sometimes you have to be a little more flexible than you would otherwise. Seeking professional help is also helpful if your child is particularly defiant.

Holly  
My child's very resistant to therapy; he refuses to go! If he's not cooperating, is it worth forcing him or would it do more harm than good?

Sheryl Hakala MD  
In this case, it is important to be a salesman. I think that actually reading books like, Getting To Yes, Getting Past No, and How To Talk So Kids Will Listen... would be helpful.

Sheryl Hakala MD  
You can give him choices to make him feel empowered. Would you prefer to go therapist X or therapist Y? Would you prefer to go to therapy on this day or that day? Would you prefer to go every week or every other week?

Also, it is important to keep in mind that most children are resistant to therapy. They would often rather play than see the therapist. Discuss this with the therapist and see what rewards would be appropriate for your child if your child attends a therapy session.
I hope that is helpful.

el kabong
In what ways can you impart to the child, as much as possible anyway, the importance of following their treatment, as opposed to only parents who often are raring to try whatever helps?

Sheryl Hakala MD  
There are thoughts in the psychiatric community that the less exacerbations of an illness that occur, the better the prognosis will be. If this is the case with Bipolar Disorder as well, ultimately the sooner the child is treated, hopefully the more successful life he or she will lead.

Tracy Anglada  
I think it's very important to help the child view bp as any other illness that requires treatment. If you take medication for high blood pressure or some illness compare it to that and you can even take meds together.

Also if a child doesn't see the need for treatment, remember that ultimately it is the parent who makes treatment decisions. And, a teenager may not see the need for treatment but will see the need to stay stable if it is tied to their freedom and such things as driving privileges.

Nanci-The Balanced Mind Foundation  
I think it's easier to gain compliance when the treatment regime is working. During the 'trial and error' phase where the right med combo has not yet been found, there is more likely resistance from the child who's feeling is “why should I take these meds, they aren't helping”.

Chrisa_H
It's hard to be a sibling of a BP kid, particularly during times of instability.  What can we do to help our non-BP kids see their sibling, and not the BP?

Tracy Anglada  
Yes it is very hard and important that we recognize that, but not view siblings as victims either.

Sheryl Hakala MD  
I think this is an important lesson for everyone to learn in life, that someone's current mental state does not define them as a person.

Tracy Anglada  
Having a brother or sister with bipolar disorder can greatly increase a person’s empathy and understanding for others. Education is an important key so that the siblings understand what is going on in the household.
I think that sib shops are a great resource. Also getting them involved in NAMI and reading books (such as Turbo Max or the Sibling Slam book) can also help.

Chrisa_H  
Yes, Dr. Hakala, I agree. But it's hard when your big brother or sister is screaming and raging and breaking doors.

Sheryl Hakala MD  
It is a very difficult situation and very scary for the sibling without BP. The sibling without BP may even be traumatized by the actions of the sibling with BP. This is trauma that may not always be able to be avoided.

Tracy Anglada  
One thing that can help is having a safety plan in place. If the sibling if very unstable it may be good for the well child to visit grandma's for a few days or a week to remove them from the situation.

Sheryl Hakala MD  
If this is occurring, safety plans must be made for both the siblings with and without BP. Professional help for the sibling without BP may be necessary as well to process the trauma.

Janine  
I like your comment that someone’s current mental state does not define them as a person. But how about the child with bipolar disorder with the "woe is me" attitude feeling very sorry for himself?

Sheryl Hakala MD  
I often tell people that their strengths and weaknesses are two sides of the same coin so when someone is very energetic, he or she can accomplish many tasks but those many tasks may get them in trouble at the same time. Someone who has difficulty staying focused on a certain task may have the gift of being very creative at the same time.

Tracy Anglada  
It is a fine line because sometimes the child with bp doesn't feel understood and then feels the need to emphasize their woes. So it's important for adults in the child's life to really be understanding while at the same time, like Dr. Hakala said, emphasizing the positive side of the coin. 

Tracy Anglada 
It will be very important for this child to have appropriate accommodations in school. Can he learn? Yes but he will have to be taught in a way that meets his needs. This may require a smaller classroom size or even a classroom aide to keep him on task.

Janine
What recommendations do you have for educational support for a child with bipolar disorder who also has untreated ADHD (because of the fear of triggering mania)?

Sheryl Hakala MD  
Sometimes ADHD symptoms may be treated in children with Bipolar Disorder with medications but this would have to be discussed with the treating psychiatrist. If medications are not able to be used, natural remedies such as fish oil or exercise may be helpful but this again should all be discussed with the treating physicians.

Tracy Anglada  
Also you may find that he learns better with a particular method. Knowing how he learns will be a huge help. If he is a visual learner or auditory learner then that method should be used. He may be very hands on or respond well to computer programs. Also sometimes they are taking in information and it amazes you how because it doesn't look like they are.

Sheryl Hakala MD  
Psycho educational testing is also very important in assessing any educational needs.

Nanci-The Balanced Mind Foundation  
We are just about at the end of our hour. I'd like to put through one last question if you have time?

Tracy Anglada  
Sounds good.

traceybelle  
Can you recommend resources for parents with bipolar disorder who are parenting kids with bipolar disorder? I have looked extensively and found very little.

Tracy Anglada  
I think you will find that many people right here at The Balanced Mind Foundation as well as places like NAMI are in the same boat. Parents many times share the same illness as their children. One of the best gifts you can give your child is maintaining as much stability as possible.

Nanci-The Balanced Mind Foundation  
Depending on the age of your child(ren) I can suggest one book that could be helpful for adolescents. The Bipolar Workbook by Monica Ramirez Basco is a great hands on workbook that can be used in full or in part. Going through some of the sections and material as a team might be helpful and supportive for you and your child.

Sheryl Hakala MD  
Bipolar Disorder is a genetic disorder in many respects. For example if one identical twin has the disorder, the other may have a sixty percent chance of having Bipolar Disorder. I think that this is a very important concern because with this type of disorder, many parents of children with Bipolar Disorder have the disorder themselves. This is certainly an area that needs to be better addressed by mental health professionals.

Nanci-The Balanced Mind Foundation  
I'd like to thank both Tracy Anglada and Dr. Hakala for sharing their time and expertise.  
You have both contributed so much to helping families and children and making the road a bit easier.

Sheryl Hakala MD  
Thank you very much. We enjoyed chatting with you!

Tracy Anglada  
Thank you for having us today. Wishing you all stability.