My son is nine and has been diagnosed with bipolar disorder, ADHD, and OCD. When he is having one of his meltdowns what is the best way for me to help him through it?

An ounce of prevention is really worth a pound of cure. Try to develop a plan with him when he is not having a meltdown and write it down. Talk about what you’ll do and say, what you’ll want him to do, and what others in the family should do when the next meltdown occurs. List the possible triggers, such as being hungry, having a game interrupted, not getting some expected treat, or reactions to a certain parental tone of voice. List what the first signs of the meltdown usually are, such as a wild look in his eyes, moving around a lot, an angry tone of voice, speech that speeds up, cursing, and standing up when he usually sits. Make sure you put your written plan in a place where you can all see or easily find it.

Prevention may not always work. At the beginning of the escalation, he may still have some access to his own calm or “wise” mind, so try to problem-solve. Calmly say something like, “Sounds like we’re starting to go down that difficult road again. Let’s think about what we can do to keep from getting into it like we have before. Do you need some time alone? Are you hungry? Should we go for a drive and get out of the house for a while?” If his meltdown is related to something like not being able to keep playing video games, say “I know you want to keep playing. I don’t always want to stop and have dinner either. But it’s the only time we can all eat together, so let’s meet each other halfway. What do you suggest we do?”

Avoid giving him a list of instructions. If he has ADHD he won’t do well with “I want you first to get out of those clothes and take a bath. Then come down stairs and set the table, we’ll have dinner, but don’t leave right after we’re through because I’ll need help with the dishes.” He could lose control just because he’s not able to keep track of all those steps.

It’s not necessary to let him have his way every time and, in the long run, that can be a bad idea. Stick with your position, but try to understand (and show you understand) how he feels.  Monitor your own tone of voice, and don’t encourage others to intervene. Remember the adage “Don’t let your kid’s mood dictate everyone else’s mood in the household.” Kids get more riled up when they sense their parent is losing control.

I hope this has been helpful. Ross Greene’s classic book, The Explosive Child, includes more information about these and other techniques.

About the Doc

About the Doc

David Miklowitz, Ph.D., is Professor of Psychiatry and Director of the Child and Adolescent Mood Disorders Program at the UCLA School of Medicine. He has been conducting research in psychosocial treatments for patients with bipolar disorder since the mid-1980s. A previous winner of DBSA’s Gerald Klerman Senior Investigator Award, he is the author of The Bipolar Disorder Survival Guide; The Bipolar Teen: What You Can Do to Help Your Child and Your Family, and most recently, Clinicians’ Guide to Bipolar Disorder with Michael Gitlin, M.D.

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