A variety of approaches to bipolar disorders that are therapeutic but that do not rely on talk as the primary principle. These include bodywork, light therapy, and other interventions that you may hear about. Most of these are considered alternative medicine by psychiatrists and psychologists--although many professionals support or even recommend trying them.

For bipolar children, certain other interventions that use the word "therapy" may also be recommended, based on individual symptoms and needs. These have been used for many years to help children with other neurological problems, and have been effective for some people with bipolar disorders as well. They include:

• Auditory integration training
• Occupational therapy
• Sensory integration
• Speech therapy

Auditory integration training

Some children with unusual sensitivity--or lack of sensitivity--to sounds or types of sounds have found relief with auditory integration training (AIT) or auditory processing stimulation, both relatively new approaches.

Although it's rarely addressed in the medical literature, extreme auditory sensitivity is actually fairly common in people with bipolar disorders. These patients will describe many normal sounds as affecting them like fingernails scraping a blackboard. Naturally, this distortion can increase a child's level of anxiety and discomfort, make school more difficult, and encourage him to withdraw from social contact.

Many audiologists (hearing specialists) and other professionals can test for auditory sensitivity and offer therapeutic treatment. Based on principles first developed by French audiologist Guy Bérard, AIT involves listening to particular sounds through earphones. The process is believed to retrain the hearing mechanism, and there is some evidence that it is effective for many patients. A similar therapy is called the Tomatis method.

The most dramatic results from AIT have been in people with autism or related disorders. You can learn more from the Society for Auditory Integration Training or through the Autism Society of America.

Strides are also being made in auditory processing stimulation and other auditory therapies for those who seem to have problems in differentiating and processing sounds.

Dance, music, or art therapy

There is no proof that dance, music, or art therapy has curative value for people with bipolar disorders, but these activities often draw out hidden talents, bring a sense of joy and accomplishment, and help young children communicate nonverbally. They may be a part of a play therapy program, especially for older children. Sometimes dance, music, or art therapy is integrated into hospital or day-treatment programs.

Occupational therapy

Occupational therapy (OT) is intended to help people with fine motor skill problems or other impediments improve their ability to perform daily activities, ranging from walking to writing. Because young children with bipolar disorders sometimes have an erratic pattern of development due to their illness, occupational therapy may be recommended to address specific problem areas.

If the focus of OT is on school-related skills, such as handwriting, it should be available at no charge through your Early Intervention program or school district. OT services can be delivered via consultation with the child's teacher, or directly to the child within the classroom or in an office.

Another type of OT focuses on self-care skills, vocational skills, esteem-building activities such as arts and crafts, and therapeutic exercise. Your child may have this kind of program in day treatment or in a hospital, or you might ask that it be added to her school program. This form of OT can be especially useful as part of transition planning in the teen years.

Sensory integration

Sensory integration (SI) is a specific type of occupational therapy that can be invaluable for people whose sensory systems are unbalanced. Like the auditory processing problems described earlier in this chapter, sensory integration difficulties seem to be more common in people with bipolar disorders than the literature would indicate. These can include over- or undersensitivity to smell, taste, texture, types of touch, and even the forces of gravity.

Sensory integration therapy can help reduce or enhance sensitivity levels as needed. It is used with increasing frequency for children with other neurological problems, including cerebral palsy, autism, and ADHD, but has rarely been offered to bipolar children. If your child has symptoms of sensory dysfunction, ask about SI.

In bipolar disorders, sensory disturbances can be cyclical. A person in a manic phase may find that she has a heightened response to certain types of sensation. This increased sensitivity may be perceived as pleasurable, but in some cases it can be painful. Bipolar children seem to be especially sensitive to sensory input when they are in a depressed-irritable state, sometimes to the point of being unable to wear their usual clothes (jeans and socks are suddenly too scratchy), eat their regular diet (everything smells gross, tastes weird, and makes them feel like retching), or handle a normal level of sensory input (the sounds and smells of school or the shopping mall become rapidly overwhelming).

Occupational therapists who know about SI use simple techniques to retrain the body's sensory apparatus. These can include brushing and joint compression, exercises that improve and strengthen the sensory part of the nervous system, and targeted work on specific sensory difficulties. Much SI work does not require any special devices, or employs inexpensive items like stretchy strips of rubber for arm exercises or weighted vests for calming. Many SI specialists do use occupational therapy equipment, such as scooter boards, huge therapy balls for improving balance, and prone-position swings.

One area in which SI techniques really shine is helping children with eating problems. If your child limits her food choices to a very few items, sensory problems can be at the root of this potentially unhealthy behavior. Certain textures and tastes may simply be unbearable. It is possible to desensitize the nerve endings in the mouth and throat enough to permit eating more types of food, and even desensitizing the taste buds a bit can be done.

SI specialists recommend making a sensory diet part of the classroom and home environment for children with difficulties. This means building experiences with different types of textures, tastes, smells, and physical sensations into daily activities. The Out-of-Sync Child, by Carol Stock Kranowitz, which is listed in the appendix, can provide some suggestions for home exercises.

SI therapists can also teach patients how to use self-calming activities and devices when they are reaching the point of sensory overload. Parents can be trained on the signs of sensory difficulties and on how to initiate these activities.

Speech therapy

Speech defects such as apraxia, dyspraxia, stuttering, or cluttering occur slightly more often in people with bipolar disorder. However, as far as medical science knows, these are a separate problem.

If your child has problems with producing understandable speech, he should be evaluated as early as possible. Speech therapy can be tremendously helpful. Provide his speech therapist with information about bipolar disorders in children so that his behavior will be better understood, and provide suggestions for structuring speech sessions to minimize behavior problems and maximize compliance. Token economies and other reward systems are widely used by speech therapists, and can help a lot. Short, frequent sessions may be more effective than long, infrequent ones. Your child may perform better in one-on-one sessions than in a speech group. Also, as at home and in the classroom, the rules for speech time should be clearly delineated.

Problems with prosody (speech flow and conversational skills) and volume are seen rather often in bipolar children. Children with these difficulties are less likely to be referred to a speech and language specialist than are children who cannot produce certain sounds or who stutter, but they can benefit nonetheless from speech therapy. Make sure the evaluator or therapist your child sees for these difficulties knows these topics well--not all speech specialists have expertise in these areas.

Prosody problems lend themselves best to group work. If your child's speech is consistently too loud or too soft, one-on-one work seems to be most effective, often using a tape recorder and other tools in order to encourage self-observation and to build skills for assessing and using proper speech volume.