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Parenting Among Mothers With BipolarDisorder: Children's PerspectivesMeenakshi Venkataraman aa West Virginia University, Morgantown, West VirginiaPublished online: 22 Mar 2011.

To cite this article: Meenakshi Venkataraman (2011) Parenting Among Mothers With Bipolar Disorder:Children's Perspectives, Journal of Family Social Work, 14:2, 93-108

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Parenting Among Mothers With BipolarDisorder: Children’s Perspectives

MEENAKSHI VENKATARAMANWest Virginia University, Morgantown, West Virginia

Four children from three families in which the mother had abipolar disorder were interviewed to understand their perspectiveson their mothers’ parenting. Children identified strengths in theirmother’s parenting, such as helping them with homework andmoods and providing for their wants. They also identified chal-lenges, such as mothers sleeping well into the day and displayinganger. Two children were worried over the possibility of having abipolar disorder themselves. Implications of these findings forsocial work practice include acknowledging and supportingmothers’ strengths in parenting, providing appropriate services tomanage mothers’ sleep and anger, and psychoeducation forchildren.

KEYWORDS bipolar disorder, children’s perspectives, parenting

Bipolar disorder is a severe form of mood disorder that affects approximately5.7 million adult Americans (National Institute of Mental Health [NIMH],2010). Symptoms of bipolar disorder, such as fluctuations in mood, can affectall activities of daily living. Parenting is one such activity of daily living,requiring complex competencies, that can be affected by bipolar disorder.Baumrind (1967) measured parenting competencies in her study on parent-ing styles, including disciplinary strategies, warmth and nurturance, clarity ofcommunication, and maturity. More recently, the U.S. National Library ofMedicine and the National Institutes of Mental Health (2009) identified pro-viding safety, affection, discipline, listening to the child, spending time withthe child, monitoring his or her activities, and being a good role model assome of the characteristics of good parenting.

Address correspondence to Meenakshi Venkataraman, West Virginia University, B15Knapp Hall, Morgantown, WV 26506. E-mail: Mevenkataraman@mail.wvu.edu

Journal of Family Social Work, 14:93–108, 2011Copyright # Taylor & Francis Group, LLCISSN: 1052-2158 print=1540-4072 onlineDOI: 10.1080/10522158.2011.553781

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Faulty parenting styles can affect child behavior. For example, Baumrind(1967; as cited in Neal & Frick-Horbury, 2001) indicated that authoritarianand permissive parenting can instill characteristics such as low self-esteemor immature behaviors in children. Insecure attachment between motherand child is another problem in parenting that can increase risk of academic,behavioral, and emotional problems in children (Irons, Gilbert, Baldwin,Baccus, & Palmer, 2006; Perry, 2009). Moreover, problems instilled in child-hood may continue well into adulthood. For instance, Rothrauff, Cooney,and An (2009) found that adults who remembered having authoritarianand uninvolved parents had lower psychological well-being and higherdepressive symptoms in adulthood. Therefore, understanding parenting inpersons with bipolar disorder is important.

This article presents children’s perspectives on parenting from three fam-ilies in which mothers had a bipolar disorder. Obtaining children’s perspectiveson their mothers’ parenting provides amore holistic understanding of parentingamong mothers with bipolar disorder. The recent growing body of literature onparenting among mothers with severe mental illness (Ackerson, 2003; Bassett,Lampe, & Lloyd, 1999; Diaz-Caneja & Johnson, 2004; Mowbray, Oyserman,Bybee, MacFarlane, & Rueda-Riedle, 2001; Nicholson, Sweeney, & Geller1998; Sands, 1995) predominantly focuses on the mothers’ perspective only.

REVIEW OF LITERATURE

Several studies involve children of mothers or parents with severe mental ill-ness (Abbott, Dunn, Robling, & Paykel, 2004; Aldridge, 2006; Duncan &Browning, 2009; Hipwell, Goossens, Melhuish, & Kumar, 2000; Kahn,Brandt, & Whitaker, 2004; Mason, 2004; Ostman, 2008; Scherer, Melloh,Buyck, Anderson, & Foster, 1996; Schreier, Wittechen, Hofler, & Lieb,2008). Some of these studies document the behavioral and emotionalproblems of children who have mothers with a severe mental illness. Forinstance, higher incidence of anxiety disorders has been identified inchildren of mothers with severe forms of generalized anxiety disorder orsocial phobia (Schreier et al., 2008).

Other studies have attempted to understand the development ofpsychopathology, and to a lesser extent, resilience to psychopathology inchildren whose mothers have a serious mental illness. For instance, Hipwellet al. (2000) found that infants of mothers with depression exhibited insecureattachment patterns. Similarly, Hobson, Patrick, Crandell, Garcia-Perez, andLee’s research, as cited in Macfie (2009), found that infants of mothers witha borderline personality disorder exhibited disorganized attachment patternstoward their mothers. Another study found that presence of mentallyhealthy fathers can buffer the effects of mother’s mental health problemson children’s behavioral and emotional problems (Kahn et al., 2004).

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Other studies discuss adult outcomes of children with a mother withsevere mental illness (Abbott et al., 2004; Duncan & Browning, 2009) andpersonal reports of adult children of mothers with severe mental illness(Mason, 2004). However, only three studies were found that addressed chil-dren’s perspectives on parenting among mothers with severe mental illness.Scherer et al. (1996) conducted a study on predominantly poor, AfricanAmerican families to understand how 8- to 12-year-old children’s perceptionsof their severely mentally ill mothers affected the children’s psychologicaladjustment. They found that children who perceived their mothers as havinga more discouraging style of parenting experienced problems inself-confidence. However, they also found that these children rated theirmothers as experiencing less psychological distress compared to the mothers’own ratings.

Young children who were carers of their severely mentally ill motherswere interviewed as part of a study conducted by Aldridge (2006). Thesecarers reported that, in spite of their care giving roles, they continued to haveappropriate mother–child relationships. To understand the children’s lifesituation, Ostman (2008) interviewed eight children between ages 10 and18 who had one parent with a severe mental illness. Children reported thatthey loved their sick parent unconditionally, gained maturity because ofhandling difficult situations, understood the parenting limitations of theirsick parent, needed someone to converse to about their experiences, andexperienced stigma.

Literature on children of mothers with bipolar disorder specificallyalso covered aspects, such as the psychosocial outcomes of such children(Anderson & Hammen, 1993), or factors, in addition to the mothers’bipolar disorder, that led them to develop psychopathology, such asexposure to higher stress or presence of clinical disturbances in psycho-logical tests (Adrian & Hammen, 1993; Worland, Lander, & Hesselbrock,1979). However, there appears to be a lack of studies that exclusivelyexamined how children perceive parenting of mothers with bipolar dis-order. This article is a beginning to fill this gap, by providing children’sperspectives on the parenting of mothers with a bipolar disorder. Itspecifically attempts to answer the following question: What are thestrengths and challenges perceived by these children in their mother’sparenting?

METHOD

This article reports findings of a part of a larger study to understand parentingamong mothers with bipolar disorder and discusses relevant methodologyonly. It employed a qualitative research design involving face-to-face inter-views with children of mothers with bipolar disorder.

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Sampling and Data Collection

Convenience sampling was used to obtain the sample for the study. The selec-tion criteria included children of the mothers initially recruited for the largerstudy (fromcommunitymental health centers and support groups in andarounda small urban town in the Midwest), between ages 10–19, without a psychiatricdiagnosis, willing to participate in the study, and whose mothers provided per-mission for their participation. Three of the 10 families in the larger study metthese criteria, and four children from the three families were recruited. The chil-dren were age 10 to 15 and were fifth to 10th graders (see Table 1). The namesprovided for the children and mothers in this report are pseudo names.

Data were collected in 2004 and 2005, using semistructured interviewschedules prepared for the children just for the current study. This schedulehad predominantly open-ended questions covering areas such as socio-demographic details of the child and details on the strengths and challengesof their mother in parenting.

Children from two families were interviewed twice: an initial interview anda follow-up interview. However, one family had shifted their residence andcould not be traced for the follow-up interview. The initial interview involvedcollecting data using the semistructured interview schedule mentioned earlier.The follow-up interview was used to clarify information provided during theinitial interview and for a procedure to check validity of the findings. In this pro-cedure, each child was shown a summary, about a paragraph in length, of theirresponses to questions in the initial interview about their mother as a parent.They were asked to verify if the summary accurately represented what theysharedwith the researcher in the initial interview. All children reported that theirsummarywas, by and large, accurate. Further techniques to check for credibilityof the findings are provided in the Data Analysis section.

The interviews were confidential. All children were first reassured thatthe purpose of the interview was to understand parenting and to find waysto enhance their mothers’ parenting and not to find fault in the family. Theinterviews were audiotaped and lasted approximately ½ to 1 hour. For a1-hour interview, the child was paid $5.

Approval to conduct the study was obtained from the InstitutionalReview Board (IRB) of the University and the respective Community MentalHealth Centers. In accordance with the recommendations of the IRB, a planwas put in place in case the children got upset during the course of the inter-view. None of the children became sufficiently upset to warrant implemen-tation of this plan.

To contextualize the findings from the children, brief information on thesociodemographic characteristics of the mothers and the characteristics oftheir illness are provided: The mothers were in their late 30 s and early 40 s(see Table 1). All the mothers were educated, at least with a GeneralEquivalency Diploma (GED). Two of them were employed, one as a faculty

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TABLE1

Sociodemographic

CharacteristicsofChildrenan

dTheirMothers

Child’s

Pseudonam

eChild’s

Age

Child’s

Education

Mother’s

Pseudonam

eMother’s

Age

Mother’s

Education

Mother’s

Occupation

Fam

ily

Inco

me

Marital

Status

Andrea

11

5th

Jenny

39

Bachelors

Teacher

$3,900

Divorced

Robert

13

8th

Jenny

39

Bachelors

Teacher

$3,900

Divorced

Ricki

10

5th

Margaret

49

GED

Ticketagent

$700

Widowed

Angela

510th

Julie

42

GED

Student

$650

Unmarried

GED¼GeneralEquivalency

Diploma.

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in a community college and another as a ticket agent. One mother was a stu-dent enrolled in an online computer course. Reflecting their education andoccupation, their socioeconomic status ranged from lower to middle, withincomes of approximately $650, $700, and $3,900 per month. All motherswere single at the time of the interview, either widowed, divorced, or neverbeing married. Two mothers were breadwinners for the family. The familysize was three in two families and five in one.

All mothers were diagnosed with bipolar disorder, either I or II, and werestabilized with medication (see Table 2). The duration of their diagnosis variedwidely from about 5 to 15 years. One mother had been hospitalized in the pastfor this disorder. Twoof themothers had beendiagnosedwith a physical disease,such as diabetes or additional psychiatric disorders, such as panic attacks.

Data Analysis

The interviews were transcribed verbatim. The data obtained from the inter-views were analyzed using the technique of constant comparison of thegrounded theory methodology (Strauss & Corbin, 1990). In the process ofdata analysis, two levels of coding, open and axial, were done based onthe procedure discussed by Strauss (1987). The final products of the analysiswere main themes related to strengths and challenges in parenting.

Interrater agreement was conducted to check for credibility of thethemes. The transcript of one child’s interview and the codebook obtainedfrom the analysis were shared with a colleague with a mental health back-ground, who independently coded the interview. The agreement betweenthe codes was 100%. In addition, a peer debriefer, with experience in quali-tative research methods, checked the interpretations made of the interviewdata and corroborated 83% of them.

RESULTS

Strengths in Mothers’ Parenting

Five themes were identified by children as strengths in their mother’s parent-ing: being helpful, providing for their wants, having a good sense of humor,setting good limits, and being available whenever they need them.

TABLE 2 Illness Characteristics of Mothers

Mother’sPseudoname

Mother’sDiagnosis

Duration ofDisorder

PastHospitalizations

AssociatedConditions

Jenny Bipolar II 5 No YesMargaret Bipolar I 15 Yes NoJulie Bipolar I 7 No Yes

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HELPFUL

Three children from two families reported that their mother helps them withhomework or any problems they face.

She is helpful, she is usually nice, and she does a lot of things forme . . .Take me to store or buy me something to eat. . . . She just helpsme like with my school work and stuff. (Ricki, 10-year-old daughter ofMargaret)

When she can tell I am annoyed or angry or something, when I wentmoping around the house or something, she will tell like, ‘‘Hey, what’swrong?’’ And we might talk about it for a while, and she will assureme it is ok or whatever . . . that’s all there really is to it, you know, itsnot to say in like a bad way, but, you know, it is really nice to have,you know, a person who can comfort, you know, in times when you[are] scared, angry, or afraid. I already said scared . . . that’s why she isspecial to me because she can cheer me up like that. (Rob, 13-year-oldson of Jenny)

If we have a problem she will help us with it. Like once Ihad to return a report about Amelia Earhart and I didn’t think Icould do it and she said I could work on it later when I wokeup in the morning if I woke up early and I did and I got it fin-ished and I got a good grade for it. (Andrea, 10-year-old daughterof Jenny)

PROVIDES FOR CHILD’S WANTS

Two children from two families reported that they liked their mother becauseshe takes them out and buys them things they want.

Oh she is a good parent you know . . . she will take us out. (Rob,13-year-old son of Jenny)

GOOD SENSE OF HUMOR

Two children in the same family acknowledged that their mother had a goodsense of humor.

We might joke around a bit and kind of make fun of each other . . . like, ifshe likes country music and I don’t and I make fun of country music, andshe just laughs at it.

(Rob, 13-year-old son of Jenny)Well, when she is angry or sad, sometimes something funny

will happen, like something my brother says that will cheer her up(laughs) . . . she has a very good sense of humor. (Andrea, 10-year-olddaughter of Jenny)

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GOOD AT SETTING LIMITS

Two children from the same family indicated that their mother was good atsetting limits.

She knows the limits of the kind of movies I watch because there was thismovie called Science that my brother’s friend watch[ed]. And my brother’sfriend is like 15 and it gave him nightmares . . . and she told me I couldn’twatch that and that was understandable. But she said I could watch Jawsbecause I am really deep into animals. (Andrea, 10-year-old daughter ofJenny)

When my mom got divorced, it was really unique because their law-yers were really shocked . . . ‘‘You are going to let him take the kids out ofthe state?’’ . . . ‘‘Sure, [she said] I will let him take them out of the country.[They will] always come back.’’ and her lawyer was just like ‘‘What?’’(Andrea, 10-year-old daughter of Jenny)

I would saymay be a 7.5=10 . . .well if wewere arguing over somethingin one room . . .may be I just want some space and K���[sister’s real name] isin that room . . .mom might say, ‘‘Why don’t you move if you are so con-cerned,’’ and, you know, I oftentimes do. (Rob, 13-year-old son of Jenny)

BEING AVAILABLE

One child indicated that her mother was always available if the child and hersibling needed her. In addition, from the kind of answers all other childrenprovided about their mothers, it seems possible that they would also identifythis quality in their mothers, though they did not speak explicitly about it.

She is just, she is always there for us. If ever we need anything we cantalk to her about it no matter what happens we can tell her and she justlets us know that it is better not to lie [even] if there is something wrong.(Angela, 15-year-old daughter of Julie)

Challenges in Mothers’ Parenting

Three themes were identified by the children as challenges in their mothers’parenting, sleeping well into the day, anger issues, and other challenges(unpredictable moods and being dependent on children).

SLEEPING WELL INTO THE DAY

Three children from two families reported that their mother slept well intothe day, disturbing their weekend outings or their scheduled activities, suchas going out with friends or even sometimes going to school. One child, Rob,reported the average frequency of this behavior in his mother as once aweek. Another child Angela viewed the things she had to do, such as guard-ing her house when her mother slept, as a lot of responsibility. This response

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seemed to indicate role reversal to some extent. However, during thefollow-up interview, Angela reported that her mother was not sleeping asmuch any more. Andrea, another child who also mentioned this problemin her mother, also reported in the follow-up interview that her motherwas not sleeping as much.

Well, usually she sleeps really late most of the time, I mean, like until 1 or2 o’ clock in the afternoon. But during that time, it is really no big deal. Iwatch some movies in my room because I have a small TV that will playvideo, play some of my video games, and play with my toys. I have thishuge collection of dinosaur toys and little animals for them to eat.(Andrea, 10-year-old daughter of Jenny)

She will be up all night on the computer and she will sleep kind of allday . . . I will wake up, but she will still be up and she will want to take anap or something [during the day]. I will just let her sleep longer, I mean,I will stay at the house all day because I don’t want anyone to walk in oranything and I can’t lock the door because my sister is already gone andshe doesn’t have her key. It doesn’t really bother me, just feel like I havelot of responsibilities sometimes . . . I think that I would like to haveresponsibilities because I feel like needed but sometimes it is just likewow! (Angela, 15-year-old daughter of Julie)

Researcher: What are the things you think you would like changed in yourmom?

Rob: If she didn’t sleep so much, you know, its really, you know, moreannoying than terrible . . . like there is never been a occasion where shespent an entire day through without getting up once. . . .But maybe, likesay, she woke up really early, like say 8, maybe, and she went to bedsay around 1, ok, she is going to want to go back to bed . . .we go inand say ‘‘Hi mom, what time would you like to wake up?’’ . . . I will comeback whenever she said she wanted to wake up.

Researcher: How often does it happen, this kind of sleeping you know late?How often does it happen?

Rob: I would say once a week. Sometimes may be twice. But on an averageonce a weekend.

Researcher: So what do you do during that time when she is asleep?Rob: I kind of like having time alone. I am not that really social, you

know, sort of but not really that much, you know, I am more of a . . . Iwouldn’t say antisocial at all . . . but, you know, do you get where I amcoming from?

ANGER ISSUES

Two children from two families discussed their mothers’ anger issues as achallenge. Rob discussed his mother losing her temper when he fights with

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his sister. Angela reported that her mother screamed at them, unproductively.She also thought that her mother’s screaming had increased as her motherbecame older.

Ok, where me and K��� [sister’s real name] are fighting, may be I wouldn’tgo ‘‘Stop it’’ (elongated tone), you know, I would go like, ‘‘Stop it’’ (shortand firm). I would like hold myself . . .break them apart. ‘‘You go to thatroom, you go to that room.’’ Often time[s] that is done, you know, it’swhen sometimes we really get mad at each other that she loses hertemper understandably so. (Rob, 13-year-old son of Jenny)

Its like . . . if we clean the house, we don’t clean it spotless, we justlike clean it enough so that it looks lived in, and sometimes she will startcomplaining, ‘‘You need to do this, you need to do this,’’ but then noth-ing gets done. Its like she has got to scream, and I wish she didn’t have toscream. And I wish we just like, if she starts and then may be we wouldfollow. I mean . . . if it is important she will clean, but otherwise she willtell us what to do. (Angela, 15-year-old daughter of Julie)

Other Challenges

UNPREDICTABLE MOODS

One child, Angela discussed her mother’s unpredictable moods. Angelareported that she sometimes felt on the edge and had to gauge her mother’smood before interacting with her.

That mood spike thing, one minute she will be all happy and the nextminute she will be ignoring you and trying to do your home work andI know that’s just me not her homework . . . I just kind of sit back andlisten to how she . . . reacts to [others], and then if I have something I haveto ask I ask . . . if she is in a good mood . . . [If in a] bad mood I really don’twant to ask her because her first word is going to be, ‘‘No.’’ I mean, evenif it is a small thing like ‘‘Can I take the dog for a walk?’’ ‘‘No’’ (laughs).

BEING DEPENDENT ON CHILDREN

Angela also reported that her mother experienced irrational fears and conse-quently was dependent on her children. Elaborating on her mother’s depen-dency, she reported how her mother was afraid to take a shower when alonein the house and wanted Angela to stay at home when she took her shower.

I will be wanting to go outside, she will [go] ‘‘Can you please just wait forme to take the shower?’’ And she won’t take [one for hours] and so I justfeel like, ‘‘Why do I have to be there . . . for you to take the sho-wer . . .Come on mom, Why don’t you take one on your own’’ (laughs).(Angela, 15-year-old daughter of Julie)

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Other examples of her mother’s irrational fears that annoyed Angelaincluded being scared to go to a big store or to go camping. These behaviorsalso indicated role reversal to some extent. In addition, Angela seemed tostart believing that taking a shower alone can be a scary thing. In thefollow-up interview, she narrated an incident of taking a shower alone andhow it could be a ‘‘big responsibility sometimes.’’

In summary, children did identify strengths and challenges in theirmothers’ parenting. Overall, they viewed their mothers as a good parent. Theydid not perceive livingwith their mother as anything out of the ordinary for themost part. For instance, when Robwas askedwhat hewould like to tell profes-sionals about living with a mother with bipolar disorder this is what he said:

She has probably had it longer than you have been alive, and so youhave probably actually grown up with except you haven’t known itand so can I go make a big deal about nothing? . . . .There aren’t thatmany drawbacks to it, you know, if they are medicated . . . . So it is prettymuch the same as a regular parent. I have gone over to other people’shouses and they treat exactly the same, except mainly they are up a bitearlier. (Rob, 13-year-old son of Jenny)

Other Finding

FEAR OF HAVING OR GETTING THE DISORDER

Two children from two families worried that they themselves had or maydevelop a bipolar disorder. When Andrea was asked about the possibilitythat she had or might acquire a mood disorder herself, she responded:

Actually, I am not concerned because it makes me who I am and it makesme a unique kind of person, who wishes to be an astronaut, even thoughshe wishes she does not go through the torment of military training.(Andrea, 15-year-old daughter of Julie)

A little later she added the following voluntarily: ‘‘Well, which is some-times I act really different and well I just think, well I inherited a bit of hermood disorder. It is inheritable.’’

She seemed anxious when she spoke these words. She also reported herbrother commenting that she might have a mood disorder. Her verbal andnonverbal behavior showed that she was concerned about having a mooddisorder and she used a lot of defenses to handle these fears.

DISCUSSION

Overall, as mentioned earlier, children in these families rated their mothers asa good parent. In fact, most children rated their mothers’ parenting more

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positively than did their mothers themselves (Venkataraman & Ackerson,2008). Similar finding was reported by Scherer et al. (1996). The reason forsuch ratings by children may be because their mothers do have some positivecharacteristics, or their relationship with their mothers is important to themregardless of their mother’s parenting practices. Alternatively, it might alsobe that the children know no other ways of parenting and, to them, theseparenting behaviors are normal; or that they feared the possibility of beingreported to the child welfare agency, if they were more open.

Ostman (2008) found some evidence in support of the view thatchildren loved their sick parent unconditionally, based on his interviews ofchildren who have one parent who was severely mentally ill. Nevertheless,children’s positive rating of their mothers’ parenting reiterates the importanceof mothers to these children and lends support to the idea prevalent in theliterature that children are affected when they are separated from their par-ents, even if it is to prevent the children from harm (Jones, Macias, Gold,& Barreira, 2008). Thus, taking into account the importance of a mother’srelationship to a child is necessary in custody decisions.

The strengths children identified in their mothers included helping withtheir homework and any problems the children face, buying them things,being available for them, having a good sense of humor, and being goodat limit setting. In their interviews, the mothers in all these families corrobo-rated that they loved their children and gave priority to their children’s needsover their own (Venkataraman & Ackerson, 2008). Although the last twostrengths identified by the children were in one family only, it is possible thatother mothers with bipolar disorder possess them as well. In fact, thesestrengths were reported by other mothers interviewed in the larger study(Venkataraman & Ackerson, 2008).

These strengths are obviously similar to behaviors one would expect inany average parent in a ‘‘normal’’ family. These findings show that bipolardisorder in mothers does not automatically mean poor parenting. Identifyingand using such strengths in helping mothers counter their challenges in par-enting can be one way to intervene and is consistent with social work’sstrengths perspective (Saleebey, 2006).

The children not only identified strengths, but identified some chal-lenges as well, in their mothers’ parenting. All of the challenges identifiedwere corroborated by their respective mothers in their interviews as well(Venkataraman & Ackerson, 2008). One challenge was anger issues, ident-ified in two families. The association of bipolar disorder and anger is notunknown; irritability and anger are symptoms characterizing manic anddepressive phases. Moreover, some proposed models to explain psychopath-ology associate bipolar disorder or manic and hypomanic episodes with thetrait of anger (Harmon-Jones, Abramson, Bohlig, Hogan, & Harmon-Jones,2002; Lara, Pinto, Akiskal, & Akiskal, 2006). In addition, negativity and irrita-bility in mother–child interactions have also been found in mothers with

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bipolar disorder and their school age and adolescent children in previousstudies (Inoff-Germain, Nottelmann, & Radke-Yarrow, 1992, 1997). Copingwith anger could be an area that mental health professionals need to addressin their parenting programs to help mothers with bipolar disorder.

Second, sleeping in the daytime was identified in two families. Issueswith sleep could be another aspect that needs to be addressed in any parent-ing program for mothers with bipolar disorder. It would be beneficial toexplore the reasons for such sleep patterns and figure out strategies to copewith any sleep-related issues. For instance, providing education on the nat-ure of sleep and our body’s innate nature to strive toward homeostasis inall its functioning, including sleep, could be helpful. Maintaining a sleep rou-tine has also been found to have beneficial effects on the outcome of bipolardisorder (Frank et al., 2005).

Other challenges identified in one family included the mother’s unpre-dictable moods and being dependent on children due to irrational fears.Unpredictable moods can be seen as another expression of anger. This prob-lem can be present in other mothers with bipolar disorder as well and needsto be addressed in parenting programs. Being dependent on the children, inthis case, indicated role reversal. In addition, it seemed to also interfere withthe child’s healthy psychological growth. Such situations are important toaddress in any parenting program. However, the literature indicates rolereversal in children may (Ackerson, 2003) or may not (Aldridge, 2006) leadto inappropriate mother–child relationships.

The worry that children had about acquiring or having already acquired abipolar disorder themselves is important to address because it can interfere withthe children’s confidence andmood and could continue to affect their function-ing in the long-term. Psychoeducation programs for children can help them bet-ter understand bipolar disorder and to learn to better cope with their anxieties,and the disorder itself, should they develop one. The need to include the wholefamily in parenting programs has been emphasized in the literature (Aldridge,2006; Fudge, Falkov, Kowalenko, & Robinson, 2004; Ostman, 2008).

Although the current study is based on a very small sample andexplored only limited aspects of the parenting practices of mothers withbipolar disorder, it does provide preliminary insights into parenting as per-ceived by these mothers’ children. These findings also suggest some servicerecommendations. Further studies with larger samples are required tosupport and expand these findings and recommendations.

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