| For Your Child's Teacher What a teacher should know about Bipolar Disorder in Children and Teen |
Bipolar disorder is a genetic disorder that affects a person's moods, sleep and wake cycles, and executive functions. It is a spectrum disorder with some people only having mild symtoms while others can have very severe problems and require medication. It affects about 1 out of every 100 people. In children and teens both depression and manic episodes can occur at the same time throughout the day. Without proper medication they are very emotionally unstable. Some may have psychotic episodes during manic cycles. It may take several months to a couple of years to find the right combination of medication that will stop the mood swings and not sedate the child at school or home, allowing the child to have a more normal life. Bipolar disorder does not go away as the child or teen grows older. The cycling pattern may or may not change but the severity may lessen if on medication and in a structured environment. Bipolar disorder can have accompanying (comorbid ) disorders such as anxiety disorder, ADHD, and conduct disorder. Bipolar disorder can affect the way a person thinks and reasons (executive functioning) so that learning and social skills are affected. Some bipolar children and teens have auditory and/or visual field/ground problems. They also may have some sensory integration problems. School is important because it is a structured environment. Bipolar children and teens begin to heal in a very stuctured environment so they need a classroom setting that is very structured. They appear to have ADHD like symptoms because the same areas of the brain, the prefrontal cortex is affected. This means that these children may have problems with starting a task, stopping a task, sticking with it, changing jobs/settings/activities, organizational skills of time and things, and understanding cause and effect. They may also have problems with active working memory. Field/ground problems means that whole class instruction may be more difficult for them and they may prefer small group instruction or one-on-one. As the teacher, your student may or may not have a 504 or be in special education. It is important to remember that behavior problems and academic problems stem from the disorder. As the student becomes more stable he or she is better able to control his or her behavior. Patience and calmness is important as the teacher becomes the student's "executive" and provides the structure and guidance until it can be established. Anxiety Problems - The bipolar student with anxiety problems may need more support in handling such issues as separation anxiety, or concerns about peer relationships. Being able to express oneself is important to avoid "meltdowns." A time alone with the teacher, or an opportunity to write or draw a picture about the problem may help. Organizational Skills - Teaching and reinforcing organizational skills is important. That includes how to organize and keep organized the student's binder, bookbag, and desk and how to keep track of assignments. Remember homework may be very difficult to do if the child or teen is having a rough time in the evenings. Writing may be affected because it requires organizational skills. The student may need to learn how to use graphic organizers for prewrite activities. Shifting Skills - The predictable structure of a classroom will help. Make sure that the student clearly understands what is going to happen, and give a warning before the change ie. "We will change groups in 5 minutes. Start cleaning up now." Initating Skills - Beginning a task by him or herself may be difficult. Working in a small group or with the teacher may help. Check for on-task behavior. Encourage and praise when you see good effort. Social Skills - Social skills may be a problem for several reasons. The problem of peer acceptance when the child or teen is unstable can be a real concern. The child or teen may not have developed good social skills because of executive dysfunctioning. This can affect understanding the cause and effect of one's actions. It may also be because the child or teen doesn't process well auditory or visual information with peers or may have poor non-verbal skills. Sleep/Wake problems and Medication problems- Problems with medication causing sedating may be a problem for the student who is constantly falling asleep in class. The medication can affect the student's processing rate and ability to remember skills taught. Bipolar children and teens may also have a problem with the sleep/wake cycle in that they find it hard to get up in the morning and go to sleep at night. Distractions - Staying on Task Auditory and visual field/ground problems means that noise and visually stimulating walls may be too much. These students prefer a quiet environment with little movement in the room. Sucking on hard candy or chewing gum may actually help them focus better and remember skills taught. They stay attentive if they are interested in the subject, it is broken down into small parts and clearly presented. Check frequently for understanding. One of the important goals will be to teach and reinforce self-worth, and then self-discipline. Medication compliance with teens may be a big issue as some of the medications may also cause weight gain and nauseousness. The child and teen will have their self-esteem shaken by the depression/manic episode/s. Building self-worth is important. Developing self-care and then self-discipline is a slow process. At times it may seem there is little or no progress or there is only baby steps. Be patient and encouraging because your role is so important in the well being of the bipolar student. |