Bipolar disorder in adolescence: The effects of school life

-Author: Zoe Rodriguez

8/1/24

Introduction:

Bipolar disorder(BD), formerly known as manic-depressive illness, is a chronic mental health condition characterized by extreme mood swings, including episodes of mania and depression. While BD can affect individuals at any age, its onset often occurs in adolescence, a critical period for emotional and psychological development. The impact of bipolar disorder on any child is profound, especially concerning their academic performance and overall school experience.

Mania vs Depressive episodes:

Bipolar disorder in adolescents manifests in various unique forms that can be challenging to identify. Among the different variations of BD, the most prevalent types are bipolar I disorder and bipolar II disorder. Individuals with bipolar I disorder typically endure more severe manic episodes, referred to as hypomania. Hypomania, often described as a "high," is triggered by the excessive release of norepinephrine/noradrenaline. Symptoms of hypomania encompass bursts of energy, insomnia, impulsivity, and the emergence of a "god complex," among others.

Conversely, individuals diagnosed with bipolar II disorder exhibit contrasting symptoms, such as low energy, hypersomnia, sluggish movements/speech, and the development of an "inferiority complex." This type of BD is frequently misdiagnosed due to its symptomatic overlap with major depressive disorder. A common feature shared by both forms of BD is the significant mood swings between depressive and manic episodes.

Effects on school work:

  Children diagnosed with bipolar disorder often encounter significant academic obstacles. The disorder's symptoms can directly impede cognitive functions crucial for academic achievement, including concentration, memory, and executive functioning. Throughout manic episodes, students may display hyperactivity, distractibility, and poor judgment, making it challenging to concentrate on school tasks and adhere to classroom expectations. This can lead to submitting incomplete or off-topic assignments. Furthermore, the lack of focus during manic episodes can result in decreased academic performance and low grades.

Conversely, depressive episodes may result in absenteeism, lack of motivation, and compromised cognitive processing, further impeding educational success. Children grappling with these symptoms often struggle to persevere, leading to missed deadlines and incomplete work. The exhausting cycle of fluctuating energy levels induced by bipolar mood swings can be particularly draining for individuals grappling with the disorder, exacerbating the academic challenges they face.

Behavioral and social impact:

Behavioral effects associated with bipolar disorder can have intense repercussions on school environments, often giving rise to disciplinary challenges. When children are in a manic state, they may exhibit disruptive behavior, aggression, and an inability to adhere to rules, culminating in frequent conflicts with teachers and peers. These behavioral patterns can escalate to the extent of suspensions or expulsions, significantly derailing the academic journey of these students. Socially, children grappling with bipolar disorder frequently encounter difficulties in forming and sustaining relationships. The erratic nature of mood swings can alienate peers, leading to social exclusion and instances of bullying. As a result, these individuals may find themselves isolated, compounding feelings of loneliness and hopelessness. This cycle of social marginalization and emotional distress can further deteriorate their mental well-being and school experience, creating a challenging environment that hampers their overall growth and development. In addition to the immediate impact on their academic performance, these social and behavioral challenges can have long-term consequences on their social skills, emotional resilience, and mental health outcomes.

 Children grappling with these experiences often find themselves questioning their thoughts and behaviors. Bipolar disorder poses a significant challenge to both children and adults due to its inherently unpredictable nature. The diagnosis of BD is typically not made before the age of 18, leaving children with BD to navigate, understand, and adjust to their condition amidst a lack of clarity and guidance. In the absence of proper diagnosis and support, children frequently resort to developing unhealthy coping mechanisms to deal with their symptoms and behaviors. Regrettably, these coping strategies can inadvertently place the affected children and those around them in potentially hazardous situations. The absence of early intervention and appropriate management strategies can exacerbate the risks associated with the disorder, underscoring the critical need for timely diagnosis and comprehensive support systems for children with BD.

Support and Intervention

 Adequate support and intervention are crucial for mitigating the impact of bipolar disorder on adolescents' school performance. Early diagnosis and comprehensive treatment plans, including medication management and psychotherapy, are essential. Schools play a pivotal role in supporting students with bipolar disorder through individualized education plans (IEPs) or 504 plans, which provide accommodations such as extended time for tests, modified assignments, and a supportive learning environment. Mental health education and training for teachers and staff are also vital. Educators need to recognize the signs of bipolar disorder and understand how to manage its symptoms in the classroom. Providing a supportive and empathetic environment can significantly improve the educational experience for these students. Moreover, fostering a collaborative approach involving parents, teachers, mental health professionals, and students is critical to ensuring consistent and effective support. Open communication and a strong support network can help adolescents navigate the challenges of bipolar disorder and achieve their academic potential.

 Medications play a crucial role in managing bipolar disorder in children. Mood stabilizers such as lithium or valproate are commonly prescribed to help regulate mood swings and prevent manic episodes. Antipsychotic medications like risperidone or aripiprazole can also be used to control symptoms of mania or psychosis. These medications work by altering neurotransmitter levels in the brain to stabilize mood. However, it's important to note that medications for bipolar disorder in children can have various side effects, including weight gain, drowsiness, and metabolic changes. Regular monitoring by a healthcare provider is essential to adjust medication dosages and address any emerging side effects.

In some cases, a combination of medications may be necessary to manage symptoms effectively. It's crucial for parents and caregivers to closely observe their child's behavior and mood while on medication to track its effectiveness. Psychotherapy and behavioral interventions often complement medication treatment to provide comprehensive care for children with bipolar disorder. Overall, a multidisciplinary approach involving medication, therapy, and family support is vital to helping children with bipolar disorder lead fulfilling lives.

True testimony

 Warning: This story may be hard to read and has some triggering topics. 

  To truly put into perspective the effects of bipolar disorder in adolescence, I would like to share a member's story. They have chosen to be anonymous and will be referred to as "Az."

  " I was a lucky one, apparently, but it did not feel that way. I got diagnosed when I was 13. When I was talking to my psychiatrist, I knew what he was going to say, but it still hit me like a bus. My mother suffered with it, my grandmother shows signs, and we have distant family members with it. I was too young to actually understand it. At that time, I had tons of, um, mood swings? I don't know. I am type one, so I didn't really sleep." (Az, patient of bipolar I disorder)

  Az continues their story by explaining what the diagnosis meant to them and how it has "made life difficult." "I had a lot of symptoms when I was 12. I would stay up for days. Actually, I think the longest I stayed up was a week. My brain would be going at 100 miles an hour all the time. And oh my god, the crashes were just awful. Let me see; I was 12 and awake for maybe 60 hours. I could feel myself crashing, and it was probably the worst crash I'd ever had. The highs and lows made life very difficult. I was so young with virtually no support, so I turned to self-harm. No 12-year-old should have to turn to something like that. Even today, I have to deal with the stares at my scars." (Az, patient of bipolar I disorder)

 Az explains their experience with peers as their condition worsened.  "I would push my friends away, make more, go manic, and push them away again. Social settings were hard because I never kept friends for more than a week. My doctor put me on lithium, and it was h*ll. It made me feel like a zombie robot person. I never felt anything, not happy, not sad, not mad, just nothing. The most I would feel on it was sickness. I would throw up a ton, and the world felt like it was spinning. I got so sick one time, I passed out in the middle of the school hallway and that was when I stopped taking my meds. Let me tell you, an unmedicated child bipolar is one of the scariest things for family and friends. I was hostile and just awful. No one liked to talk to me, and some even started bullying me. Eventually, I was able to get the help I needed. Everything worked out. I am in my last year of medical school now, and with the right meds, I was fine." (Az, patient of bipolar I disorder)

Conclusion

Bipolar disorder presents a complex array of hurdles for adolescents as they navigate their academic journeys, impacting not only their school performance but also their overall educational experience. The erratic mood fluctuations and behavioral disturbances characteristic of the disorder can significantly impede learning, disrupt social interactions, and jeopardize future academic achievements. Nevertheless, by identifying and addressing bipolar disorder early on, implementing tailored treatment plans, and establishing robust support networks, adolescents grappling with this condition can surmount these obstacles and flourish academically. Collaboration among schools, families, and mental health professionals is paramount in ensuring these young individuals receive the requisite assistance and are enveloped in a nurturing, empathetic environment that nurtures their intellectual and emotional development. By fostering a culture of understanding and support, educational institutions can empower students with bipolar disorder to not only excel academically but also thrive personally, fostering resilience and a sense of belonging within the school community. Through this united effort and unwavering commitment to the well-being of these students, the educational landscape can be transformed into a space where every individual, regardless of their mental health challenges, can reach their full potential and lead fulfilling lives.

References

U.S. Department of Health and Human Services. (n.d.). Bipolar disorder in children and teens. National Institute of Mental Health. https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens

The Children’s Hospital of Philadelphia. (2014, August 24). Bipolar disorder in adolescents. Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/bipolar-disorder-adolescents

American Psychological Association. (n.d.). Treating bipolar disorder in kids and teens. Monitor on Psychology. https://www.apa.org/monitor/2020/10/ce-corner-bipolar

professional, C. C. medical. (n.d.-a). Norepinephrine: What it is, function, deficiency & side effects. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22610-norepinephrine-noradrenaline