Educating the Child with Bipolar Disorder: Child and Adolescent Bipolar Foundation

What is Pediatric Bipolar Disorder?

Bipolar disorder is a biological brain disorder causing severe fluctuations in mood, energy, thinking and behavior. It was previously known as manic depression, as it causes moods to shift between mania and depression. Children—whose symptoms present differently than those of adults—can experience severe and sudden mood changes many times a day. Symptoms of mania and depression can also occur simultaneously. Young people with this disorder are frequently anxious and have very low frustration tolerance.

At least three quarters of a million American children and teenagers struggle with bipolar disorder, most of them undiagnosed and untreated. Children with bipolar disorder are at risk for school failure, substance abuse, and suicide. The lifetime mortality rate for bipolar disorder (from suicide) is higher than some childhood cancers. Yet children who are stable and have the right support can thrive in school and develop satisfying peer relationships.

Commonly Seen Behaviors:

• Crying for no apparent reason
• An expansive or irritable mood
• Depression
• Rapidly changing moods lasting a few minutes to a few days
• Explosive, lengthy, and often destructive rages
• Separation anxiety
• Defiance of authority
• Hyperactivity, agitation, and distractibility
• Sleeping too little or too much
• Night terrors
• Strong and frequent cravings, often for carbohydrates and sweets
• Excessive involvement in multiple projects and activities
• Impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
• Dare devil behaviors
• Inappropriate or precocious sexual behavior
• Delusions and hallucinations
• Grandiose belief in personal abilities that defy the laws of logic (ability to fly, knows more than the teacher or principal)
• Extreme irritability

Depressed children may not appear to be sad. Instead they may withdraw, not want to play, need more sleep than usual, display chronic irritability, or cry for no obvious reason. Children may also talk of wishing to die and may need to be hospitalized for harm to themselves or others.

Symptoms of mania may include elation, grandiose thinking, racing thoughts, pressured speech, hypersexuality, and decreased need for sleep. Since hyperactivity can be seen in both bipolar disorder and ADHD, a growing number of researchers believe that many children who are diagnosed with "severe ADHD" may actually have undiagnosed bipolar disorder.

Bipolar disorder is a chronic, lifetime condition that can be managed, but not cured, with medication and lifestyle changes. Because the symptoms wax and wane on their own, and children’s bodies change as they grow, managing medication to ensure continued stability is a complex and ongoing challenge.

How Bipolar Disorder Affects Cognition and Learning

Recent brain imaging studies show biological differences in patients with bipolar disorder. The disorder affects learning in a number of ways, ranging from difficulties with sleep, energy, school attendance, concentration, executive function, and cognition. Side effects from medications can affect the child’s learning and energy. Moreover, while many of these children are uncommonly bright or creative, they often have co-occurring learning disabilities.

Even when moods are stable, the condition often causes cognitive deficits, including the ability to:

• Pay attention
• Remember and recall information
• Think critically, categorize, and organize information
• Employ problem-solving skills
• Quickly coordinate eye-hand movements

In addition, bipolar disorder can cause a child to be at times impulsive, talkative, distractible, withdrawn, unmotivated, or difficult to engage. Medications to manage the illness can cause cognitive dulling, sleepiness, slurring of speech, memory recall difficulties, and physical discomfort such as nausea and excessive thirst.

Despite all these challenges, a student with bipolar disorder can succeed in the classroom with the right supports and accommodations.

Strategies for Teaching a Child with Bipolar Disorder

The teaching skills that make a classroom teacher successful with typical students are essential when working with children who have bipolar disorder:

Flexibility to adapt assignments, curriculum and presentation style as needed.

Patience to ignore minor negative behaviors, encourage positive behaviors, and provide positive behavioral choices. Most important is the ability to stay calm and be a model of desired behavior.

Good conflict management skills to resolve conflicts in a non-confrontational, non-combative, safe, and positive manner.

Receptivity to change and to working collaboratively with the child’s parents, doctors, and other professionals to best meet the needs of the child.

The ability to laugh at oneself and at situations. Teachers who can laugh at their own mistakes, and bring fun and humor into the classroom reduce the level of stress that students feel.