Three families share lessons about parenting a teenager with bipolar, such as advocating with care providers and tools they used to help their child self-regulate.
By Stephanie Stephens
Physical changes, social pressures, hormones on the march—it’s tough to be a teenager, or the parent of one. Faced with emotions that ricochet up and down and a developmental imperative to test boundaries, it’s common for parents to wonder: “How do I handle this?”
When moody extremes, irritability, sleeplessness and other symptoms merit a diagnosis of bipolar disorder, parents face an entirely new and often daunting set of challenges. Meet three families whose tenacity, resourcefulness, and most of all, love, have seen them through stormy days to calmer harbors.
One family has piloted their child through adolescence into the waters of early adulthood. The others are still navigating the shoals of adolescence. They’re all sharing their stories in hopes that their hard-won wisdom will help you do the same.
Fighting for your child’s future: Abby, age 15 Learning to advocate
As parents of a teenager with bipolar disorder, Jane and Roger know they can’t be passive about getting appropriate care for their daughter. The Ohio couple are staunch champions for Abby, who is 15.
“We may differ from ‘typical’ parents because to get the best treatment, we know we must advocate, often going nose-to-nose with doctors, therapists, educators and others if needed,” says Jane.
Jane takes point in researching Abby’s condition, dealing with various professionals, and managing the home front. Roger attends to the family’s financial needs and provides emotional and practical support to his wife.
“I can help by lifting the acute stresses involved in day-to-day logistics,” he says.
Both parents recognize that assisting Abby is a long-term commitment, more so than in the average family. At the same time, they want to provide her with useful life skills and tools that will contribute to her independence.
“We help her realize when emotions are extremely out of line compared to ‘normal,’ ” says her mom. “Sometimes, though, we can’t intervene if she’s just not open to it.”
Abby is a highly imaginative artist and writer who is at her best when she’s outdoors. When mom and daughter spent six weeks backpacking on the Appalachian Trail, “Abby was wonderful—no anxiety or moods,” Jane reports.
Roger stresses the importance of building an effective team to help their daughter.
“We have had to cut ties with care providers because they just weren’t working for our family,” he says.
Advocacy means respectful but firm negotiation to get what is best for their child. The goal, says Jane, is “enabling more effective collaboration.”
When seeking medical providers, she begins the discussion like this: “Her dad and I know her better than anyone else, but you have specialty training that we don’t.”
A voracious consumer of reliable information about bipolar, Jane draws on her acquired knowledge when weighing interventions.
“If a medical provider says ‘Let’s do this,’ as if it’s the only approach, and I’m not comfortable with that option, I still want to discuss ‘x’, ‘y’ and ‘z’ as options.”
Abby received a bipolar I diagnosis at age 5, so her mom has lots of experience interacting with officialdom. The family tried different educational options throughout the elementary grades, including private school, homeschooling, and part-time attendance at a school where Jane was a tutor.
With Abby switching to public school in 6th grade, Jane approached school administrators to discuss accommodations her daughter was entitled to under federal law. Her requests for proper evaluation and services bore little fruit, but the tenacious mom stood her ground. After a year, Abby finally received an individualized education program (IEP).
That same tenacity paid off when it came to Abby’s diagnosis, as well. When the girl’s treatments for bipolar disorder didn’t resolve all her symptoms, Jane pushed for further assessments. Identifying additional conditions, such as executive function deficits and significant anxiety, led to changes in medication and therapy aims.
“Professionals may be content to stop with one diagnosis, rather than looking for the full spectrum of issues to be addressed,” she insists. “Having a complete understanding of [Abby’s] challenges means we can more effectively address these issues and more going forward.”
Jane and Roger have learned that there’s no such thing as one-and-done when it comes to helping their daughter. They came to see that public school wasn’t the best sphere for Abby, even with the IEP in place. She was more anxious, had more mood swings, didn’t sleep well, and at times was suicidal. Now she is being home-schooled again, showing excellent results academically and otherwise.
“We continue to work hard to understand what’s really going with our daughter and to address each issue in a targeted way,” says Roger. “The family doesn’t hesitate to seek out the most effective solutions.”
As early as age 4, Jack told his mom that he was afraid to go into subways and elevators. He was always “a really sensitive kid,” she recalls. Yet as Eleanor and her husband remember it, their son’s behavior was “pretty typical” until he transitioned to middle school in their New England city.
Not only was it a new environment, but Jack also faced bullying. He began to experience extreme anxiety and depression, and over the holiday break in sixth grade he showed symptoms of hypomania, including high irritability and excessive energy.
His symptoms intensified when Jack started seventh grade. In March 2015 he received a cutting-edge diagnosis: bipolar disorder, fear of harm phenotype.
This possible subtype of pediatric bipolar involves six major symptoms clusters, including severe anxiety, extreme irritability, and heightened sensitivity to criticism and rejection.
“Bipolar children with ‘fear of harm’ may have trouble discerning nonverbal communication—misperceiving neutral cues as threatening. We’ve been concerned about that,” says Eleanor.
A novel medication regimen cemented Jack’s healing process over a period of many months, Eleanor says. She advises parents to be patient with the trial-and error process that’s often required to find out what’s effective.
Jack also benefited from attending a “small, artsy” private school. He did well academically and became more independent, his mom says, and he now “reads” other kids much better. She credits talk therapy, which helped him feel less fearful, along with his maturation in general.
His mom reports that at 14 years old, Jack is back in public school, is an “A” student, has a close group of pals, and can be a “very funny” boy. During summer vacation, he was able to do two things that would have been impossible in his pre-treatment years: ride to the top of a skyscraper and get on a plane.
Everything’s better on the home front, too. Eleanor uses the word “traumatic” when recalling how Jack’s unpredictable and sometimes explosive behavior affected them. His older brother, now 17, became hypervigilant—watchful for abrupt changes in behavior that would be problematic for Jack or those around him.
“At first, we all walked on eggshells a bit,” says Eleanor. “Initially none of us knew what we were dealing with.”
Now that Jack is less enslaved by irrational fears, Eleanor says, “it’s fun to do things as a foursome again.” The family has resumed activities like hiking and eating out.
“The other night, we went for authentic Chinese food together, something we couldn’t always do,” she recalls.
Improved stability has also meant re-establishing more of the usual expectations and consequences. For example, Jack has household chores like putting the clean dishes away.
“It’s important to hold Jack accountable in his life,” Eleanor says.
That includes setting limits on possibly risky behavior.
“Children with bipolar often have a strong energy and imagination that sometimes leads to unusual pursuits and interests,” Eleanor reflects. “We have to rein some in, so we tack ‘No Trespassing’ signs on our trees in the woods. It’s a balance between letting him explore and keeping him within some bounds.”
Talking to other families coping with a child who has a brain-based disorder has proven incredibly helpful.
“Just being open about it, instead of hiding, and talking about it like you would a heart condition makes a real difference,” Eleanor says. “For anyone, reading and then discussing this moves us along … sharing is just better for everyone.”
It may not seem remarkable for a young woman to be studying visual arts at her local community college north of New York City. For 20-year-old Melissa and her parents, Keri and Donny, that counts as a once-unthinkable triumph.
Melissa was almost completely debilitated by bipolar symptoms when the family met psychiatrist Demitri Papolos, MD, an associate professor of clinical psychiatry at the Albert Einstein College of Medicine in New York City and director of research at the Juvenile Bipolar Research Foundation (JBRF).
Melissa was 13 at the time. The treatment she received “changed everything,” Keri says, because it provided enough stability so that behavioral interventions could take hold.
“Things are still difficult, but at least now she can identify feelings, verbalize what’s going on with her, and use tools to accomplish goals. It’s a slow process for Melissa, but a process no less,” says Keri, who describes her daughter’s emotional age as “more like a 14-year-old.”
Over the years, the family has instituted various methods to help Melissa self-regulate. For example, a 1-to-10 scale to rate her current emotional state, paired with a behavior “toolbox” decorated with glitter and stickers and filled with suggested activities.
A rating of 5 or higher would mean it’s time to choose a tool to calm down, such as “read the dog a story,” “go sing and swing,” or “sit in a quiet tent and draw.”
It’s important to have “both active and quiet options, to calm down or go use up her energy,” Keri says.
The mood rating system still proves useful for Melissa, her boyfriend, and her family. So does taking “time outs”—for Keri and Donny.
“When one of us is at our wit’s end, we ‘tag’ the other to prevent burnout, saying, ‘It’s your turn,’ ” Keri says. “I also take calming ‘mommy minutes’ on my own.”
“This is tough with two teens, but we remind them they are different people with different needs and different rules,” Keri says.
As Melissa gained in self-knowledge, she became more of a partner in managing her bipolar. Recognizing that holidays with her dad’s large family can be overwhelming, Melissa came up with the idea to limit the blocks of time she spends with her beloved relatives.
The young woman also started a yoga practice, which Keri says “really helped regulate her mood and keep her calm.” She adds that regular yoga has also improved Melissa’s sleep, “a big key to sustaining her wellness.”
Melissa contributes entries to a mood journal that Keri maintains. It’s a kind of centralized data base that includes Melissa’s writing and poetry, plus “notes from doctors’ appointments about new meds, lab reports, [and] bipolar episodes,” Keri says.
“This really helps us see patterns of behavior so we can all start working back toward wellness as soon as she starts to slip.”
Developing skills to communicate calmly and honestly has been important. It’s something they try to practice even during testy disagreements between daughter and parents.
“No one likes being wrong, but we both remain open to correction from each other,” Keri says.
When things go verbally awry, they have a “do-over” policy that applies to everyone equally.
“You can restate something that you said meanly or rudely,” says Keri. “It helps model the correct way to ask or say things.”
Keri says she and Donny work hard to stay on the same page with Melissa.
“Now Melissa makes her own friends and her own plans,” Keri explains, “so we just help her modify and figure out what she can handle.”