teen issues

Teen Issues

Lions and tigers and teens, oh my!

It seems that as our kids get older, the challenges don't go away, but rather they become even more complex in some ways, right when we are tired from the earlier battles. Pediatric Bipolar doesn't take a vacation during those turbulent teen years, and the symptoms grow and change along with everything else. Just when we get the hang of those pre-adolescent issues, BAM! a whole new set of issues to deal with. Let's look at some of the things that can pertain to teens:

Hypersexuality

From Treatment Guidelines for Children and Adolescents With Bipolar Disorder: Child Psychiatric Workgroup on Bipolar Disorder:

Children with BPD are often hypersexual. It is important to rule out sexual abuse or exposure to sexually explicit materials or behaviors as a possible cause of hypersexual behavior in any child, including one with BPD. However, sexually provocative behavior in the absence of any indication that the child has been inappropriately touched by another person is commonly seen in children with BPD. This hypersexual behavior frequently has an erotic, pleasure-seeking quality to it, whereas the hypersexual behavior of children who have been sexually abused is often anxious and compulsive in nature. The hypersexual behavior of a child with BPD frequently has a flirtatious aspect that would be appropriate if done in private between consenting adults (e.g., a child trying to open-mouth kiss his mother or trying to touch others’ private parts, dancing in an erotic manner in front of a mirror). Adolescents may seek out sexual activity multiple times in a day. These behaviors are thought to be the child counterparts of adult promiscuity and multiple marriages (Geller et al., 2002).

How does a parent protect a teen from the symptom of hypersexuality? Recognizing it is easier, protecting them is the hard part! Both boys and girls need information on sexually transmitted diseases, although they may not be able to use this information "in the heat of the moment". Pregnancy is also an issue of concern as well. Some parents place their daughters on birth control to try to protect them, and others try to control their opportunities for sexual activity, although that can be difficult at best. Young men, and even young women can easily be trapped in to pornography, and this can even lead into hardcore porn addiction which can easily destroy a young persons life. If a teen has many sexual partners or inappropriate behavior in a social setting they may develop a reputation in their social group and have difficulties when they are stable and this symptom is under control. Hypersexuality is like regular teen hormones on rocket fuel, so if this is an issue with your teen, be sure to wear your seat belt!

Certainly as parents we must monitor our teens activities online and in person socializing and this may be difficult when they are manic and constantly on the go already. Too much time (possibly any time) without accountability is often asking for trouble. They may be unable to behave appropriately when they have as much freedom as a "typical teen", so they may need earlier curfews, and more "chaperones" than other young people. They may need internet filters or logging software on their computers so you can monitor their internet usage. One option that has been recommended to us is http://www.bsafe.com.

Probably the best defense is stability. Getting the meds right so this destructive symptom is minimized is critical to helping our kids grow up healthy. If your child is not stable, take a look at the above mentioned guidelines at The Journal of the American Child and Adolescent Psychiatry and discuss optimizing your teen's treatment to achieve a reduction in hypersexuality.

Substance Abuse/Alcohol

Signs of possible drug or alcohol abuse in teens: (from http://www.focusas.com/SubstanceAbuse.html)

Physical

fatigue, repeated health complaints, red and glazed eyes, lasting cough

Emotional

personality change, sudden mood changes, irritability, irresponsible behavior, low self-esteem, poor judgment, depression, general lack of interest

Family

starting arguments, negative attitude, breaking rules, withdrawing from family, secretiveness

School

decreased interest, negative attitude, drop in grades, many absences, truancy, discipline problems

Social problems

new friends who make poor decisions and are not interested in school or family activities, problems with the law, changes to less conventional styles in dress and music

Obviously, these red flags may be caused by many things, not the least of which is Bipolar cycling. If you see these signs in a teen who has previously been stable, it may mean returning instability or drug or alcohol abuse. If your teen has not been stable, it is possible that substance abuse is interfering with the ability to become stable. It is critical to success that substances that increase instability (marijuana, cocaine, alcohol, etc.) not interfere. Again, the best defense is monitoring your teens activities and not assuming that they aren't or won't because they haven't in the past. If you have suspicions, you could ask the doctor to order drug screening when ordering regular blood work, or to purchase an over the counter drug screening test to administer yourself.

According to the above mentioned Treatment Guidelines:

The optimal treatment of adolescents with substance abuse and BPD involves an integration of treatment modalities rather than merely consecutive treatments with a specific focus on either substance abuse or BPD (Wilens et al., 1999).

If your teen is abusing drugs or alcohol, the best solution is to find a program that will address both Bipolar medical issues as well as treat substance abuse at the same time. Trying to treat one issue without the other can cause all treatment to fail.

For further information see: http://www.healthyplace.com/communities/bipolar/related/substance_abuse.asp

In the future we will address some of the following teen issues, so check back soon for more information:

Transitioning to Adulthood/Independence, Medication Refusal, Running Away, Learning to Manage the Illness, Impulsivity/Driving, Hospitalization/RTC/Wilderness Programs, Socialization, Finishing High School/School Refusal, College Planning, Career Planning, Dealing With Doctors, Suicide/Cutting.

If you have experiences or suggestions about these subjects, please email us and we may be able to include your information in upcoming articles. teen issues at bpinfo.net