Post by misty on Mar 25, 2006 0:26:13 GMT -5
Description and Suggested Academic Interventions
by Quackenbush, Kutcher, et al.
School Program Modifications
A variety of useful school program modifications can be implemented to meet the needs of the adolescent bipolar patient. The development of these programs requires active collaboration between the clinician and the school setting. This requires identifying the teen's disorder to the appropriate educator-a process, which requires patient or parent (caregiver) consent, and which can, at times, be resisted by the adolescent or parents because of concerns regarding social stigmatization. Clinical experience indicates that a supportive, educational approach, which aims at helping the adolescent and family to understand the illness, its effect on academic performance, and the need for intervention, is usually most helpful for the development of an appropriate academic prescription involving the teens, parents, clinician and school.
From the outset, it is crucial that effective lines of communication be developed between the clinician and the patient's school. School-based guidance counselors can be invaluable advocates once they have a appreciation of the illness and its impact on the student's academic and psychosocial functioning. Information can then be communicated through the guidance counselor to administrators, special education teachers, and perhaps most importantly, classroom teachers themselves. the guidance counselor will be instrumental in advocating the implementation of specific program modifications. Therefore, to ensure maximum opportunity for school success, it is essential that the counselor be educated about the illness and that a close liaison be developed early in the treatment course-preferably prior to a patient's discharge from the hospital.
As stated, a number of practical strategies can be employed by the patient's school. Recommendations might include all or some of the following, tailored to the individual's needs:
1. REDUCED COURSE LOAD. Due to problems associated with poor concentration and fatigue, a reduced course load is often more manageable. Courses should be scheduled for a time when these students are functioning at their highest level. Our clinical impressions suggest that late afternoon or evening classes should generally be avoided, as concentration difficulties seem to be more prevalent at those times.
2. REDUCED ACADEMIC LEVEL. Because of cognitive, memory-related, and attention problems, these students often find advanced level courses too difficult. General level courses may be preferable. Although some teens or parents feel that taking classes of "lower academic standing" is undesirable, a successful outcome in a general course is to be preferred over failure in an advanced course.
3. TAILORED COURSES. Courses capitalizing on the strengths and interests of the student with a bipolar illness may be more appropriate than simply taking a generally prescribed course load. Courses requiring high levels of concentration (e.g., mathematics) might need to be avoided altogether if they prove to be excessively difficult.
4. RECOMMENDATIONS FOR TEACHERS. Teachers who possess a calm demeanor, provide clear structure, but maintain flexibility in evaluation methodology as well suited to working with this population. Teachers who are excessively detail oriented or demanding may contribute to increased anxiety which, coupled with existing cognitive difficulties, may lead to academic failures. Careful matching of student to teacher is a helpful strategy that requires the support of school administrators.
5. TIME-OUTS. Owing to problems with concentration, restlessness, and medication side effects (e.g., dry mouth), these adolescents may need brief classroom time-outs. These should be scheduled or structured in such a way as to minimize disruption of classmates and limit attention to the student's difficulties.
6. TIME EXTENSION. Due to slowed thought processing and medication-related writing difficulties such as hand tremor, time extensions for tests may be necessary.
7. MARK ESTIMATES. Estimated marks can be given for assignments and tests when students are unable to complete work due to rehospitalization or illness relapse.
8. ORAL TESTS. Problems stemming from hand tremor or thought expression and writing may necessitate the presentation of content orally.
9. PEER HELPER. A peer helper can be an invaluable aid in alleviating anxiety and in familiarizing the student with a bipolar illness with school routines. In schools where such programs are not available, a responsible senior student may be asked to take on this role. If such a structure is implemented, proper training of the peer helper is essential, and close supervision is necessary. Such issues need to be identified and appropriate structures put into place before peer helping begins. At all times, confidentiality must be maintained.
10. COURSE AUDIT. Pre-exposure to course content and classroom teachers can help test academic readiness and serve to prepare the adolescent for the future demands of a course. Thus, a course audit prior to enrolling for a graded credit, although lengthening the overall time spent in secondary education may, in the long run, improve the teen's chances for success.
11. INDIVIDUALIZED PROGRAMS/PROGRAM CHANGES. Correspondence courses and in school independent study programs allow the student to work at his or her own pace and can provide flexibility in the evaluation process.
Clinician awareness of the above options for academic intervention will help her or him to develop appropriate treatment plans for adolescents with a bipolar illness. The implementation of interventions directed towards improving academic functioning should be an integral part of the entire treatment strategy in this population.