Dear Your Teen:
“My 17-year-old daughter has ADHD and was recently diagnosed with Bipolar Disorder. I’m struggling because I don’t know how to deal with her instability. How do I address this without her thinking I am spying on her or that I don’t trust her?”
Answer | Stephanie Newman, PhD
You’ve done well in getting her a medical evaluation. Diagnosis and treatment can be difficult, as the symptoms of ADHD and bipolar disorder overlap. Now that you have a diagnosis, you’ll have a clearer idea of what you and your daughter may be facing and can more effectively address her ADHD and Bipolar treatment needs.
We’ll talk about managing your daughter’s care—i.e., the medical team, different therapies, and things you can do at home—in Part 2 of my answer. For now, let’s focus on getting your teenager on board with your taking an active role in helping her learn to manage her illness. It’s important for her to realize that you’re not spying. Rather, you’re playing a crucial role by monitoring her health.
How to Manage Mental Illness with Your Teen
Your teen needs your help to build insight and manage their illness.
The first step is to discuss medication, therapies, and lifestyle recommendations with your daughter. If you’re met with resistance, don’t pull back. Some resistance to treatment is natural. If resistance escalates into a battle, be sure to ask the psychiatrist or pediatrician for support.
If your teenager balks at seeing a therapist or psychiatrist, try reframing: “When you had trouble in math, we got you a tutor; now you need this other type of help.”
Allow your teen to discuss their feelings openly.
Listen to why they’re resisting medication or psychotherapy. Maybe their provider is not a good fit and you need to find another one.
Whatever your teen’s resistance is, try to suss it out rather than let it deter you from your caregiving role.
Take your teenager’s psychological pulse. Do it often.
Regular safety assessments are a must—even if you worry about seeming mistrustful. Follow the psychiatrist’s or therapist’s suggestions for at home check-ins. If you hear about active thoughts of suicidality, your first calls should be to your daughter’s psychiatrist and 911.
Call the National Suicide Prevention Lifeline 800-273-8255 for support.
Help your teen develop insight about the nature of their illness.
Helping your teen develop insight into the nature of bipolar disorder and their need for ongoing medication, while crucial, is often a thankless job. It can take years before your teenager understands that their rising euphoria signals the onset of a manic episode. Your daughter might be one of the many people who enjoy their soaring mood and balk at suggestions to level off. Wait until she’s calm and her mood is regulated to discuss the episodic and dangerous nature of her illness; she’ll have more understanding then.
Ask them to fast forward the tape.
Try taking a page from the playbook for managing addictions: encourage your daughter to fast forward the tape to envision a manic episode. Ask, “Say you don’t take your meds. What do you think will happen?” She might answer, “I’ll fail my test,” “I’ll argue with my friends,” “I’ll feel embarrassed,” or “I’ll hook up with someone and later regret it.” Discussing the episodic nature of her illness and the likely adverse consequences if she skips her medication can help even a reluctant teen develop insight into why she needs to continue taking her medicine, even if her initial elation feels good.
By checking in, flagging the need for medication, and actively monitoring compliance, you’re teaching your teen how to take care of themselves. Those are not signs of your mistrust. Those are signals showing you care.
Motivated teens have the most success in following treatment recommendations and protocols. One way to build motivation is to ask your daughter what improvements she’d like to see in her life. Does she desire better relationships with friends? Does she want to elevate her performance in school?
Continue discussing her expectations for treatment. Show you understand her overwhelm and collaborate together on ways you can help. But also, find balance and respect her boundaries because teens like your daughter need space to process. Most of all, remember to express how much you love and support your teen, how you are proud of them, and that you’re there to help.