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School Success for Children with Mental Illness:
The Role of Stress

by Susan Mikolic, R.N.

If there is only one message that you take from this work, let this be it. Stress is The Enemy. Whatever stress can be prevented, needs to be prevented, to leave the child enough energy to cope with the things that cannot be prevented.

The Energy Game

We all move through our day adding and subtracting energy from our being. We have breakfast….we add energy. We have a fight with our spouse…we subtract energy. We have lunch with a friend…we add energy. Life is a game of energy in and energy out. It is similar to a bank account in that way. So let's use this similarity to give us a context, a framework, for discussion. Say children wake up in the morning with $10.00 of energy available. Let's say the effects of their various illnesses on their body and the medications used to treat them consume about $5.00 of that energy, although it is probably more. They get to school with $5.00 of energy left to spend. They use $3.00 of energy trying to interpret social cues, make friends, dealing with negative self-talk and self-esteem issues because of their lack of friends, so that leaves them with $2.00 of energy to spend on this huge task of learning. Talk about being behind the 8-ball from the get-go.

The Goals

The goals for the child's life have to be:

#1: Keep the Illness Stable
#2: Learning

It is a shame. But it is the truth. This is psych 101…Maslow's Heirarchy of needs. One must attend to primitive health and safety concerns before they can move on to higher order work. They must be as medically stable as possible so they can be available for higher order learning. When a woman gets breast cancer or a man has a heart attack, they take off work and focus on their healing and recovery. It is expected. It is essential. When a child has leukemia, they "take off work", school, to attend to their healing and recovery. But when someone has a brain disorder such as bipolar disorder, they are expected to function as if the illness did not exist. They are not provided the same acceptance and support of their need to stabilize their illness before they get back to work. We must help the child keep their illness as stable as possible so they will have the energy necessary to devote to learning.

The Kindling Effect

The kindling effect is a theory that attempts to explain an interesting phenomenon that occurs in many illnesses. It was named after the phenomenon that occurs with fires. Once a fire is kindled, and it is put out, it takes less stimulus to start it again.

This concept was applied to Epilepsy research years ago. It was noted that while it might take a significant stimulus to trigger an initial seizure, it took less stimulus to trigger subsequent seizures.

Dr. Robert Post, M.D., of the National Institute of Mental Health, was the first to look at the possibility of kindling's role in psychiatric illness. It has now been implicated in mood disorders, schizophrenia, drug addiction, post-traumatic stress disorder, multiple chemical dependency, and pain.

John Krauss, M.D., Ph.D. says in his article, "Sensitization Phenomenon in "Psychiatric Illness, Lessons from the Kindling Model"1:

"During kindling, the strength of the repeated stimulus does not vary, however the behavioral response to the stimulus becomes progressively more severe over time. By analogy, repeated stimuli in psychiatric illness (be it an episode of affective illness, exacerbation of psychosis, environmental or physical stress, or exogenous substances) may, over time, lead to a progressively more severe clinical presentation."

Related to bipolar illness, in particular, Demitri Papolos, M.D., writes in his book "The Bipolar Child"2:

"Initial periods of cycling may begin with an environmental stressor, but if the cycles continue unchecked, the brain becomes kindled or sensitized - pathways inside the central nervous system are reinforced, so to speak - and future episodes of depression, hypomania, or mania will occur by themselves (independent of an outside stimulus) with greater and greater frequency."

What this means is that it may have taken a large stimulus to trigger an initial episode of illness, but subsequent episodes require less and less stimulus to trigger an exacerbation of the illness, and at some point, these exacerbations can begin to occur independently. The illness begins to take the path of least resistance.

So our task is to help save energy for those functions that are absolutely vital. Eliminate all activities and expenditures of energy that are not high-value. Reserve the limited energy for important tasks.

In practical terms one must anticipate and limit stressors when possible so this limited energy can be used to live, learn, and handle all the stressors that couldn't be anticipated.

Application to School Settings

How do we apply this concept to school success? We need to find ways to minimize energy going out in non-essential ways. Re-examine how the child spends "their time", which is how they spend their energy.

Is it essential they use energy to copy assignments from the board? Could another system be used freeing up that energy for learning? Copying assignments from the board may sound like a simple activity, but it reality it is an extremely complex task. It requires thoughts to be stored in memory, retrieved, sending signals down the arm and hand, gripping the pencil correctly, holding the paper, forming letters. If you are interested in learning more about the complex task of writing look into the work of Mel Levine, M.D. He is a pediatrician who has written multiple best seller books on learning.

Is the environment too stimulating to the child's sensory system? Would it help to have some small group learning environments? Does the child need more time to change classes? How much homework can this child get accomplished without triggering stress? Would breaking down large assignments into pieces make the task more manageable?

Re-examine all energy expenditures. See where keeping the task and goal the same but modifying the approach can free up some energy for the heavy duty task of learning. We needn't reduce our expectations. These children can accomplish a lot…IF we support them adequately. These are exceptional children. Let's help them shine!

©Susan Mikolic, R.N.


1Krauss, John E., M.D., Ph.D., "Sensitization Phenomenon in Psychiatric Illness, Lessons from the Kindling Model", Journal of Neuropsychiatry, Clinical Neuroschience 12:328-343, August 2000 2Demitri Papolos, M.D. & Janice Papolos, "The Bipolar Child", 2000

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