Overview

All children experience regular fluctuations in mood. These ups and downs are usually a normal part of growing up. You may want to consider having your child evaluated for bipolar disorder if they are experiencing changes in mood that are accompanied by:

  • increased energy and activity
  • agitation
  • sleeplessness
  • depression

Bipolar disorder is a psychiatric illness characterized by drastic mood changes. It occurs in 1 to 3 percent of youth. It’s more common in adolescents than in younger children.

Bipolar disorder used to be referred to as “manic depression.” This describes the two extreme emotional states people experience. During manic episodes, your child may be unusually active, energetic, or irritable. Extreme silliness may also accompany increased energy in children. During depressive episodes, they may be especially low, sad, or fatigued.

Symptoms of bipolar disorder in children

The symptoms of bipolar disorder are defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The key features are mood episodes, which reflect major changes from a child’s regular behavior and the behavior of other kids.

Parents will notice ups and downs in:

  • activity
  • energy
  • thoughts
  • feelings
  • behavior

Kids can have manic episodes, depressive episodes, or mixed episodes where there are features of both mania and depression. These episodes typically last for several days, and the disturbance in mood is present most of the time.

Children in a manic episode may:

  • sleep little without being tired
  • talk very quickly, and about many different things at once
  • be easily distracted
  • seem unusually happy or too silly for their age
  • talk about sex or demonstrate sexual behavior
  • engage in risky behavior that’s not normal for them
  • be constantly on the go
  • have explosive temper tantrums

Children in a depressed episode may:

  • appear tearful, sad, and hopeless
  • show little interest in activities they usually love
  • have increases or decreases in appetite and sleep
  • complain about stomach aches and headaches
  • feel worthless or bad
  • have difficulty concentrating or appear agitated
  • think about death and suicide

Bipolar disorder symptoms may cause your child to have problems at home, school, or with peers.

Bipolar disorder in children often occurs with conditions such as:

Suicide prevention help

If you or someone you know is experiencing signs of depression, you can find help. Organizations like the National Alliance on Mental Illness offer support groups, education, and other resources to help treat depression and other mental illnesses. You can also call any of the following organizations for anonymous, confidential help:

  • National Suicide Prevention Lifeline (open 24/7): 800-273-8255
  • Samaritans 24-Hour Crisis Hotline (open 24/7, call or text): 877-870-4673
  • United Way Crisis Helpline (can help you find a therapist, healthcare, or basic necessities): 800-233-4357

Bipolar disorder vs. disruptive mood dysregulation disorder

The definition of mania in children has been a significant source of disagreement among professionals. Some professionals wanted to include irritability and other emotional problems as traits of mania. Others thought that mania should be more narrowly defined like it is for adults. As a result, the American Psychiatric Association (APA) introduced a diagnosis in 2013 called disruptive mood dysregulation disorder (DMDD) that describes chronically irritable and explosive children that are likely not bipolar.

Risk factors of bipolar disorder | Risk factors

It’s unclear what exactly causes bipolar disorder in children. A number of factors may increase a child’s risk for developing this disorder, however:

  • Genetics: A family history of bipolar disorder is likely the greatest single risk. If you or another family member has bipolar disorder, your child is more likely to develop the condition.
  • Neurological causes: Differences in brain structures or functions can place a child at risk for developing bipolar disorder.
  • Environment: If your child is already at risk for bipolar disorder, stressors in the environment may increase their risk.
  • Adverse childhood events: Having multiple adverse childhood events increases risk. Adverse childhood events may include things like family separation, abuse, or parental imprisonment.

Diagnosing this disorder

Bipolar disorder must be diagnosed by a medical professional. Diagnosis is only made following an assessment.

The assessment should involve an interview with caregivers and an observation or meeting with the child. Standardized questionnaires, school visits, and interviews with teachers or other caregivers may be part of the assessment.

To be diagnosed with bipolar disorder, mood episodes can’t be caused by a medical condition or intoxication.

In children, doctors will be very careful to make the distinction between bipolar disorder and DMDD. Children with DMDD experience chronic irritability and explosive temper tantrums. Before the introduction of DMDD as a diagnosis, many doctors were describing these children as being manic. Children with bipolar disorder may be irritable and angry, but they will also show depressive symptoms.

Another difference between bipolar disorder and DMDD is that with bipolar disorder, mood episodes are significant changes from a child’s usual way of being. In DMDD, the symptoms are constant.

Treatment for bipolar disorder in children

Treatment for bipolar disorder in children should involve a combination of medication and talk therapy.

Medication

There are a number of different prescription medications that may help your child manage their symptoms. Children should take the lowest dose and fewest number of medications as possible to manage their symptoms. Your child may need to try a few medications and doses before finding the right treatment.

It’s important to let doctors know about side effects and to never stop medications suddenly. Stopping medications suddenly can be dangerous.

Talk therapy

A number of talk therapy options are available. These are often used in combination with medication. Therapy isn’t just for your child either. Therapy can help parents and caregivers learn about what their child is going through and can be helpful for the whole family. Use these pointers to choose the right therapist for you and your family.

Outlook for this disorder

There’s no cure for bipolar disorder, but symptoms can be effectively managed with the right treatment regimen. The outlook is more favorable:

  • in older children
  • when episodes are short, meaning less than a week or two
  • when children are supported by family members or live in a stable environment

In all cases, it’s critical to reach out to your child’s doctor if you’re concerned. It’s also always important for parents to have an active role in treatment.

Coping and caregiving

Bipolar disorder in children is a serious condition. It can have a major impact on other family members and on parental relationships. More and more, families are being incorporated into therapy. Ask your doctor for a referral to a therapist who can provide support and treatment to the entire family.

It’s also important to remember that your child isn’t misbehaving on purpose. Rather, they are dealing with issues that are out of their control. Patience, understanding, and a listening ear can go a long way.