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A to Z: Bipolar Disorder

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May also be called: Manic Depression; Manic-Depressive Disorder; Manic-Depressive Illness; Bipolar Mood Disorder; Bipolar Affective Disorder

Bipolar Disorder in Children

Moodiness is a fact of life in childhood when the brain is still developing. But highs and lows that are extreme or last longer than usual could be a sign of bipolar disorder in children. How can parents recognize this mental health disorder?
Bipolar disorder is a type of mood disturbance characterized by episodes of low-energy depression (symptoms include sadness, fatigue, and hopelessness) and high-energy mania (signs include increased energy, sleep loss, and reckless behavior). It is characterized as a mood disorder  has been previously referred to as manic depression, bipolar disorder is characterized by drastic mood changes.


Bipolar disorder in children explained

Bipolar disorder is a type of mental health condition known as a mood disorder. Previously referred to as manic depression, bipolar disorder is characterized by drastic mood changes.

In adults, bipolar disorder typically involves lengthy but intermittent episodes of drastic highs (mania) and deep lows (depression). People see changes not only in mood and energy but in sleep, eating habits and cognition (brain function). Such episodes can last several days to weeks at a time.

Bipolar disorder in children, however, can look very different, depending on the age of the child. In young children, the episodes of highs and lows can occur more rapidly, even multiple times throughout the day. Children are also more likely than adults to experience “mixed states.” This is when they have symptoms of mania and depression at the same time.

Because the signs of bipolar disorder in children overlap with other conditions, it’s common for the disorder to be mistaken initially for attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder, depression, behavioral problems or a learning disability. Children with bipolar disorder are also more likely to have these other disorders as well, further complicating a proper diagnosis. As with other mental health disorders, bipolar disorder requires careful evaluation and diagnosis by an experienced psychiatrist or psychologist.

How common is bipolar disorder in children?

For a long time, it was presumed that bipolar disorder did not develop in children. Today we know bipolar disorder can and does affect children. It can be diagnosed as early as 5 years old. In fact, the median age of onset of symptoms for a mood disorder is 13, according to research published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Prevalence rates among children and adolescents are similar to those of adults. About 4% of children under 18 and just under 3% of adults in the U.S. are estimated to have bipolar disorder, according to the American Psychological Association. However, it has historically taken much longer for children than adults to receive a diagnosis — around 10 years from first seeking help.

Bipolar disorder appears to affect the sexes equally. While females are about twice as likely to have major depression or mania, they’re only slightly more likely to develop bipolar disorder as compared with males.

What causes bipolar disorder in children?

Scientists aren’t entirely sure what causes bipolar disorder, but genetics and environment — particularly stress and sleep — appear to be factors. Children with a parent or sibling with bipolar disorder have about a 5% to 10% chance of developing the disorder themselves. Children who have an identical twin who has bipolar disorder have about a 70% chance of developing it.

While family history is an important risk factor, and you should be sure to discuss it with your child’s mental health provider, it’s not everything. Keep in mind that most children (90%–95%) of adults who have bipolar disorder never develop the disorder.

Signs of bipolar disorder in children

Symptoms of bipolar disorder in children vary by age. It may be more difficult to distinguish bipolar disorder symptoms from normal behavior in a young child, considering young children are more likely to experience rapidly changing moods and mixed states. As children get older, their symptoms get increasingly similar to the symptoms adults exhibit, which may make the disorder easier to spot in adolescents and teens.

The hallmark signs of bipolar disorder in children and adults are periods of intense lows (depression) contrasted with euphoric-like highs (mania).

Behaviors associated with episodes of depression include:

  • ● Sadness or feelings of worthlessness or guilt
  • ● Tiredness
  • ● Loss of interest in usual activities
  • ● Sleeping too much or trouble sleeping
  • ● Trouble concentrating and a drop in academic performance
  • ● Inability to experience pleasure
  • ● Overeating or loss of appetite
  • ● Intense anger, worry or anxiety
  • ● Thoughts of death or suicide

Behaviors associated with episodes of mania include:

  • ● Increased physical and mental activity
  • ● Racing speech and thoughts
  • ● Elevated mood and exaggerated optimism
  • ● Inflated sense of self-importance
  • ● Decreased need for sleep
  • ● Trouble concentrating
  • ● Reckless or aggressive behavior
  • ● Anger, excessive irritability or impatience
  • ● Poor judgment and making rash decisions

Almost all of these symptoms, even when standing alone, warrant a trip to the pediatrician or a mental health professional. Seek an appointment sooner than later if your child has multiple symptoms or if they’re having thoughts of death or suicide.

How is bipolar disorder in children diagnosed?

There are no lab or imaging tests for diagnosing bipolar disorder in children. Instead, children exhibiting symptoms of bipolar disorder — or any mental health disorder, for that matter — should be evaluated by a trained pediatric mental health provider, such as a child psychologist or pediatric psychiatrist.

Your child’s mental health provider will conduct a psychiatric evaluation. It will include meeting with your child and having you and your child fill out a detailed questionnaire about your child’s health and family health history, sociodemographic background, behavior and more. Your child’s provider may also ask other involved caregivers and teachers and/or coaches to answer questions about your child’s behavior as well. He or she will then use this information to diagnose your child’s condition and diagnose or rule out other disorders, such as ADHD, substance abuse, depression, anxiety and others.

Treatment for childhood bipolar disorder

Childhood bipolar disorder is a lifelong diagnosis that will need to be managed long term. The sooner your child begins treatment, the better. The earlier your child begins treatment, the milder his or her moods and episodes are likely to be.

Bipolar disorder in children is treated with a combination of medication and therapy. Medication includes a mood stabilizer to control episodes of mania and ease the symptoms of depression. Sometimes an antidepressant is prescribed in addition to the mood stabilizer.

There are several medications on the market approved to treat bipolar disorder and more being studied in clinical trials. Each drug has its own side effects. The most common include drowsiness, dizziness, dry mouth, weight gain and feeling mentally foggy. Discuss side effects with your child’s provider, who may be able to recommend a different medication. In the meantime, do not stop giving your child their medication.

Similarly, mental health providers use several types of evidence-based therapies to treat bipolar disorder in children. Common approaches include:

  • ● Psychotherapy (talk therapy)
  • ● Cognitive behavioral therapy (talk therapy)
  • ● Family-focused therapy
  • ● Multifamily psychoeducational therapy
  • ● Interpersonal and social rhythm therapy
  • ● Dialectical behavioral therapy

Some of these therapies include an educational component, covering how certain lifestyle choices and habits can affect the frequency and severity of bipolar episodes. No matter the type of therapy recommended for your child, it’s critical your family learn about bipolar disorder in children and how to manage the condition.

Sleep disturbances and stress are major triggers of bipolar episodes in both children and adults. Teaching your child healthy sleep hygiene and ways to manage their stress levels will serve them for the rest of their life.

Long-term outlook for kids with bipolar disorder

Bipolar disorder is one of the top 10 causes of disability in adults. Without proper treatment, it can lead to hospitalization, substance abuse, relationship problems, financial issues, and injury or illness from engaging in risky behaviors. People who live with bipolar disorder are also at much greater risk for dying by suicide than the general population.

These facts are the reason it’s imperative your child be properly evaluated for bipolar disorder and begin treatment without delay. Treatment should continue throughout your child’s life, even if they haven’t had any episodes in a long time. Stopping treatment abruptly can be dangerous to your child’s health and puts them at risk for relapse.

Conversely, children who receive a thorough diagnosis and adhere to their treatment plan can typically lead normal, productive lives and go on to succeed in their career, have a family and enjoy life.

More to Know

Bipolar disorder is a type of depressive disorder, a medical condition that affects the way a person’s brain functions. Someone with bipolar disorder will go through episodes of mania and at other times experience episodes of depression.

Doctors aren’t sure exactly what causes bipolar disorder, but they believe it’s linked to imbalances in certain brain chemicals called neurotransmitters. If the neurotransmitters aren’t in balance, the brain’s mood-regulating system won’t work the way it should.

Often, episodes of mania or depression last for weeks or months, but they can change rapidly, even during the course of a day. During manic episodes, a person with bipolar disorder may have increased energy and activity, an elevated mood, racing thoughts, difficulty concentrating, and less need for sleep. He or she may also exhibit poor judgment and engage in reckless or aggressive behavior.

Periods of depression are marked by a loss of energy, prolonged sadness, feelings of guilt or worthlessness, sleeping and eating problems, and thoughts of death or suicide.

Keep in Mind

There’s no cure for bipolar disorder, but most people who have it can be helped if a psychiatrist or psychologist diagnoses the disorder. Without treatment, bipolar disorder can get worse, but by following a treatment plan and making a few lifestyle changes — such as reducing stress, eating well, and getting enough sleep and exercise — people living with bipolar disorder can usually control their symptoms and lead normal lives.

Mental healthcare at Rady Children’s

At Rady Children’s, we have a team of mental health experts that includes board-certified child and adolescent psychiatrists, pediatricians and psychologists who are experts in bipolar disorder. We offer integrative care and a variety of family-inclusive services at the hospital and other locations around San Diego.

To schedule an appointment with a Rady Children’s mental health specialist, call us at 858-966-6789.

All A to Z dictionary entries are regularly reviewed by KidsHealth medical experts. Appended content provided by Rady Children’s Hospital.