Bipolar disorder (formerly known as manic-depressive illness or manic depression) is a lifelong mood disorder and mental health condition that causes intense shifts in mood, energy levels, thinking patterns, and behavior. These shifts can last for hours, days, weeks, or months and interrupt your ability to carry out day-to-day tasks. In this article, we shall discuss bipolar disorder in children: a thorough guide.
Most people are diagnosed with bipolar disorder in adolescence or adulthood, but the symptoms can appear earlier in childhood.
There are a few types of bipolar disorder, most of which involve experiencing manic and depressive episodes. However, people with bipolar disorder don’t always experience either manic episodes or depressive episodes. They also experience euthymia, which is a relatively stable mood state in which they are their usual self.
It can be tempting to explain any emotional and physical changes your child experiences as just part of the process of growing up. But when does their behavior point to a mental health condition like bipolar disorder?
Experiencing episodes of mania or depression (or both) could point to a diagnosis of bipolar disorder in children.
Bipolar disorder is a mental health condition where you experience shifts in the mood for certain periods of time. There are three diagnoses of bipolar disorder:
- Bipolar I. Your child has episodes of mania. They might also experience depression or hypomania (mild mania).
- Bipolar II. Your child has had at least one depressive episode and an episode of hypomania.
- Cyclothymic disorder. Your child experiences periods of milder depression and hypomania, and they have done so for at least one year.
If your child shares thoughts of hopelessness or dying and frequent but unexplained sadness, they may be experiencing a depressive episode.
On the flip side, a shift in mood where your child is more hyperactive than usual may be a sign of mania.
While bipolar disorder is often a lifelong condition, symptoms can start to show in early childhood. About 1% to 3%Trusted Sources of children and teens could have bipolar disorder.
According to the National Comorbidity Survey, about 2.6%Trusted Source of teens reported that bipolar disorder severely impairs their day-to-day activities. Females were slightly more likely to have a bipolar disorder diagnosis than males.
One reviewTrusted Source reported that bipolar disorder could be more likely to develop around ages 15 to 24 years. And according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the average ages of onset for bipolar disorder are:
- 18 years old with bipolar disorder I
- the mid-20s for bipolar disorder II
It’s still possible for some people to have symptoms earlier than that.
Bipolar disorder shows up differently in children than in adults. In kids, bipolar disorder can sometimes be mistaken for other conditions, such as ADHD.
Because of the chances of misdiagnosis, parental involvement in noticing signs and supporting the child can be key to helping them manage symptoms.
There’s some debate surrounding the diagnosis of bipolar disorder in children — especially young children.
While some researchersTrusted Sources question the existence of bipolar disorder in children due to a lack of data, others suggestTrusted Source that early diagnosis is key to helping people manage mood episodes in the long term.
Table of Contents
What bipolar disorder looks like in kids
Does bipolar disorder look the same in everyone? Not exactly. According to the National Institute of Mental Health Trusted Source, children experience a range of symptoms and emotions depending on the episode.
Children with bipolar disorder may also be more likelyTrusted Source to have symptoms of psychosis than people who develop it later.
For episodes of mania, children might:
- have trouble concentrating
- engage in risky or impulsive behaviors
- experience strong anger, irritability, or restlessness
- have more trouble getting to sleep at bedtime
- seem extra silly or hyperactive
And in children, a depressive episode might look like this:
- unexplained and constant sadness
- thinking or talking about suicide
- lack of motivation or energy to do everyday activities
- changes in eating patterns
- irritable mood
- not gaining weight as expected for the age group
What causes childhood bipolar disorder?
There is no single cause of childhood bipolar disorder. But genetics and environmental factors such as stressful life events likely play key roles.
A family history of bipolar disorder can make you more genetically likely to develop it. In fact, some research suggests bipolar disorder is around 60%Trusted Source heritable. Several gene mutations have also been linkedTrusted Source to bipolar disorder.
Stressful life events
Trauma can increase the risk of developing bipolar disorder, especially in children genetically predisposed to it.
- A recent studyTrusted Source found that people with a bipolar disorder diagnosis who had experienced physical abuse in childhood showed altered gene expression for sleep.
- Another study focused on people with bipolar disorder who experienced emotional abuse as children. It found decreased gene expression in two genes that help regulate stress.
Getting a diagnosis of childhood bipolar disorder
If you think your child could have bipolar disorder, consider taking them to their pediatrician for a referral to a therapist or psychiatrist.
According to the DSM-5Trusted Source, mood changes need to be different from a child’s usual behavior and present for at least one week.
Children who’ve experienced at least one manic episode could meet the diagnostic criteria. Experiencing depressive episodes or a “mixed” episode — both mania and depression — helps in confirming your child’s diagnosis.
A medical visit could involve an in-person interview or a complete psychiatric evaluation with questions about:
- family mental health history
- sleeping patterns
- energy levels
- current symptoms and behaviors
- family or environmental stress
Your child’s doctor might also rule out ADHD, which can have overlapping symptoms with pediatric bipolar disorder. Similar symptoms include:
- rapid speech
- tendency to get distracted
- racing thoughts
- less need for sleep
Your doctor might also interview family members, friends, and teachers to track your child’s changes in mood. This could help them determine whether it’s childhood bipolar disorder or two conditions together.
You have many options when it comes to helping your child manage bipolar disorder.
Treatment is often dependsTrusted Source on what symptoms your child has. For example, a combination of therapy and medication is usually recommended for severe bipolar disorder symptoms. Kids with milder symptoms might be best served by therapy alone.
Some common medications for childhood bipolar disorder could include:
- valproic acid
- lamotrigine (Lamictal)
- oxcarbazepine (Trileptal)
Antipsychotic medications can stabilize moods for kids with bipolar disorder. Some examples include:
- quetiapine (Seroquel)
- aripiprazole (Abilify)
- risperidone (Risperdal)
- olanzapine (Zyprexa)
- asenapine (Saphris)
For children who experience depressive episodes, antidepressants could help. But if your child also experiences mania, antidepressants aren’t recommended. Fluoxetine (Prozac) is one antidepressant that could help during depressive episodes.
Some of these medications may cause side effectsTrusted Sources like irritability or weight gain. If you notice your child having side effects, it’s a good idea to let their doctor know.
Therapy is another viable optionTrusted Source for childhood bipolar disorder. Some therapies that could help include:
- cognitive behavioral therapy (CBT)
- family therapy
- mindfulness-based interventions
- child and family-focused CBT
- dialectical behavior therapy (DBT)
- interpersonal and social rhythm therapy
In therapy, kids with bipolar disorder can learn skills for managing emotions and mood changes.
Managing an at-home care strategy can help keep symptoms at bay. The International Bipolar Foundation recommends daily exercise as a good outlet for releasing energy connected to mania. Kids may find it easier to overexercise if they’re experiencing mania, so moderation is key to preventing overuse injuries.
Exercise can also lift a low mood during depressive episodes, but your child might not feel up to it during these times. Rather than forcing anything, encouraging them to move in gentle ways — like taking a walk around the yard or playing with a pet — can be just as beneficial.
Getting enough sleep is important in stabilizing mood and overall child development. The Centers for Disease Control and PreventionTrusted Source recommends 9 to 12 hours of sleep for children 6 to 12 years old. By the time your child reaches their teens, the CDC recommends 8 to 10 hours per night.
Living with childhood bipolar disorder
If you have a child with bipolar disorder, you might find they have problems with school or socializing with friends. They may also go through times when they have a hard time holding a conversation or feeling motivated to get out of bed.
Children and teens with bipolar disorder could also be more likely to have another mental health issue. Anywhere from 20% to 80%Trusted Source of children and teens with bipolar disorder could have another condition like:
- an anxiety disorder
- substance use disorder
- a disruptive behavior disorder
But with a care plan that fits their needs, your child’s symptoms can become more manageable.
My child has bipolar disorder. How can I help?
Bipolar disorder can feel stressful for both you and your child, especially if you feel unsure about how you can help.
If you think your child is experiencing an episode, you can offer support by:
- staying patient and encouraging them to talk out their feelings; listening helps children feel that they are not alone and helps remove the stigma around discussing their experiences
- maintaining a routine for taking medication and leaving enough time for movement and sleep
- teaching children how to cope with intense feelings of irritability or temper tantrums
- limiting triggers for mood episodes
In summary, bipolar disorder can be a lifelong condition. While it’s more often diagnosed in teens and adults, it can develop in younger children.
Managing the ups and downs of bipolar disorder may feel overwhelming at times, but you’re not alone. Your child’s doctor can share various approaches to stabilizing moods and managing symptoms.
I hope you find this article helpful.