Bipolar disorder in children

Many children and especially adolescents experience mood swings as a normal part of growing up, but when these feelings persist and begin to interfere with a child's ability to function in daily life, bipolar disorder (sometimes called manic depression) could be the cause. Bipolar disorder is a type of mood disorder marked by extreme changes in mood, energy levels and behaviour.

Causes of bipolar disorder in children

The illness tends to be highly genetic in origin, but there are clearly environmental factors that influence whether the illness will occur in a particular child. Bipolar disorder can skip generations and take different forms in different individuals.

For the general population, there is a 1% risk of having bipolar disorder. When one parent has bipolar disorder, the risk to each child is 15-30%. When both parents have bipolar disorder, the risk increases to 50-75%. The risk of siblings and fraternal twins is 15-25%. The risk in identical twins is approximately 70%.

Symptoms of bipolar disorder

Symptoms can begin in early childhood but more typically emerge in adolescence or adulthood. Research by the American Academy of Child and Adolescent Psychiatry shows that up to one third of 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder.

Below are a series of symptoms associated with the manic and depressive states of bipolar disorder. Not all children with bipolar disorder have all symptoms. If a child you know is struggling with any combination of these symptoms for more than two weeks, talk with a doctor or mental health professional.

  • Manic symptoms
Severe changes in mood - from unusually happy or silly or irritable, angry or aggressive.
Unrealistic highs in self-esteem. May feel indestructible or believe he or she can fly, for example.
Great increase in energy level.
Sleeps little without being tired.
Excessive involvement in multiple projects and activities.
May move from one thing to the next and become easily distracted Increase in talking.
Talks much too fast, changes topics too quickly, and cannot be interrupted. This may be accompanied by racing thoughts or feeling pressure to keep talking.
Risk-taking behaviour such as abusing drugs and alcohol, attempting daredevil stunts, or being sexually active or having unprotected sex.
  • Depressive symptoms

Frequent sadness or crying.
Withdrawal from friends and activities.
Decreased energy level, lack of enthusiasm or motivation.
Feelings of worthlessness or excessive guilt.
Major changes in habits such as over-sleeping or over-eating.
Frequent physical complaints such as headaches and stomach-aches.
Recurring thoughts of death, suicide, or self-destructive behaviour.

Children with bipolar disorder usually alternate between extremely high moods (mania) and low moods (depression). These rapid mood shifts can produce irritability with periods of wellness between episodes, or the young person may feel both extremes at the same time. Parents who have children with the disorder often describe them as unpredictable, alternating between silly and withdrawn. Children with bipolar disorder are at a greater risk for anxiety disorders and attention-deficit hyperactivity disorder (ADHD). These "co-occurring" (co morbid) disorders complicate the diagnosis of bipolar disorder and contribute to the lack of recognition of the illness in children.

When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, muscle aches, stomach-aches or tiredness, frequent absences from school, poor performance in school, talk of or efforts to run away from home, irritability, complaining, unexplained crying, social isolation, poor communication, and extreme sensitivity to rejection and failure.

Many teens with bipolar disorder abuse alcohol and drugs as a way to feel better and escape. Children with bipolar disorder may also have difficulty with relationships.

For more general information about this condition, see the Bipolar disorder section.

When manic, children and adolescents, in contrast to adults, are more likely to be irritable and prone to destructive outbursts than to be elated or euphoric.

Treatment of bipolar disorder in children

Early intervention and treatment offer the best chance for children with emerging bipolar disorder. Once the diagnosis of bipolar disorder is made, the treatment of children and adolescents is based mainly on experience with adults, since there is very limited data on the effectiveness and safety of mood stabilising medications in youth.

The essential treatment for this disorder in adults involves the use of appropriate doses of mood stabilisers. It is important to note that children may experience side-effects to an increased degree compared with adults. In addition to medication, a good treatment plan should include close monitoring of symptoms, education about the illness, counselling or psychotherapy for the individual and family, stress reduction, good nutrition, regular sleep and exercise, and participation in a network of support.

Problems with bipolar disorder in childhood

Bipolar disorder is difficult to recognise and diagnose in children because it does not have exactly the same symptoms established for adults, and because its symptoms can resemble those of other common childhood mental disorders.

In addition, symptoms of bipolar disorder may be initially mistaken for normal emotions and behaviours of children and adolescents. In adolescents, bipolar disorder can be misdiagnosed as borderline personality disorder, post-traumatic stress disorder and schizophrenia.