Bipolar Disorder in Children & Teens

What Is Bipolar Disorder?

Bipolar disorder, or manic-depressive illness, is a diagnosable mental health condition recognized in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).² What distinguishes bipolar disorder from major depressive disorder is the experience of at least one manic episode in a person’s lifetime. Though typical onset occurs between 20 to 30 years of age, the condition can manifest earlier.²

Bipolar disorder is characterized by extreme shifts in mood, energy, and activity levels. Those with bipolar disorder experience episodes of mania, such as elevated or irritable mood, increased energy, and decreased need for sleep, along with episodes of depression, like low mood, loss of interest or pleasure, and feelings of worthlessness or hopelessness.²

Common symptoms of bipolar disorder include:

• Mania or hypomania: Mania or hypomania symptoms include feelings of euphoria, extreme energy, racing thoughts, impulsivity, and poor judgment
• Depression: Depression symptoms include feelings of sadness, hopelessness, worthlessness, and loss of interest in once-enjoyable activities
• Mood swings: Mood swings are sudden and intense changes in mood that may occur without any apparent cause
• Irritability: Irritability causes someone to become easily annoyed or angered
• Sleep disturbances: Sleep disturbances include difficulty falling or staying asleep or oversleeping
• Impulsivity: Impulsivity includes reckless behavior such as overspending, substance abuse, or risky sexual behaviors.²

How Common is Bipolar Disorder in Children?

Bipolar disorder is a rare mental health condition in children, but it can occur. It’s important to note that diagnosing bipolar disorder in children can be challenging, as the symptoms may be  similar to other mental health conditions (i.e., attention-deficit/hyperactivity disorder, autism spectrum disorder, oppositional defiant disorder). Additionally, children may not be able to articulate their experiences as well as adults.³

Bipolar Symptoms in Children

The basic symptoms of bipolar disorder in adults often appear in children, though they manifest and present differently in children. Like adults, symptoms and their severity do vary by individual and condition.

Here are some of the basic symptoms of bipolar disorder in children:

• Serious mood swings differing from their usual mood swings. These happen often, can last a long time, and greatly affect how a child acts.
• Being hyperactive, impulsive, and aggressive affects how a child acts socially and in other areas of life.
• Racing thoughts are sometimes shown by rapidly changing subjects when talking.
• Risky and reckless behaviors that are out of character, such as having frequent casual sex with many partners. Other examples include alcohol or drug misuse and wild spending sprees.
• Being unable to sleep or greatly decreased need for sleep.
• Depressed or irritable mood most of the day, nearly every day, during a depressive bout.
• An inflated view of capabilities that are not based on reality.
• Suicidal thoughts or behaviors. These symptoms occur more often in older children and teens.
• Loss of contact with reality, such as seeing things that aren’t there or believing someone is trying to hurt them.³

As indicated previously, it’s important to note that these symptoms may also indicate other mental health conditions and that a professional evaluation by a mental health provider is necessary for an accurate diagnosis.

Symptoms of Manic Episodes in Children

The DSM-5 defines the primary criterion of mania as being “a distinct period of abnormally and persistently elevated, expansive, or irritable mood” and “abnormally and persistently increased goal-directed activity or energy.”² Mania is oftentimes a symptom of bipolar disorder but is not exclusive to this diagnosis as it is also found in cyclothymia, postpartum psychosis, schizoaffective disorder, and seasonal affective disorder diagnoses. The symptoms of mania in children resemble those found in adults but with some marked differences.

Children presenting with bipolar mania may:

• Show intense happiness or silliness for long periods of time
• Have a very short temper or seem extremely irritable
• Talk fast about a lot of different things
• Have trouble sleeping but do not feel tired
• Have trouble staying focused and experience racing thoughts
• Seem overly interested or involved in pleasurable but risky activities
• Do risky or reckless things that show poor judgment
• Have an inflated sense of ability, knowledge, and power.⁶

Symptoms of Depressive Episodes in Children

Children with bipolar disorder may experience depressive episodes, which can be characterized by various symptoms. Symptoms can include sadness, hopelessness, and worthlessness, as well as a loss of interest in activities they once enjoyed.⁶ Children may also experience changes in appetite and sleep patterns, have difficulty concentrating, and may even have thoughts of self-harm or suicide.

Children presenting with bipolar depression may:

• Feel frequent and unprovoked sadness
• Show increased irritability, anger, or hostility
• Complain frequently about physical pain, such as stomachaches and headaches
• Start sleeping a lot more
• Have difficulty concentrating
• Feel hopeless and worthless
• Have difficulty communicating or maintaining relationships
• Eat too much or too little
• Have low energy and no interest in activities they usually enjoy
• Think about death or have thoughts of suicide⁶

Bipolar Symptoms in Children Under 10

Bipolar disorder is relatively rare in children under 10 (even more so than in older children and adolescents), but it is possible. The symptoms of bipolar disorder in young children are like their older counterparts but are expressed differently in accordance with their developmental age. Since early childhood development progresses more rapidly than at any other age, each year may be met with a substantial difference in how its symptoms present themselves.

Common symptoms of bipolar disorder in young children include:

• Severe temper tantrums that are more severe than typical tantrums and may last longer
• Rapidly changing moods that are extreme and without an apparent trigger
• Hyperactivity in that they are atypically active and have trouble sitting still
• Aggression toward others or themselves
• Risk-taking behavior, such as climbing to dangerous heights or running into traffic
• Extreme separation anxiety when separated from a parent or caregiver
• Difficulty falling asleep or staying asleep

Symptoms of Bipolar Disorder in Teens

As explained with children under age 10, bipolar disorder in teens does present with similar symptoms as younger and older individuals but presents in a manner indicative of their developmental age. Accordingly, one must consider variations from what is considered typical for adolescents.

Common symptoms of bipolar disorder in teens include:

• Extreme mood swings, which are more intense than typical teenage mood swings. They may have periods of intense happiness or euphoria (mania), followed by deep sadness or hopelessness (depression).
• Irritability occurs easily with moods that may quickly shift from one extreme to another
• Aggressive behavior towards others or themselves
• Sleep disturbances such as difficulty falling or staying asleep
• Impulsivity without thinking about the consequences of their actions
• Risky behavior such as substance abuse, reckless driving, or unsafe sexual practices
• Grandiosity presents as an inflated sense of self-importance or belief they have special abilities or powers
• Suicidal thoughts, attempts, and/or acts of self-harm

 Early Signs of Childhood Bipolar Disorder

As with any other condition, the earlier one arrives at an awareness of the problem and seeks professional assistance, the better. Especially with younger children, picking up on early signs of childhood bipolar disorder and doing something about it may help immediately curb symptoms while reducing the condition’s lifelong impact. Not only does early intervention allow one to cope effectively to the extent of living a fulfilling life, but it also helps destigmatize the condition.

Those who do not receive early intervention may grow up believing that “This is just who I am” and as a result, be opposed to seeking help. Internalizing the problem is detrimental in many ways, including cognitively and emotionally. Early warning signs do vary by individual and do resemble some of those found in other conditions.

Early warning signs of childhood bipolar disorder may include:

• Extreme mood swings
• Behavioral problems
• Sleep disturbances
• Hyperactivity
• Irritability
• Grandiosity
• Difficulty with concentration
• Interpersonal challenges, such as forming and maintaining prosocial relationships
• Compromised attachment with parents, guardians, and caregivers
• Lack of interest in activities previously enjoyed or those that are age-appropriate

Causes & Risk Factors for Childhood Bipolar Disorder

Although the exact causes of bipolar disorder are unknown, the condition can be onset by a number of factors. Genetic predisposition is a key factor widely understood, as research continually indicates a connection between onset and familial history.^4,5 At the same time, there is no guarantee that because a genetic parent, grandparent, sibling, or otherwise has a bipolar diagnosis having the condition oneself is imminent.⁶ Here, stressful environments or acute trauma may trigger onset in those where the condition may lie dormant.

Common causes and risk factors for childhood bipolar disorder include:

• Genetics: Bipolar disorder tends to run in families, suggesting a genetic component. Although there is no guarantee that one will acquire the condition, various factors, including extreme stress, may activate it. It is also important to note that there is no single gene that activates bipolar disorder.⁶ Rather, many genes are involved, which complicates the ability to readily identify potential at birth or in utero.
• Brain chemistry: Bipolar disorder is thought to be caused by an imbalance of certain chemicals in the brain, such as serotonin and dopamine. With certain chemicals being imbalanced, anything that can further compromise balance, such as extreme stress or introducing carcinogens to the body, can activate and/or further complicate the condition.
• Environmental factors: Trauma, abuse, neglect, or significant life events such as the death of a loved one, divorce, or a major move can trigger the onset of bipolar disorder in children. We cannot minimize the impact of the environment here. Especially in areas deemed unsafe where housing is uninhabitable, domestic and community violence is rampant, or where the risk is otherwise elevated.
• Neurological factors: Some research suggests that there may be differences in the brain structure and function of children with bipolar disorder compared to those without the condition.
• Substance abuse: Substance abuse, particularly drugs like cocaine and amphetamines, can trigger manic episodes in people with bipolar disorder, while depressants such as alcohol, barbiturates, and anti-anxiety tranquilizers may trigger depression. Any carcinogen or toxin introduced into one’s body compromises physiology, including brain function. This further compromises one’s balance, which may lead toward the onset or further complicate the condition.⁸

A child may be more at risk of developing bipolar disorder in the presence of:

• A family history of bipolar disorder
• Chronic stressors in the child’s life
• Physical, sexual, emotional, verbal abuse and/or neglect
• Exposure to drugs of abuse at a young age
• Parents, guardians, or caregivers who refuse to acknowledge potential mental health complications and refuse to seek help
• Biological parents, or others, with bipolar disorder who are either undiagnosed or refuse treatment and model their behavior as typical.

Treatments for Bipolar in Kids,

Fortunately, there are various means of treating bipolar disorder in children. As there is no cure for bipolar disorder, the goal is an effective treatment that aims to enhance self-awareness, build coping skills, solicit prosocial support, and oftentimes include a degree of medication management. The more holistic the treatment, meaning that all factors are covered (e.g., mental, physiological, environmental, etc.), the more likely it is to be successful—although strict adherence to a treatment regimen is required.  Accordingly, motivation to change is necessary. With children, caregivers play a major role in instilling and encouraging said motivation.

Treatment approaches should consider the developmental level of the child to ensure efficacy. What works for a child under 10 may not for an adolescent and is even more unlikely to work for an adult. The goal of any treatment is to ensure that it meets clients where they are. Accordingly, with children, it is advantageous to find professionals who specifically work with or are specialized in treating children. Here, the top priority is safely engaging the child while minimizing the fear of the condition.

Although family therapy may not prove as necessary with adults as children, there is substantial value in having pertinent family members engaged in treatment. Now, everyone may have knowledge of the condition, awareness of symptoms as they occur, know how to effectively communicate, what to do in the event of an emergency, and otherwise.

Common treatment methods for bipolar disorder in children are as follows:

1. Medication: Some medications for bipolar may not be appropriate for children, and dosages may need to be adjusted accordingly. Medications such as atypical antipsychotics (i.e., risperidone, Seroquel, aripiprazole, olanzapine) are most often used here, as they have demonstrated efficacy through research.¹⁰
   Typical mood stabilizers, such as lithium and valproate, have been shown to be less effective in some cases than others.¹⁰ Medication use in children with bipolar disorder must be carefully monitored, and the dosages are adjusted based on the child’s weight and other individual factors.
2. Psychotherapy: Different types of psychotherapy can be helpful for children with bipolar disorder, such as cognitive-behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapy. These therapies can help children learn coping strategies, improve their communication skills, and manage their emotions.
3. Lifestyle changes: Making lifestyle changes, such as improving sleep habits, getting regular exercise, engaging in healthy activities, associating with prosocial support, and eating a healthy diet, can also be beneficial in managing the symptoms of bipolar disorder.
4. Support groups: Support groups can help children and their families connect with others dealing with similar challenges and provide a sense of community and understanding. The Balanced Mind Foundation and the Depression and Bipolar Support Alliance are two notable organizations that provide support groups for families with family members or children with the diagnosis.
5. Family therapy: Prominent family members engage in therapy with the child not only for the child’s benefit but their own, as family therapy focuses on improving family communication and relationships. When an individual is diagnosed with any mental health condition, it does compromise the wellness of the whole family. Here, everyone receives the support they need to proceed in a healthy fashion.

When to Seek Professional Help for a Child

If you suspect that your child may have bipolar disorder, it’s important to seek professional help as soon as possible. Early intervention can help prevent the condition from worsening and can improve your child’s overall outcome. Professional help for this condition is best provided by a licensed and trained mental health professional such as a psychiatrist, clinical psychologist, or licensed counselor. These individuals will ultimately conclude whether the condition truly is bipolar disorder or something else, which very well could be, as there are many similar symptoms across various conditions, especially in childhood.

The first step in getting help for bipolar disorder is recognizing the symptoms, which is best done through a formal diagnosis. Once a diagnosis is made, the professional will work with the child to develop an age-appropriate treatment plan that addresses their needs. It often includes a combination of medication, psychotherapy, and lifestyle changes. Remember, the sooner one intervenes, the better. Even if there is a slight hunch that something may be off, it is better to seek assistance and confirm whether everything is okay. If everything is okay, then you know. If not, then treatment may begin promptly. An online therapist directory can be a valuable resource for finding the best professional to meet your needs.

How to Help a Child With Bipolar Disorder

The best thing a parent/loved one can do to help their child throughout treatment or cope with bipolar disorder is to remain as supportive as possible. If the child is acting out of character or presenting atypically in accordance with one’s age group, it is important to act as soon as possible. Disciplining the child or minimizing or denying the condition is problematic.

Mental health disorders can prove debilitating and cause one to act out of character. Rather than blaming the child or denying that mental health conditions exist, there needs to be some collaboration. Remember, children can only be as accountable as their developmental age. If a 10-year-old is struggling with a bipolar diagnosis, that child does not have the ability to seek and schedule treatment with caregiver involvement. Accordingly, much of the responsibility lies in the hands of the adult.

Practices that can help your child who is living with bipolar disorder include:

• Educating yourself about bipolar disorder: Learn as much as you can about bipolar disorder, including its symptoms, causes, and treatment options. This can help you better understand what your child is going through and how you can best support them.
• Encouraging treatment compliance: Make sure your child is taking their medication as prescribed and attending therapy sessions as recommended. Encourage them to be open and honest with their mental health providers.
• Helping them maintain a healthy lifestyle: Encourage your child to exercise regularly, eat a healthy diet, and maintain a regular sleep schedule. These lifestyle factors can help manage the symptoms of bipolar disorder.
• Creating a supportive home environment: Create a home environment that is supportive and accepting of your child’s condition. Encourage open communication and provide emotional support when needed.
• Seeking support for yourself: Caring for a child with bipolar disorder can be stressful and overwhelming. Seek support for yourself through therapy, support groups, or other resources.
• Managing stress: Manage your own stress levels and practice self-care. This can help you better manage the challenges of caring for a child with bipolar disorder.
• Remaining positive: Encourage your child to focus on their strengths and accomplishments and celebrate their successes. This can help boost their self-esteem and improve their overall outlook.

Final Thoughts

While it can be difficult to accept a mental health diagnosis such as bipolar disorder, it’s important to remember that finding relief is possible with a treatment plan. Remember, bipolar disorder is a treatable condition, and with proper care and support, children with bipolar disorder continually grow up to lead fulfilling lives. The first step begins with recognizing and accepting the warning signs and, from there, seeking a diagnosis and beginning treatment. With the appropriate support and working together, everyone may continue moving forward. Rather than wait and see what happens, act right away. In a medical emergency or mental health crisis, call 9-1-1 or 9-8-8 as appropriate.