Bipolar disorder is a genetic disorder marked by drastic shifts into mania and depression. People with the disorder can experience manic episodes involving euphoria, inflated self-image, high irritability and agitation, decreased desire to sleep, racing thoughts or impulsive, often destructive behaviors. They also can go through periods of profound depression, which can include feelings of low self-esteem, hopelessness and suicidal thoughts or actions.
Despite these strong symptoms, bipolar disorder often goes unidentified and untreated. This is especially true when symptoms of bipolar disorder emerge in adolescence or even early childhood.
While many who have bipolar disorder are first diagnosed as adults, the presentation of bipolar symptoms are often traced back to childhood. Children with bipolar disorder can display excessive emotional changes, outbursts of anger, excitability, anxiety, or rage, followed by periods of depression and despondency.
Since about one-fourth of all deaths by suicide may be related to bipolar disorder, 1 it’s critical that professionals and parents clearly understand when young children and adolescents are exhibiting the first signs of bipolar mood swings. Developing an early intervention treatment plan can spare children and their families years of suffering from the effects of bipolar disorder.
Signs of Childhood Bipolar Disorder
Children with bipolar disorder will show episodes of mania along with episodes of depression. In episodes of mania, children tend to show increased energy, distractibility, pressured speech, grandiose self-image, decrease need or desire to sleep, elation/euphoria and poor judgment. They may also experience delusions or hallucinations along with these symptoms.3
Mania is not always about feeling great. It’s not unusual for people in a manic episode to also feel very irritable and easily agitated. In children and adolescents, they can display explosive anger, fits of rage, and at times, verbal and physical aggression. When this kind of manic episode subsides, they may feel guilty for their behavior or dismissive of the extent of their hostile behavior.
Along with periods of high excitability and irritability, it’s critical to look for drastic and even destructive forms of depression. Stark changes in energy levels and distractibility are typical in bipolar disorder. Most importantly, any signs of suicidal thoughts or gestures should be taken seriously. When children have bipolar disorder, they frequently display cycles involving suicidal expressions and even attempts. Self-harm and early problems with substance abuse are also common and should be immediately addressed with the proper treatment professionals.
Here are some important factors to look for in a young person who may have bipolar disorder:
- Cycling episodes of sadness, rage, and elation
- History of impulsivity, aggression, self-harm, and/or suicidal thoughts and actions
- Substance abuse/Self-medication
- Manic response to antidepressant or psychostimulant (ADHD) meds
- Higher emotional reactivity compared to most same-age peers
- History of extreme and/or abrupt changes in:
- Appearance
- Interests
- Goals
- Affiliation
- Overall self-image
Causes of Bipolar Disorder In Children
Bipolar disorder is hereditary and is essentially coded in the individual’s DNA. As the young brain develops, these genetic factors affect how the brain handles emotional regulation. So, a person with bipolar does not acquire the disorder simply through life circumstances; they began life with a predisposition to it.
Commonly, the first signs of bipolar disorder occur during adolescence or early adulthood. This is likely related to hormonal changes, as well as increased social and academic pressures that can all become catalysts for bipolar symptoms. But prepubescent children can also express symptoms of bipolar. A better understanding of how bipolar disorder can manifest in younger children could improve early detection and treatment.
Diagnosing Bipolar in Children
An accurate diagnosis can be very beneficial to provide specific treatments that can improve mood and functioning without making bipolar worse. The average time it takes for someone with bipolar to be correctly diagnosed is about ten years.6
Bipolar is a mental illness of mostly young people, with the average onset in late teens to early-20’s. Identifying the disorder in adolescence (or earlier if possible) is one of the best gifts we could ever give that child. Many persons—parents and professionals alike—are fearful of attaching the bipolar “label” to a young person.
An important factor to consider is family mental health history. Because bipolar disorder is genetic, any evidence of mental health conditions in the family history, particularly bipolar disorder, could assist in developing an accurate diagnosis for the child. This is especially true if bipolar is evident in first-degree relatives.4
Why Bipolar Disorder Is Often Missed
One part of the bipolar disorder problem is that manic behaviors are not always recognized as symptoms of bipolar in children and adolescents. Those symptoms may certainly get attention from family, teachers, and peers, but they may be attributed to other problems typical of childhood development. Or they may be viewed as other clinical problems, or simply a “phase” that the child is going through. When young people are accurately diagnosed with bipolar disorder, their treatments improve substantially.
Another part of the problem is denial, which is common in bipolar disorder, but isn’t limited to people with the condition. Family members can be in denial about bipolar, too. Parents can be especially resistant to a bipolar diagnosis because no one wants to think their child has a mental illness, especially one that needs lifelong care.
These fears are understandable, but ultimately, they can interfere with accepting the reality of what’s needed to treat bipolar disorder. Good, reliable information along with support for parents and all family members can ease fears and the great burden of helping their children cope with bipolar treatment.
Normal Mood Changes vs Bipolar
We expect that kids, especially teenagers, will explore different styles, ideas, and peer associates. These changes are a part of self-discovery and can be supported in a healthy and safe manner. But with children and teenagers with bipolar disorder, their first mood episodes can swing suddenly, even within a single day. (In fact, this is one of the reasons bipolar disorder is missed in children since mania can last much longer in adults.)
Despite these wild changes in emotion and behavior, there can also be periods of relative quiet between mood episodes. That doesn’t mean that bipolar disorder has gone away. It just means that there’s a certain calm before the next storm of uncontrolled emotions. In fact, that moment of calm is often the best opportunity to get started with bipolar treatment before another bipolar crisis breaks loose.
The problem with identifying bipolar disorder early in life is that mood shifts can occur for other psychiatric or life-adjustment reasons. Children and teenagers can certainly go through mood changes as they progress through development, but bipolar results in severe difficulties in emotional management, even at a very young age. So if you suspect your child could have bipolar, it’s good to find a professional experienced in childhood bipolar disorder to accurately assess the condition.
Destructive Behaviors Caused by Bipolar in Children
It’s particularly important to look at patterns of destructive behaviors. Suicide is of the greatest concerns, along with substance abuse and other acts of self-harm. These behaviors are more easily addressed and treated if bipolar disorder is identified and treated under professional supervision.
Here are some typical problems associated with bipolar disorder that can be addressed and possibly improved with good treatment:
- Substance use (alcohol and drugs)
- Depression
- Despondency
- Suicidal feelings
- Self-harm/Cutting
- Aggression (physical fighting, yelling, profanity, etc.)
- Age-inappropriate sexual activity
- Poor grades
- Poor organization/concentration
- Poor life planning
- Poor social choices
- Disciplinary problems
How to Get Help for a Child With Bipolar
Not all mental health providers are alike. Many do not specifically focus on the special needs of children with bipolar disorder. As a parent, trying to find the right treatment team for your child with a possible bipolar disorder can easily feel overwhelming.
The first thing to know is that if your child is in a severe manic or depressive state, or is expressing suicidal thoughts or urges, or is threatening harm to self or someone else, they should be taken to a local psychiatric hospital or emergency room. You can always call 911 if you’re unable for any reason to transport your child.
In matters of less urgency, a good place to start in obtaining a referral for your child is with your child’s pediatrician or your family doctor. A child’s medical professional should certainly have your child’s mental health in mind, as well as his or her physical well-being.
Local psychiatric facilities or other resource lists can also provide referrals. Make sure to discuss with them your concerns about your child’s mood swings and behavior and ask who they typically recommend for childhood bipolar disorder.
Another resource is your child’s school counselor. While schools and school districts vary in terms of resources to help the mental health needs of their students, many have reliable referral lists in the community, which can offer you a good place to start.
While the process of finding the right treatment team for your child can seem daunting, it’s important to remember that early detection and intervention provide the best chance for your child’s success.
Treatment of Bipolar Disorder in Children
Treatment for bipolar disorder involves mood stabilizing medications and therapy designed to help the child and family heal from the effects of bipolar, and ultimately meet the child’s self-esteem, academic and social needs. Pediatric psychiatrists and therapists trained in treating bipolar disorder in young people can be good first choices in developing a treatment team.
Medication for Bipolar Disorder in Children
Medications for bipolar disorder in children are essentially the same as those prescribed to adults. Dosages may be different depending on age, but adolescents in particular can metabolize medications efficiently, and doses often reflect that factor. The basic medications for bipolar disorder include:
- Lithium
- Anticonvulsants/antiseizure/antiepileptics
- Antipsychotics
- Antidepressants (usually with another mood stabilizing med)
- Antianxiety/anxiolytics
Research has shown that untreated bipolar mood swings can actually damage the brain, resulting in greater life consequences that become harder to treat as life goes on. Therefore, proper medications for bipolar disorder are known to have “neuroprotective effects,” meaning they can protect the brain from the detrimental effects of bipolar mood swings.5 Moreover, therapy without adequate mood stabilization often impedes progress and can set back therapy goals for short- and long-term success.
Therapy for Bipolar Disorder in Children
As symptoms improve and mood swings are more manageable, individual therapy can be a useful tool for better emotional living. Since bipolar is genetic and begins early in life, it’s often difficult for a young person in early treatment to understand and manage emotions in a healthy, balanced way. Therapy can work to enhance relationships, and create new methods of organizing thoughts, feelings, and goals for lifelong success.
Families can also benefit from education and therapy to heal from the consequences of bipolar disorder. When a child’s bipolar mood swings are out-of-control, parents can suffer anxiety, frustration, and even sometimes conflicts among themselves. Understanding what bipolar is and how it forms, along with support within their child’s treatment regimen, can be helpful in reducing tension and improving family bonds. And parents may come to treatment with their bipolar children in various states of uncertainty or perhaps denial.
For kids, therapy focuses on facets of the young person’s life that offers gains in relationships, academics, social and recreational choices, and self-esteem. This is when the patient and family together go beyond stabilization towards meeting the young person’s potential.
The Importance of Continued Treatment for Bipolar Disorder in Children
Bipolar disorder is a lifelong mental health condition that requires lifelong attention. People who stop their treatments are at risk for a bipolar relapse of mania, depression, or both, along with whatever consequences that have suffered in the past.
Of course, treatment isn’t going to turn around a child’s life right away. The first point is to gain acceptance of the disorder as a family together as much as possible. Helping young people with bipolar and their parents move from pre-stabilization to stabilization can require great effort and patience.
Especially with young people, the intensity of the disorder can create numerous problems that require sorting out over time. This level of volatility makes it imperative to keep the focus squarely on the stabilization process, giving it as much time and attention as possible. It is in the post-stabilization phase that kids can develop coping skills to improve their lives beyond preventing problems experienced in pre-stabilization.
Tips for Parents of Children With Bipolar
People with bipolar disorder can face many years of misdiagnosis and failed treatment. This critical gap in treatment demands that patients and their families know how to obtain the right treatment professionals to adequately diagnose and treat bipolar disorder.
In choosing the right care for your child’s bipolar disorder, consider the following five points:
- Start with mental health providers who treat young people in your child’s age group.
- Make sure the doctor and therapist are experienced in treating bipolar disorder.
- Consider how the treatment team approaches your child’s unique brain chemistry and life circumstances.
- Help promote collaboration among your child’s care team by obtaining releases of information to speak with them when necessary.
- Inquire with the treatment team about how you can be a positive part of your child’s care.
Benefits of Early Diagnosis & Treatment of Bipolar in Children
Unlike patients who initially come to bipolar treatment well into their adult years, children and adolescents who arrive at post-stabilization have a distinct advantage. They have had fewer developmental years seeing themselves and the world around them through the distorted lens of mania and depression that marks bipolar disorder.
Thus, the formulation of a healthy and enduring sense of personal identity is generally more efficient in younger patients than compared to their adult counterparts. Parents, too, have an improved chance to establish better communication with their bipolar children, and with each other, giving the entire family better opportunities for their futures together.8
