What Are The Signs Of Bipolar Disorder In Children?

Bipolar disorder is a mental health condition characterized by changes in mood, cognition, and energy levels. Though it is often considered an adult condition, bipolar disorder in children may be more common than some realize. Although it's generally not as common as in adults, bipolar disorder can be found in about 3% of children in the United States. In addition, children as young as five years old have received bipolar disorder diagnoses, and this can be referred to as early-onset bipolar disorder or pediatric bipolar disorder. Signs of bipolar disorder in children can include less sleep and more energy than usual, impulsive behavior, changes in appetite, and excessive sadness, among other symptoms. It can be important to seek professional help for your child and yourself. One way to receive support as a parent may be to work with a licensed therapist in person or online.

Bipolar disorder in children

Bipolar disorder can have a significant impact on an individual’s life, particularly when diagnosed at an early age. In children and teens, bipolar disorder can lead to worsening mental health, problems at school, and challenges in relationships. At times, children may engage in suicidal thinking when living with bipolar disorder. Treated properly, though, the symptoms of this disorder can be managed so that their effects are limited. 

What is bipolar disorder?

Understanding bipolar disorder can help you identify the symptoms of bipolar disorder in children. Bipolar disorder is a mental health condition that can cause mood swings from extreme lows to extreme highs, which may occur in episodes lasting several days to several weeks. It can be a severe condition and may make daily activities difficult. 

Although an individual experiencing bipolar disorder may sometimes feel energetic and productive, they may not be able to get out of bed at other times. The signs of bipolar disorder in adults tend to be different than signs of bipolar disorder in children, mainly because children may have more erratic behavior and mood patterns than adults in general. 

Symptoms of bipolar disorder in children

Bipolar disorder is typically characterized by periods of high mood (called mania) and low mood (called depression). Because certain symptoms of the mental illness (e.g., irritable mood, racing thoughts) can mirror feelings and behaviors exhibited by most children, it can be hard to know when a child is developing bipolar disorder. Additionally, some symptoms of bipolar disorder mimic those of other conditions, such as attention-deficit/hyperactivity disorder. Recognizing the signs of bipolar disorder in children may help a parent decide to seek a diagnosis from a licensed professional. Then, once a child is diagnosed with bipolar disorder, their caregivers and healthcare team can develop a treatment plan. Below are some of the signs of bipolar in children. 

Mania is a period of heightened mood marked by increases in activity and energy levels, along with several other symptoms. Here are potential signs of bipolar mania in children: 

• Less sleep and more energy than usual

• Trouble staying focused

• Doing whatever they want without concern for the consequences

• Talking faster than usual

• Moving from one topic to another

• Irritability or aggression

• Impulsive behavior

• Acting sillier than usual

Depression is a period of low mood marked by decreases in activity and energy levels, along with several other symptoms. Here are potential signs of bipolar depression in children: 

• Acting or feeling sadder than usual for no reason

• Chronic fatigue

• Sleeping more than usual

• Low energy

• No interest in fun activities

• Feeling worthless or guilty (may be hard to determine with younger children)

• Changes in appetite

• Complaining of aches and pains

• Nausea or vomiting

• Zoning out

• Falling asleep during class

• Complaining about feeling sick

Understanding signs of pediatric bipolar disorder

A child experiencing bipolar disorder may not present all the symptoms listed above, and their presentation will likely depend on their age. For example, a child under 10 years old usually has different symptoms than those in their teens. 

Types of bipolar disorder

Bipolar disorder is normally classified into different types, which can make early-onset bipolar disorder harder to diagnose. Here is a summary of each primary type of bipolar disorder.

Bipolar I disorder

Bipolar I disorder usually causes at least seven days of manic symptoms, which may include hallucinations and delusions. This can alternate with periods of severe depression in which the individual can barely get out of bed and feels overwhelmingly sad. Bipolar I may also include episodes of psychosis and can require hospital treatment. 

Bipolar II disorder

A bipolar II diagnosis generally requires the individual to have had at least one major depressive period lasting at least two weeks and at least one period of hypomania, a less severe form of mania. In addition, children with this disorder might have depression and hypomania at the same time.

Cyclothymic disorder 

Cyclothymic disorder can be similar to bipolar II disorder, but the periods of elevated and depressive moods may fluctuate more quickly. However, the episodes are usually not as severe as with bipolar I and II.

Understanding psychosis and hallucinations

Some individuals with bipolar I disorder can have episodes of psychosis or hallucinations. Psychosis normally refers to not being able to recognize what is real in the world around you. It's sometimes confused with schizophrenia, and children with this symptom might be misdiagnosed. 

Hallucinations can be auditory or visual, including things like hearing voices, and they may also lead to a misdiagnosis of schizophrenia. 

Potential causes of early onset bipolar disorder

Doctors and researchers are still trying to determine the cause of bipolar disorder, but many factors can contribute to the condition. For example, bipolar disorder may have a genetic component. There is some proof that certain genes may lead to the development of bipolar disorder and other mental health conditions. Another possible cause of bipolar disorder could be a chemical imbalance or structural abnormality in the brain. 

Here are additional risk factors of bipolar disorder:

• Parents’ lifestyles (e.g., substance or alcohol use during pregnancy or breastfeeding)

• Hormonal changes (for those experiencing puberty)

• A stressful environment

• Being exposed to toxins like heavy metals during pregnancy or infancy

• Existing mental health or neurodevelopmental disorders (e.g., anxiety, attention-deficit/hyperactivity disorder)

How is bipolar disorder diagnosed in children?

Early diagnosis can be crucial to a care team’s ability to treat bipolar disorder. However, because children often exhibit shifts in mood and other changes as they grow, it can be hard to differentiate between normal behavior and bipolar disorder symptoms. For this reason, a careful and thorough examination must be administered by an experienced mental health professional before it is determined that a child’s symptoms occur due to bipolar disorder. 

During an evaluation, a provider may ask the child questions about their feelings, conduct a physical exam, and talk to family members about mood symptoms they’ve observed. They may attempt to rule out disorders with symptoms that can mimic those of a depressive or manic episode. For example, if symptoms of a depressive episode are present, but manic symptoms are not, the individual may be experiencing major depressive disorder. 

Other disorders that frequently develop in children and teens may also need to be ruled out. These include attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder. Symptoms of these conditions may mimic those of bipolar disorder, making it more difficult to provide a diagnosis. 

For example, children with attention-deficit/hyperactivity disorder often present with increased energy and activity levels—common symptoms of mania. Additionally, bipolar disorder and attention-deficit/hyperactivity disorder can both lead to trouble concentrating, irritability, and impulsive behavior. A professional may administer screenings and other assessments to determine whether a child’s symptoms are caused by attention-deficit/hyperactivity disorder, bipolar disorder, or another mental or physical health concern. 

Typically, providers compare symptoms of mood episodes to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V). If a child presents with enough symptoms to match the DSM-V criteria, they may be given a diagnosis. If you believe your child is living with bipolar disorder, a qualified mental health professional can provide an assessment and determine whether further testing, a diagnosis, and treatment are necessary. 

Treating early onset bipolar disorder

Treating bipolar disorder in children may involve medication and psychotherapy. The medications most prescribed to treat symptoms in children are mood stabilizers and antipsychotics. Studies show that lamotrigine, an anticonvulsant medication commonly used as a mood stabilizer, can alleviate symptoms of mania and depression. In some cases, antidepressants may also be utilized, though they can exacerbate manic symptoms. Always consult with a healthcare professional prior to starting or stopping any medication. 

 A child's treatment provider may also ask the parents to get involved, often to stabilize their lifestyle. For example, this may include implementing a regular schedule that organizes the child’s meals, play times, and sleep schedule. Caregivers might also consider talk therapy as it can help them learn more about bipolar disorder and overcome parenting challenges. Family therapy is another option that may be beneficial if the child is nervous about individual therapy. 

Benefits of online therapy

Online therapy can be a beneficial tool for parents of children with bipolar disorder because it tends to be convenient. You can schedule sessions that fit into your existing routine, even if they’re outside of typical office hours. In addition, you can attend therapy appointments from home or any location with an internet connection.

Effectiveness of online therapy

More research may be needed regarding the efficacy of online therapy for parents of children with bipolar disorder. However, existing evidence suggests that online therapy is typically just as effective as in-person therapy and that both treatment options may be valid choices for those seeking professional help.