Symptoms of Bipolar Disorder in Children

What to Do If You Think Your Child Has Bipolar Disorder

Moody child
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Up to 65 percent of adults with bipolar disorder experienced symptoms prior to the age of 18. So while the condition is often associated with adults, kids of any age can have bipolar disorder. 

Childhood-onset bipolar is associated with a more severe course of illness compared to people who don’t begin to experience symptoms until adulthood. Early intervention can be the key to getting symptoms under control.

Even if you know an adult with bipolar disorder—or you have been diagnosed with it yourself—it might not look the same in a teenager. Teens tend to more irritable than elated during manic episodes and their depressive episodes may involve more complaints of physical symptoms than sadness.

Understanding Bipolar Disorder

Bipolar disorder is a mental illness in which people experience severe mood swings that may consist of episodes of mania or hypomania and depression. Children and adolescents with bipolar disorder experience severe mood and behavior changes that are extreme and represent a major change from their typical mood and behavior.

It might be difficult to know when the symptoms are severe enough to warrant evaluation and, potentially, diagnosis, so consider these three basic factors: functioning, feeling, and family.

Functioning

Here are some questions to ask yourself about your child's functioning:

  • Are the problem behaviors of your child interfering with his daily functioning?
  • Is she able to play with other children her age?
  • Is he able to attend school regularly?
  • Do the demands of her difficulties outweigh the needs of other members of the family, maybe including you?

Feeling

Here are some questions to ask yourself about your child's feelings:

  • Does your child feel like there is something wrong with him?
  • Does she feel overwhelmed handling normal activities other kids her age engage in?
  • Does your child worry about things other kids don’t even think about?

Family

Is there a history of mental illness in your child’s family? Research indicates that having a parent or sibling who has bipolar disorder increases your child's chances of developing it, though this factor may or may not be meaningful.

Symptoms of Childhood Bipolar Disorder

If you've said YES to questions in at least two of the three items above (functioning, feeling, and family), you're probably curious about the specific symptoms of bipolar disorder. Experts disagree about the exact symptoms that may appear in childhood and adolescent bipolar disorder because they​ appear to manifest differently than the symptoms of adults, but some of these symptoms may include:

  • Separation anxiety
  • Rages & explosive temper tantrums (lasting up to several hours)
  • Marked irritability
  • Oppositional behavior
  • Frequent mood swings
  • Distractibility
  • Hyperactivity
  • Getting involved in many projects or activities at once
  • More energy than normal
  • Less need for sleep
  • Impulsivity
  • Restlessness/ fidgetiness
  • Silliness, goofiness, giddiness

Diagnosis

If you think your child may have bipolar disorder (or any other mental health issue), talk to his physician. Schedule an appointment to discuss your concerns.

A physician may refer you to a mental health treatment provider for a complete evaluation. A mental health expert will likely want to interview you and your child to get a full picture of the signs and symptoms.

There isn’t a lab test that identifies bipolar disorder.

And sometimes, other conditions such as depression or ADHD have similar presentations. So it’s important to offer as much information as you can about your child’s mood, sleep patterns, energy level, history, and behavior.

Treatment

Bipolar disorder must be managed throughout a person’s life. Treatment may require adjustments over time. Your teen’s treatment team may recommend:

  • Medication: A psychiatrist may prescribe medication to stabilize your child's mood. It’s important to monitor your child’s medication and be on the lookout for side effects. Finding the right medication and the right dosage may take some time as there isn’t a single medication that works best for everyone with bipolar disorder.
  • Talk therapy: A therapist may educate your child about bipolar and may offer coping strategies to help manage the symptoms. Therapy often includes family members. Family therapy may address relationship issues, behavior management problems, or strategies to help the entire family cope with a child's mental illness.

A psychiatric hospitalization may be required at one time or another if a child poses an acute safety risk. A serious suicide attempt, thoughts of suicide with a clear plan, self-injury, or psychosis are just a few of the possible reasons a child with bipolar disorder may need to stay in a hospital.

Treatment works best when the child, parents, doctors, therapists, and other treatment providers work together as a team. So it’s important to attend your teen’s appointments, ask questions, communicate with other treatment providers, and continue to educate yourself about your child’s mental health needs.

A therapist or psychiatrist may request that you log your teen’s moods, sleep patterns, or behavior. Charting your chlid’s progress can help treatment providers determine how well therapy or medications are working to keep your child’s moods stable.

Risks to Consider During Adolescence

Teens are already prone to risky behavior, but that risk is multiplied when the teenager also has bipolar disorder. Keep an eye out for substance abuse, such as drinking or taking drugs, as well as suicidal behavior.

The risk for suicide in people with bipolar disorder is among the highest for all psychiatric disorders.

Studies show that between 25 and 50 percent of adults with bipolar make at least one suicide attempt over the course of their lives and between 8 and 19 percent of individuals with bipolar disorder die from suicide.

Studies have also found that 72 percent of adolescents with bipolar disorder acknowledge thinking about suicide at one point or another. Research shows teens with both bipolar I and bipolar II are at an elevated risk for suicide.

If your teen has been diagnosed with bipolar disorder, take the risk of suicide seriously. Work with your teen’s treatment providers to assess your teen’s risks and to develop a safety plan.

Common Co-Morbid Conditions

Many children with bipolar disorder have an additional mental illness, addiction, or behavior disorder. Some research has estimated that up to 90 percent of youth with bipolar disorder may have attention deficit hyperactivity disorder as well.

Anxiety disorders, substance use, and disruptive behavior disorders are among the other most common issues children with bipolar disorder may experience.

Support Your Child at School

It’s important to work with your child’s school if he’s been diagnosed with bipolar disorder. School officials can assist with a plan that will best support your child’s education.

Your child’s academic needs will depend on his symptoms and his academic issues. If he exhibits behavior problems at school, the teachers may create a behavior plan that will use appropriate disciplinary action.

If he struggles academically, the school may provide services to help ensure he is able to get an education. The school may be able to offer things such as a modified schedule or a hall pass that lets your teen visit the guidance counselor whenever necessary. Encourage your child to participate in meetings to talk about how the school could support his education as well.

Support Your Child at Home

Bipolar disorder affects the entire family so it’s important to work together to help your child manage the symptoms.

Learn as much as you can about bipolar disorder and the latest treatment options—and make sure other family members learn about it too. It’s important for siblings to understand what to expect.

Hold regular conversations with your child about treatment and treatment-related issues. There’s a good chance that at some point your child won’t want to take medication or attend therapy. Validate her feelings and talk about the importance of following doctors’ recommendations.

It’s important to take care of yourself as well. Coping with the challenges of raising a child with bipolar disorder can be stressful. Consider joining a support group for parents with teens with bipolar disorder (or mental illness in general). Connecting with other parents may help you gain emotional support as well as practical advice about how to support your child.

What to Do If You Think Your Child Has Bipolar Disorder

It's important to know that children with bipolar disorder usually have extreme, severe fluctuations in their mood and behavior. With that, it's common for children to experience some of the symptoms listed above, and the majority do not have bipolar disorder.

If your child is having difficulty with daily functioning or if your child is struggling with feeling normal— especially over an extended period of time—an evaluation by a psychiatrist may be warranted. An unbiased, professional opinion could bring you some peace of mind and perhaps a few new parenting skills. Talk to your pediatrician and seek out advice for your precious one so that you are not carrying your worries or concerns alone. 

Sources:

Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD). Pediatric Bipolar Disorder

Hall-Flavin DK. Bipolar Disorder in Children: Is It Possible? Mayo Clinic. Published January 4, 2017.

National Alliance on Mental Illness (NAMI). Bipolar Disorder. Updated August 2017.

National Institute of Mental Health (NIMH). Bipolar Disorder in Children and Teens. National Institutes of Health. U.S. Department of Health and Human Services. Updated 2015.