Extreme mood shifts and high-low cycles might be more than just teenage hormones. Bipolar disorder in children is possible.
As a parent, you’ve probably come to expect rebellion and outbursts from your kids. Hormones, responsibilities, and increasing social expectations can create a daily emotional roller coaster.
However, extreme episodes of mood, self-destructive behaviors, and bouts of feeling low — lasting a week straight or longer — often suggest there is more going on.
While bipolar disorder is more common in adults than in children, it can affect people of all ages. As many as
There is no cure for bipolar disorder, but early detection and a long-term tailored management plan can help ease symptoms and set your kid up for success.
As it’s often said, “Children are very adaptable.” An early response to a bipolar disorder diagnosis will allow them space to discover what treatments and bipolar disorder routines are most effective for them, before jobs, bills, relationships, and responsibilities take a front seat.
Bipolar disorder, as it’s defined in clinical research, focuses primarily on symptoms observed in adults.
Medical experts continue to debate the symptoms of bipolar disorder in children. The concern has to do with over-diagnosing the condition.
The question up for debate is, Where do regular childhood tantrums and behaviors end and ones linked to bipolar disorder begin?
Regardless of the answer, pediatric bipolar disorder follows the core structure of the adult condition, even if symptoms may be slightly different.
Children as young as 5 years old can experience any of the three major types of the condition. This is called early-onset bipolar disorder.
Bipolar disorder I
Manic episodes last at least a week and significantly impair functioning. They may happen in tandem with a depressive episode that lasts at least 2 weeks.
What bipolar disorder I looks like in kids
Fast talking, sleeping little but not feeling tired, agitation, fidgetiness, restlessness, and even what might resemble a “sugar high” type of elation are all ways mania might present in kids and teens.
And just like a sugar high, this high-octane animation reaches a peak, which may involve consequences due to risk-taking or impulsiveness during the episode.
In some kids and teens, bipolar disorder I mood episodes may require hospitalization, regardless of how long the episode has lasted.
Bipolar disorder II
Bipolar disorder II generally features the same mood episodes as bipolar disorder I, only with less impairing symptoms of mania.
Bipolar disorder II manic episodes last for a shorter duration — at least four consecutive days — and are referred to as “hypomania.” This type of the condition does include depression as well.
What bipolar disorder II looks like in kids
Your teen, or even your younger child, may switch between a low-grade energetic or agitated state lasting some days, some period without symptoms, and what looks to be profound lows that can last a few weeks straight.
Bipolar disorder II is still a serious mental health condition but doesn’t require the intense level of treatment as bipolar disorder I.
Living with cyclothymic (sigh-clo-thigh-mick) disorder as a kid means experiencing at least a 1-year period with multiple stretches of both hypomanic symptoms and depressive symptoms.
During that year these overlapping symptoms would have to be present at least half of the time with no break longer than 2 months.
What cyclothymia looks like in kids
Think of the phrase “happy-sad.”
Your kid might have a temperament that resembles an energetic agitation or bouncing-around irritability that’s coupled with a helpless, hopeless mood. This is not to be confused with self-deprecation. Your child might truly feel a deep sense of worthlessness, even though their activity level could be described as “happy.”
These symptoms aren’t severe enough to meet full hypomania or major depression classification, but kids living with cyclothymic disorder are rarely free of symptoms for more than a couple of months at a time.
During manic or hypomanic episodes, children may show symptoms such as:
- Restlessness. Your kid may seem restless and unable to relax. They may act bored, fidgety, or distracted.
- Irritability. Little things may agitate your child. They may be short-tempered or more easily frustrated than is typical for them.
- Elated mood. Your teen or younger kid may be excessively happy during circumstances that don’t seem to warrant such a response.
- Inability to focus. A need to be doing many different things at once might make concentration and focus difficult.
- Racing thoughts. Your kid may suddenly get a rash of ideas and start multiple tasks all at once or jump from project to project without finishing them.
- Inflated ego. Children may seem overly sure of themselves or believe they have abilities others don’t.
- Decreased need for sleep. Your child may sleep significantly less and not seem tired.
- Excessive energy. You may see a spike in energy, despite sleep patterns.
- Rapid speech. Children may develop speech patterns that are much faster than usual.
- Impulsivity. Your child may be more prone to making quick, uninformed choices or decisions. Teens may act on increased arousal during manic episodes or have other goal-oriented drives.
- Risky behavior. You may see an increase in behaviors that can have long-term consequences, such as substance use, sex, or activities where personal injury is likely.
Symptoms of depressive episodes may include:
- Disinterest. Activities your kid used to enjoy may suddenly seem unappealing or boring.
- Irritability. Children may be quick to anger or upset. They may become easily frustrated.
- Sleep issues. Your child may sleep excessively or not enough.
- Frequent crying. Feelings of sadness and depression may result in frequent crying.
- Decreased activity. Your child’s activity level may decrease, even when performing everyday tasks like showering or brushing teeth.
- Low self-esteem. Children may be self-critical or speak negatively about who they are or what they are doing.
- Difficulty concentrating. Apathy and lack of motivation may make it difficult to concentrate on tasks or schoolwork.
- Thoughts of death or suicide. Your child may think and speak more about death or suicide.
Signs of suicide risk in kids and teens
There are some things we should all know: how to perform CPR, the Heimlich maneuver, basic first aid. How to identify suicide risk needs to be one of those things, too.
Signs of suicide risk in kids include:
- withdrawing from close friends or family and self-isolating
- wavering between not wanting to live and feeling undecided about wanting to die
- talking, drawing, or writing about death or suicide
- putting personal affairs in order, such as giving away prized possessions
- previous suicide attempts
Here’s more info to recognize and address suicidal behaviors in adolescents.
The main differences between pediatric bipolar disorder symptoms and adult bipolar disorder symptoms
Controversy persists about the presentation of bipolar disorder in children, but a
- Childrens’ mood episodes may last longer than adults’.
- Mixed episodes of mania and depression are more common in kids.
- Children are less likely than adults to experience psychotic symptoms.
- Kids are more likely than adults to also be living with ADHD or other behavior disorders at the same time.
- Children are more likely to shift from milder bipolar disorder to a more severe type.
Pediatric bipolar disorder is a complex mental health condition. Its exact causes are unknown, though experts believe there may be multiple factors involved, including:
- Brain chemistry. Children with bipolar disorder have neuropsychological differences in the areas of the brain related to impulse control, judgment, and planning. These differences are present even without signs of mania or depression.
- Environmental factors. Adversity, trauma, and stressful experiences may all increase the chances of pediatric bipolar disorder.
- Presence of other mental health conditions. Other mental health conditions such as depression or anxiety disorders may increase a child’s chances of experiencing bipolar disorder.
- Genetics. Children of parents with bipolar disorder are more likely to experience pediatric bipolar disorder.
A note on genetic predispositions
Your genes play a role in whether you will develop some mental or physical health conditions, but they’re only one piece of the puzzle.
There is no cure for bipolar disorder in children, nor is there a cure for the condition in adults.
While symptoms may change in type and severity as children age, treatment and management plans can be an important part of success into adulthood.
Traditional treatment options often include:
- Medication. Mood-stabilizing treatments often include the use of medication. The type will depend on your child’s symptoms and what works best for their individual circumstances.
- Psychosocial therapy. Cognitive behavioral therapy (CBT), family-focused therapy, and educational guidance can help children and families learn to live with bipolar disorder.
Routines can also help lessen the severity and duration of episodes. They don’t have to be lengthy or complex. Taking medications at the same time every day, or maintaining a super sleep-friendly environment, are both examples of routine.
If your child is living with bipolar disorder, help and support are available. This mental health condition doesn’t have to put life on hold.