Children, like adults, can have bipolar disorder (BD). It causes people to experience extreme changes in mood which affect their daily lives.
BD is marked by alternating episodes of high mood and low mood. According to the National Alliance on Mental Illness (NAMI), it affects about 2.8% of the U.S. population.
Although the average age of diagnosis is 25, people with BD can also be diagnosed in childhood and adolescence.
It is a lifelong condition that people manage with medication and therapy. With treatment, children and teens can lead active and fulfilling lives.
Read on to learn more about the symptoms of bipolar disorder in children, how it is diagnosed and treated, and related mental health conditions.
Bipolar disorder (BD) is a mental health condition causing extreme shifts in energy. They affect a person’s mood, activity levels, and concentration.
When a child has a low — or depressive — episode, they may have low energy and lose interest in enjoyable activities.
During a high — or manic — episode, a person may notice their child has a lot of energy.
For example, they may be speaking faster and for longer than usual. Some children also experience hypomania, which lasts a minimum of 4 consecutive days, compared with a manic episode’s 7 consecutive days.
There are three types of bipolar disorder, each with distinct characteristics.
People with bipolar I usually experience manic episodes lasting at least 7 days. If these episodes are particularly severe, they may need to seek medical attention.
They may also experiences depressive episodes lasting about 2 weeks.
Similar to bipolar I, people with bipolar II experience depressive and hypomanic episodes. These hypomanic episodes are shorter in duration than normal manic episodes.
Cyclothymic disorder (cyclothymia)
Cyclothymic disorder causes hypomanic and depressive symptoms that do not meet the criteria for hypomanic and depressive episodes.
While similar to BD, cyclothymia mood changes are less severe. A person can still function and complete day-to-day tasks, although not necessarily as well when they are symptom-free.
For a doctor to diagnose this condition, an adult needs to have symptoms for at least 2 years. In children, this reduces to 1 year. During this time, the hypomanic and depressive symptoms should be present at least half the time.
An adolescent experiencing a manic, hypomanic, or depressive episode may have a range of symptoms. Each mood episode could last for several days or weeks, and the symptoms may change throughout.
Symptoms of a manic episode include:
- showing intense happiness
- joking around for a long time
- talking fast and flitting from topic to topic
- having difficulty falling asleep
- losing the ability to focus
- having racing thoughts
- seeming overly interested in some activities
- making risky decisions
Symptoms of a depressive episode include:
- feeling sad for no reason
- becoming angry very quickly
- complaining about stomach and head aches
- sleeping for longer
- losing the ability to concentrate
- feeling hopeless and worthless
- eating too much or little
- having no energy
- losing the ability to communicate effectively
- losing touch with friends
- thinking about death or suicide
Sometimes a child may experience a mixed episode, which means they show both manic and depressive symptoms.
Mixed episode symptoms include:
- feeling agitated
- getting upset over small issues or for no reason at all
- having trouble falling or staying asleep
- eating too much or too little
- talking about suicide
Bipolar disorder can be tricky to diagnose because it shares symptoms with other common mental health conditions. Additionally, children with bipolar disorder may have multiple mental health conditions at the same time. Some of these, called co-occurring conditions, often appear in children with BD. They include:
Without mania, bipolar disorder can look very similar to major depressive disorder because people with bipolar often experience episodes of depression. This means a medical professional may need to rule out depression before diagnosing a child with bipolar disorder.
There are no blood tests or brain scans that can diagnose bipolar disorder. A doctor, psychologist, or psychiatrist will ask a number of questions when making a diagnosis.
The questions may relate to a child’s:
- sleeping patterns
- energy levels
- general behavior
Bipolar disorder may have a genetic link, so the doctor will want to know if any family members have bipolar disorder or depression.
Sometimes, substance use may worsen symptoms. A person should tell the doctor about any substances they are taking so they can receive safe and suitable treatment.
There are a variety of treatment options available for children and teens. With the right treatment plan, young people can live fulfilling lives with bipolar disorder.
Treatment options include:
Depending on the child’s symptoms, a healthcare professional may prescribe a mood stabilizer or antipsychotic with or without an antidepressant.
Bipolar differs from major depressive disorder in several ways. A person may have cyclical depression, unstable moods, ad different behavior. Bipolar disorder medications target these unique aspects.
Mood stabilizers control mood swings and can prevent the onset of mania. Some medications a doctor may prescribe include carbamazepine (Tegretol) and oxcarbazepine (Trileptal).
Doctors prescribe different medications depending on a person’s age and symptoms. When discussing medication options, a doctor will thoroughly discuss the risks and benefits.
Antipsychotic medications relieve symptoms of psychosis, which is a break from reality during a manic episode. These medications also have a mood-stabilizing effect.
A doctor may prescribe antipsychotics such as quetiapine (Seroquel), olanzapine (Zyprexa), and ziprasidone (Geodon).
Antidepressants reduce the symptoms of a depressive episode. However, they may make mania symptoms worse, so doctors only prescribe them as part of combination treatment.
Doctors have also linked antidepressants to an increase in suicidal thinking and behavior in children and teens with major depression and other psychiatric disorders.
A doctor may prescribe antidepressants including sertraline (Zoloft), escitalopram (Lexapro), and citalopram (Celexa).
Psychotherapy, or talk therapy, enables children to recognize when they are experiencing a manic or depressive episode. With the help of a professional, they can learn to recognize and manage their symptoms.
In addition to talk therapy, a child will likely receive cognitive behavioral therapy (CBT). This type of therapy helps people understand and control thoughts, feelings, and behaviors.
Although therapy is an important part of a child’s treatment plan, it is often used in conjunction with medication. Every individual has different symptoms and needs, and their treatment plan will be tailored to them.
When a child or teen has untreated BD, they may engage in risky behaviors. In some cases, they may unknowingly put themselves in danger.
Young people with BD also have an increased risk of:
- dropping out of school
- not forming lasting relationships
- getting into financial or legal troubles
- taking harmful substances
- considering suicide
One study of children and adolescents with bipolar I found that
Therefore, it is important that families of young people with BD are aware of this risk and seek support when needed.
Bipolar disorder does not impact one person — it impacts the entire family. A child with BD may struggle to understand their condition, and they may feel isolated. Family members may find it hard to cope with being unable to help a child deal with these difficulties.
There are support groups for both young people with BD and their families. Some groups they may want to consider include:
- Depression and Bipolar Support Alliance (DBSA)
- Bipolar Caregivers
- Juvenile Bipolar Research Foundation
- Daily Strength (a teen support group)
Some families also take part in family-focused therapy (FFT), which is an evidence-based intervention involving both the individual with BD and caregiver(s).
FFT focuses on education, communication skills, and problem-solving. One review of the research showed that 12 sessions of FFT
Bipolar disorder can affect both children and adults. It can be difficult to diagnose in children because the symptoms are similar to other co-occurring conditions, such as ADHD and anxiety disorders.
Treatment for bipolar disorder includes a combination of therapy (such as psychotherapy and CBT) and medication (such as mood stabilizers, antipsychotics, and antidepressants).
Although bipolar is a lifelong condition, with treatment children and teens can lead fulfilling and happy lives. Young people with BD, as well as their families, may find support groups useful in navigating challenging times.