Any parent knows that a child’s mood, behavior, attention, or energy level can change without warning. But sometimes these shifts are not a sign of a child’s developmental level but an indication that a child’s mental health is suffering. When a child has bipolar disorder, they experience extreme shifts in mood in behaviors that can result in a high, known as a manic episode, or a low, known as a depressive episode. Bipolar disorder is more likely to emerge in the late teen years or in early adulthood, but children can experience it as well. Early diagnosis and treatment are key to helping kids learn how to manage symptoms and succeed in life.

Bipolar disorder is estimated to occur in 1-3% of youth, the majority of whom are adolescents rather than children.1 The condition can be challenging to diagnose—it can take several years for clinicians to follow the patient and make an accurate diagnosis. There are two types of bipolar disorder—Bipolar I and Bipolar II.  To receive a diagnosis of Bipolar I, a child must meet the criteria for a manic episode (see below). They may also experience depressive episodes, but not necessarily. To receive a diagnosis of Bipolar II, a child has experienced both hypomania (a milder form of mania) along with a major depressive episode.

Symptoms of Mania in Children

  • acting unusually silly or happy
  • having a short temper
  • hyperactivity
  • irritability
  • talking with rapid speech
  • trouble sleeping or needing less sleep
  • trouble concentrating
  • talking excessively about sex
  • engaging in risky behaviors2

*A child may have experienced a hypomanic episode if their mood is elevated and they are more hyperactive than usual, but the symptoms do not impair them so much that they require hospitalization or experience impairment at school or at home.

Symptoms of Depression in Children

  • feeling very sad or low
  • lack of interest in playing
  • complaining about stomachaches and headaches
  • trouble sleeping or sleeping excessively
  • over or undereating
  • expressing feelings of guilt or worthlessness
  • thinking about death or suicide
  • trouble concentrating
  • feeling fatigued3

Bipolar Disorder and Disruptive Mood Dysregulation Disorder

In the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association, writers added a new pediatric mood disorder called Disruptive Mood Dysregulation Disorder (DMDD). Children can be diagnosed with DMDD between the ages of 6 and 18, and many of the symptoms of DMDD are similar to bipolar disorder. These include temper outbursts, irritability, and anger. A child cannot receive a diagnosis of both bipolar disorder and DMDD, so a clinician must determine which diagnosis most accurately captures a child’s symptoms.4

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ADHD and Bipolar Disorder

Sometimes the symptoms of ADHD and mania or hypomania associated with bipolar disorder can be very similar. Kids might exhibit distractibility, talkativeness, difficulty maintaining attention, and loss of social functioning. Clinicians must assess whether it is one condition or whether the disorders are co-occurring. A child may have both ADHD and bipolar disorder if they experience behavioral outbursts, severe mood swings, and impulsive behaviors. If your child has already been diagnosed with ADHD and they exhibit an inflated sense of self, risky sexual behavior, lack of need for sleep, and self-harming behaviors, then they also may be experiencing mania associated with bipolar disorder. A child psychiatrist can help rule out other diagnoses and suggest treatment options.5

Treatment for Bipolar Disorder in Children

Treatment for children with bipolar disorder usually involves a combination of medication, therapy, psychoeducation, and school support.

Medication may include a combination of drugs, which can include antidepressants, mood stabilizers, antipsychotics, and/or anti-anxiety medication. Because child’s brains are still developing, doctors recommend that children “start low and go slow” when it comes to medication. Doctors want the fewest medications and the lowest dosages that produce the best results for your child.6 Parents must be patient, as it can take several tries to find the right medication for your child. The effectiveness of medication may also change as they age. If you have concerns, ask your child’s doctor whether a medication has been approved by the FDA for pediatric use and whether what have been the results in clinical trials with children. Parents should also be aware that there is a small but increased risk of suicidal thoughts for children and adolescents who take antidepressants, so it’s important to monitor for these signs in your child.

Therapy is an essential component in treating bipolar disorder. For older children, therapy can help them learn how to cope with symptoms and develop healthy self-care habits that reduce the risk of substance abuse or other risky behaviors. For younger children, play therapy can help them express their ideas and explore positive ways of coping and building up their self-esteem. Above all, a therapist’s office can be a safe place for children to feel heard and voice their concerns.

Psychoeducation can be an important component of treatment for both parents and children with bipolar disorder. Hospitals, clinics, schools, and other community organizations can provide educational information about mental illness, communication strategies, and coping strategies for children with bipolar disorder as well as their family members. Support groups can also be a valuable tool for parents who want to learn more about children’s mental health.

School support is essential in treating children with a mental illness. If your child is diagnosed with bipolar disorder, they may qualify for an individualized education program (IEP) that tailors their educational experiences to their needs, strengths, and challenges. School counselors, school psychologists, social workers, nurses, and other staff can participate in implementing this plan and helping your child succeed in school and beyond.

Alternative treatments are increasingly becoming popular for treating bipolar disorder. Children who participate in meditation have shown improvement in executive functioning and flexibility. The use of cannibidiol (CBD) oil is also being increasingly researched as a potential alternative treatment for mental illness in children. Talk to your doctor about the potential usefulness of alternative treatments for your child and the potential risks and benefits.

Crisis support may also be needed if your child is experiencing an extreme high or low. You can call 911, help them to an emergency room, or call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or their TTY number at 1-800-799-4TTY (4889).

While it can be easy to feel helpless when a child experiences symptoms of bipolar disorder, the best thing you can do is to stay patient and surround your child with love and support. Though it may take time for an accurate diagnosis to be given, know that in the meantime, various forms of treatment can make a huge difference in a child’s life. If your child is struggling with any of these symptoms, consider how you can become more knowledgeable about your child’s mental health challenges and opportunities where you can assist them to reach their full potential in life. Bipolar disorder is treatable, and people with bipolar disorder can live healthy and happy lives.

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Last Updated: Jun 20, 2019