Although considered rare, bipolar disorder in children does exist. Bipolar disorder, formerly known as manic depression, is a mood disorder that alternates between manic or hypomanic and depressive episodes.
The rate of childhood bipolar disorder is approximately 1%, according to the National Institute of Mental Health (NIMH). The rate of bipolar disorder in adolescents is estimated to be as high as 3%.
Symptoms of Bipolar Disorder in Children
The severity of symptoms may be partially determined by the specific type of bipolar disorder that a child experiences.
Symptoms associated with bipolar disorders in general include:
- Feelings of grandiosity
- Psychomotor agitation
- Temporarily increased self-esteem
- Difficulty completing tasks
- Easily distracted
- Racing thoughts
- Fast or pressured speech
- Excessive involvement in pleasurable, but risky activities
- Decreased or no need for sleep
- Extreme displeasure at being thwarted
- Angry or aggressive outbursts
- Unpredictable or changing moods
For a diagnosis of bipolar disorder, a child's symptoms must not be better explained by substance or medication use, or another psychiatric or medical illness.
Types of Bipolar Disorder
- Bipolar I Disorder: Bipolar I disorder is characterized by manic episodes, often cycling with depressive episodes. Mania is an elevated state, which may produce psychotic symptoms, like hallucinations, delusions or paranoia. Symptoms of bipolar I disorder are severe enough to significantly interfere with a child's daily functioning and may require hospitalization for treatment.
- Bipolar II Disorder: Bipolar II disorder is classified by hypomanic episodes, often cycling with depressive episodes. Hypomania is an elevated state, which shares many of the symptoms of mania, but may not be as severely debilitating. Although altered, a child in a hypomanic state may adequately function in her daily life enough "to get by."
The Course of Bipolar Disorder
The onset of bipolar disorder may begin in childhood or adolescence. As mentioned before, it is frequently misdiagnosed in childhood, presumably because its symptoms are attributed to another disorder.
Lewinsohn and colleagues found in their study of bipolar adolescents that the average onset of bipolar disorder was 11.75 years old, and that the average length of a symptomatic period was approximately 6 1/2 years.
The course of bipolar disorder will vary in every child. It is thought that various factors, such as treatment, family history, and the co-existence of other mental or physical illnesses, all contribute to the severity and outcome of bipolar disorder.
It is important to note that often, a child may not formally ask for help or complain about symptoms until he reaches a depressive episode.
Many who have experienced a manic or hypomanic state report feeling euphoric, productive, creative, and/or uninhibited. In fact, it may be a relief to a person who also experiences depressive episodes. However, this is not to say that manic or hypomanic episodes are not problematic in many ways.
It is typically a parent or teacher that notices something is "off" during an elevated state and seeks evaluation and treatment for the child.
Appropriate treatment may significantly lessen the severity and duration of bipolar disorder in children.
Outcomes of Bipolar Disorder in Children
Bipolar disorder in children is often associated with excessive engagement in risk-taking behaviors, like substance use, sexual behavior, excessive spending, reckless driving, or other dangerous and impulsive behaviors.
Adolescents in general often feel invincible and may engage in risk-taking behaviors -- this can be a normal developmental process. However, if there is excessive and repeated risk-taking despite negative consequences, it is worth considering the possibility that these actions are associated with a bipolar disorder.
Treatment for Bipolar Disorder in Children
Treatment is always required for children with bipolar disorders, and may be continued even once a child's symptoms are in remission. Mood stabilizers, like lithium, are commonly used and are shown to be effective in children.
Psychotherapy, including psychoeducation to learn how to recognize triggers and mood changes, is also thought to be helpful in combination with medication.
Antidepressant medications are used with caution in the treatment of bipolar disorders in children, as they may actually induce manic episodes in some children.
While bipolar disorder is a serious medical illness, with treatment a child can live a very happy, full, and productive life.
If you think that your child may have a bipolar disorder or another mood disorder, talk to her pediatrician or other mental health professional for an evaluation and treatment options.
Depression and Suicide in Children and Adolescents. A Report of the Surgeon General. Accessed: 02/14/2011. http://mentalhealth.about.com/library/sg/chapter3/blsec5.htm
Gabrielle A. Carlson. Annotation: Child and Adolescent Mania - Diagnostic Considerations. Journal of Child Psychology and Psychiatry. 1990; 31(3): 331-341.
Jim Rosack. Bipolar Disorder Often Misdiagnosed In Children, Expert Says. Psychiatric News. July 5, 2002 37(13): 26.
Peter M. Lewinsohn, Ph.D., Daniel N. Klein, Ph.D. and John R. Seeley, M.S. Bipolar Disorders In a Community Sample of Older Adolescents: Prevalence, Phenomenology, Comorbidity, and Course. Journal of the American Academy of Child and Adolescent Psychiatry. 1995; 34(4): 454-463.
Press Release: Rates of Bipolar Diagnosis in Youth Rapidly Climbing, Treatment Patterns Similar to Adult. September 03, 2007. National Institute of Mental Health. Accessed: 02/14/2011. http://www.nimh.nih.gov/science-news/2007/rates-of-bipolar-diagnosis-in-youth-rapidly-climbing-treatment-patterns-similar-to-adults.shtml