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Bipolar Disorder in Children

Many children, and especially adolescents, experience mood swings as a normal part of growing up, but when these feelings persist and interfere with a child's ability to function in daily life, bipolar disorder could be the cause. Bipolar disorder, also known as manic-depression, is a mood disorder marked by extreme changes in mood, energy levels and behavior.

Unlike most adults who have bipolar disorder, children who have pediatric bipolar disorder are characterized by abrupt mood swings, periods of hyperactivity followed by lethargy, intense temper tantrums, frustration and defiant behavior. This rapid and severe cycling between moods may produce a type of chronic irritability with few clear periods of peace between episodes.

What Are the Signs and Symptoms?

Bipolar disorder begins with either manic or depressive symptoms. Not all children with bipolar disorder have all symptoms.


MANIC SYMPTOMS

  • Severe changes in mood - from unusually happy or silly to irritable, angry or aggressive.
  • Unrealistic highs in self-esteem. May feel indestructible.
  • Great increase in energy level. Sleeps little without being tired.
  • Excessive involvement in multiple projects and activities. May move from one thing to the next and become easily distracted.
  • Increase in talking. Talks too much, too fast, changes topics too quickly, and cannot be interrupted. This may be accompanied by racing thoughts or feeling pressure to keep talking.
  • Risk-taking behavior such as abusing drugs and alcohol, attempting daredevil stunts, or being sexually active or having unprotected sex.

DEPRESSIVE SYMPTOMS

  • Frequent sadness or crying
  • Withdrawal from friends and activities
  • Decreased energy level, lack of enthusiasm or motivation
  • Feelings of worthlessness or excessive guilt
  • Extreme sensitivity to rejection or failure
  • Major changes in habits such as over-sleeping or over-eating
  • Frequent physical complaints such as headaches and stomachaches
  • Recurring thoughts of death, suicide, or self-destructive behavior

Possible Causes:

The exact cause for bipolar disorder is difficult to ascertain, but several things may contribute to the illness.

Family genes may be one factor because bipolar disorder sometimes runs in families. However, it is important to know that just because someone in your family has bipolar disorder, it does not mean other members of the family will have it as well.

Another factor that may lead to bipolar disorder is the brain function of the person with the disorder. Specifically, they have neuropsychological deficits in the area of executive functioning which involves judgment, planning, and impulse control. As a result, they are more likely to act on instinct without stopping to think things through or fully consider the consequences of their actions.

Research and clinical experience also suggest that trauma or stressful life events can trigger an episode of bipolar disorder in people who are genetically vulnerable. However, many episodes occur without an obvious or identifiable cause.


Bipolar disorder and ADHD

There is a significant overlap in the symptoms of mania, and to a lesser extent depression, and the symptoms of ADHD. ADHD, mania and depression may all involve inability to concentrate and problems with distractibility. Mania and ADHD may both involve hyperactivity and impulsivity. Though the symptom overlap is significant there are several factors that can help to distinguish these disorders.

ADHD in children usually does not involve mood symptoms such as depression and euphoria to the extent seen in bipolar disorder. ADHD symptoms usually first appear early in childhood while the onset of bipolar disorder appears to occur later in childhood or adolescence. ADHD also usually involves normal sleep, at least once a child has settled down in bed and is ready for sleep. Mania, in contrast, involves decreased need for sleep with the individual still "raring to go" the next day despite little sleep. The family history can be helpful, as both disorders appear to run in families.


Treatment

Bipolar Disorder is treatable. Doctors often treat children who have the illness in much the same way they treat adults. Treatment can help control symptoms. Steady, dependable treatment works better than treatment that starts and stops. Treatment options include:

Pharmacological: There are several types of medication that can help. The first-line medication used to treat bipolar disorder is often a mood stabilizer. Children respond to medications in different ways, so the right type of medication depends on the child. Do not stop giving your child medication without a doctor's help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse.

Psychological: Bipolar is often treated with cognitive behavioral therapy in addition to medications. CBT helps children and adolescents with the disorder understand what triggers their episodes, how their thoughts influence their feelings, and how to control and manage them. Family therapy is often employed to engage parents and other family members in keeping track of symptoms and managing stress levels in the home, which can lead to episodes.


How can parents help their child or teen?

Help begins with the right diagnosis and treatment. If you think your child may have bipolar disorder, make an appointment with a psychiatrist/psychologist to talk about the symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

  • Be patient.
  • Encourage your child to talk, and listen to your child carefully.
  • Be understanding about mood episodes.
  • Help your child have fun.
  • Help your child understand that treatment can make life better.
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