Bipolar disorder in children and teens
Children are known for being moody, shifting from tears to laughter in seconds. And fluctuating hormones during puberty can make adolescents more temperamental. But for a small number of children and teens, moodiness may indicate a more serious problem: bipolar disorder.
Bipolar disorder is a type of mood disorder that more commonly affects adults. But experts believe this type of mental health disorder is underrecognized, and therefore underdiagnosed, in children and teens.
Approximately 7% of children who receive care at behavioral health centers (some as young as 6) show signs of bipolar disorder. And experts believe that as many as 1 million children diagnosed with depression may actually be showing early signs of bipolar disorder.
From the community: “I am raising a child with bipolar and reactive attachment disorder. She is 9 and has been very manic and meds were just increased recently. She has been very aggressive and she has been taking taekwondo for the past year I really think it helps her with her confidence and self-esteem but she is being aggressive towards me. Does anyone have a child with similar issues and if so can you give me how you are handling these manic times.” – Inspire member
What is bipolar disorder in children and teens?
Bipolar disorder tends to present a little differently in a child than in an adult. A child or teen with bipolar disorder is more likely to have mixed moods, which means they have mania and depression symptoms at the same time. They may switch between moods often within a 24-hour period. For example, a child may go from being extremely silly to becoming extremely irritable, losing their temper, and then being inconsolably sad.
What are the signs of bipolar disorder in children and teens?
Bipolar disorder was once known as manic depression because it causes episodes of mania (high energy or happiness) and episodes of depression (low energy or sadness). In between these episodes, a child may have regular moods.
Symptoms are often present throughout an entire day and may last for several days or weeks. There are four different types of bipolar disorder, and symptoms can vary depending on the type.
Signs of mania in a child or teen include:
difficulty sleeping, yet not feeling tired
extreme irritability or short temper
fast speech on a wide range of quickly shifting topics
inflated ego
persistent, intense feelings of happiness or silliness
poor judgment and reckless or risky behaviors
racing thoughts and trouble concentrating
Signs of depression in a child or teen include:
changes in eating (overeating or not eating)
difficulty concentrating
feeling sad, hopeless, or worthless
frequent headaches or stomachaches
increased irritability, hostility, or anger
lack of interest in activities they usually enjoy
problems with friends or family members
sleeping more than usual
thoughts of suicide or self-harm
What causes bipolar disorder in children?
As many as 8 in 10 people with bipolar disorder have a family member with a mood disorder. This high rate suggests that a gene change may play a role. However, researchers are still trying to determine why some people with a family history of bipolar disorder develop it while others do not.
Certain factors may also play a role like:
sleep disruptions
traumatic, stressful life events
use of alcohol or drugs
From the community: “Hello! My therapist told me I have signs of bipolar disorder but he wasn't positive I have it. I'm 14 and also am suffering from anorexia, depression, anxiety cutting, and suicidal plans/thoughts. I don't know what to do! I'm already taking 6 pills a day. I don't need more. Haha. I weigh 100 pounds and am 5'7.” – Inspire member
What other conditions can occur in children with bipolar disorder?
A child or teenager with bipolar disorder is more likely to have other disorders like:
anxiety disorder or panic disorder
conduct disorders like oppositional defiant disorder
major depression
substance use disorder (a co-occurring disorder)
From the community: “I have a 13 year old daughter who has recently been diagnosed with bipolar disorder. She also has a diagnosis of ADHD. She's been dealing with ADHD diagnoses since elementary school. I am about to meet with some of her middle school teachers and school staff regarding her IEP and am contemplating whether or not I should discuss with all of them or just one of them her recent bipolar diagnosis. We've been through quite a few behavior issues in the past two years and this is the first time I took the initiative to set up a meeting at the beginning of the school year as a proactive step to working with the school staff in helping my child to succeed this year. As I am trying to come to terms with what this diagnosis means and also dealing with my child's behaviors, can anyone share or give advice on how to approach the school? I am concerned about triggers that cause her to act out (such as other people picking on her or calling her names) and just the kind of help that ADHD/bipolar teens need. Can anyone share their experiences in approaching teachers/schools on their teen's behalf?” – Inspire member
How do doctors diagnose bipolar disorder in children?
Your child’s pediatrician or primary care physician may suspect bipolar disorder based on symptoms. They may refer your family to a psychiatrist for a bipolar disorder diagnosis. A psychiatrist is a medical doctor who specializes in diagnosing and treating mental health disorders. You should look for a psychiatrist who has deep experience helping children and teens. This expertise is important in getting an accurate diagnosis since it can sometimes be challenging to tell the difference between bipolar disorder and schizophrenia. In addition, other conditions like ADHD can occur along with bipolar disorder.
Your child’s doctor may ask you to document your child’s moods, sleep patterns, eating habits, and other behaviors for several weeks. They use this information to see if your child’s symptoms fit with bipolar disorder diagnostic criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).
How do experts treat bipolar disorder in children?
Treatments for bipolar disorder in children include a combination of therapies like:
Psychoeducation: Your family meets with a mental health specialist to learn more about bipolar disorder, like these surprising facts. A specialist can help you understand the specific type of bipolar disorder your child has and the treatment plan. It’s also important to know how to get help whenever you’re concerned about your child’s safety and well-being, how to help a loved one with bipolar disorder, and how to help your child live with bipolar disorder.
Psychotherapy: Your child may participate in one-on-one psychotherapy (talk therapy) with a psychologist, licensed clinical social worker, or other mental health professional. This expert can teach your child strategies to regulate emotions, cope with stress, and manage the stigma associated with mental illness. You may also participate in family therapy sessions with your child. It’s important to find the right therapist for your family’s needs. You may also find it helpful to talk to other parents of children with bipolar disorder. Your child’s psychiatrist or therapist may recommend a local support group. You can also join an online group like Mental Health America’s online support group and discussion community on Inspire.
Medications: Medications like mood stabilizers, antidepressants, and antipsychotics are highly effective at keeping bipolar disorder symptoms in check. Your child’s doctor will start off with the lowest dosage possible and increase the amount as needed. Some children need to take more than one medication.
What’s the outlook for children with bipolar disorder?
Bipolar disorder is a lifelong condition that requires ongoing care. Your child will need to follow their treatment plan for life and seek help if symptoms change or worsen. Untreated bipolar disorder can be life-threatening, increasing your child’s risk of substance use disorders, self-harm, and suicide.
Fortunately, bipolar disorder treatments can reduce the severity and frequency of manic and depressive episodes. With your family’s love and support (plus ongoing mental health care), there’s no reason your child can’t enjoy a happy, productive, long life.
Sources
What are bipolar disorders? American Psychiatric Association. January 2021.
Bipolar disorder. Boston Children’s Hospital.
Bipolar disorder in children (PDF). Brain & Behavior Research Foundation (formerly NARSAD).
Pediatric bipolar disorder. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
Bipolar disorder in children. Cleveland Clinic. November 2019.
Bipolar disorder in children: Is it possible? Mayo Clinic. January 2017.
Bipolar disorder in children. Mental Health America.
Bipolar disorder in children and teens. National Institute of Mental Health. 2020.
Disclaimer
Member comments are lightly edited for length and to remove identifying information but are otherwise reproduced as they appear in the community as part of public posts.
This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.
