Does your child go through intense mood changes? Does your child have extreme behavior changes too? Does your child get too excited or silly sometimes? Do you notice he or she is very sad at other times? Do these changes affect how your child acts at school or at home?
All parents can relate to the many changes their kids go through as they grow up. But sometimes it’s hard to tell if a child is just going through a “phase,” or showing signs of something more serious.
In the last decade or so, the number of children receiving the diagnosis of bipolar disorder, sometimes, called manic-depressive illness, has grown substantially. But what does the diagnosis really mean for a child?
What is bipolar disorder?
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, and activity levels. It can also make it hard to carry out day-to-day tasks, such as going to school or hanging out with friends.
Symptoms of bipolar disorder can be severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor school performance, and even suicide. But bipolar disorder can be treated, and many people with this illness can lead full and productive lives.
Symptoms of bipolar disorder often develop in the late teens or early adult years, but some people have their first symptoms during childhood. At least half of all cases start before age 25.
Bipolar disorder tends to run in families. Children with a parent or sibling who has bipolar disorder are up to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.
What are the signs and symptoms of bipolar disorder in children and adolescents?
Youth with bipolar disorder experience unusually intense emotional states that occur in distinct periods called “mood episodes.” The extreme highs and lows of mood are accompanied by extreme changes in energy, activity, sleep, and behavior. Each mood episode represents a drastic change from a person’s usual mood and behavior.
An overly joyful or overexcited state is called a manic episode. An extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Chart of symptoms of bipolar disorder in children
Symptoms of mania include:
Symptoms of depression include:
Being in an overly silly or joyful mood that is unusual for your child. It is different from times when he or she is just being silly and having fun.
Having an extremely short temper and unusual irritability.
Sleeping little but not feeling tired
Talking a lot and having racing thoughts
Having trouble concentrating or paying attention, jumping from one thing to the next in an unusual way
Talking and thinking about sex more often than usual
Behaving in risky ways more often, seeking pleasure a lot, and doing more activities than usual.
Being in a sad mood that lasts a long time
Losing interest in activities once enjoyed
Feeling worthless or guilty.
Complaining about pain more often, such as headaches, stomach aches, and muscle pains
Eating a lot more or less than usual and gaining or losing a lot of weight
Sleeping or oversleeping when these were not problems before
It’s normal for almost every child or teen to show some of these behaviors sometimes. These passing changes should not be confused with bipolar disorder.
Symptoms of bipolar disorder are not like the normal changes in mood and energy that everyone has. Bipolar symptoms are more extreme and tend to last for most of the day, nearly every day, for at least one week.
Also, depressive or manic episodes include moods very different from a child’s normal mood, and the behaviors described in the chart generally all come on at the same time. Sometimes the symptoms of bipolar disorder are so severe that the child needs to be treated in a hospital.
Bipolar disorder can be present even when mood swings are less extreme. For example, sometimes a child may have more energy and be more active than normal, but not show the severe signs of a full-blown manic episode. This is called hypomania. It generally lasts for at least 4 days in a row. Hypomania causes noticeable changes in behavior, but does not harm a child’s ability to function in the same way that mania does.
How does bipolar disorder affect children and adolescents differently than adults?
Bipolar disorder that starts during childhood or the early teen years is called early-onset bipolar disorder, and seems to be more severe than the forms that first appear in older teens and adults. Youth with bipolar disorder are different from adults with bipolar disorder. Young people with the illness appear to have more frequent mood switches, are sick more often, and have more mixed episodes.
Watch out for any sign of suicidal thinking or behaviors. Take these signs seriously. On average, people with early-onset bipolar disorder are at greater risk for attempting suicide than those whose symptoms start in adulthood. One large study on bipolar disorder in children and teens found that more than one-third of study participants made at least one serious suicide attempt. Some suicide attempts are carefully planned and others are not. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that must be treated.
How is bipolar disorder detected in children and adolescents?
No blood tests or brain scans can diagnose bipolar disorder. However, a doctor or health care provider may use tests like these to help rule out other possible causes for your child’s symptoms. In addition, they may recommend testing for problems in learning, thinking, or speech and language. A careful medical exam may also detect problems that commonly co-occur with bipolar disorder and need to be treated, such as substance abuse.
Health care professionals who have experience with diagnosing early-onset bipolar disorder will ask questions about changes in your child’s mood. They will also ask about sleep patterns, activity or energy levels, and if your child has had any other mood or behavioral disorders. They may also ask whether there is a family history of bipolar disorder or other psychiatric illnesses, such as depression or alcoholism.
Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistic Manual of Mental Disorders (DSM). To be diagnosed, the symptoms must be a major change from your child’s normal mood or behavior.
There are four basic types of bipolar disorder:
Bipolar I Disorder: defined by manic or mixed episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
Bipolar II Disorder: defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
Bipolar Disorder Not Otherwise Specified (BP-NOS): diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
Cyclothymic Disorder, or Cyclothymia: A mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.
When children have manic symptoms that last for less than 4 days, experts may diagnose BP-NOS. Some evidence indicates that many of these young people will develop longer episodes within a few years and then meet the criteria for bipolar I or II.
What illnesses often co-exist with bipolar disorder in children and adolescents?
People with bipolar disorder may develop other mental illnesses as well, including:
Alcoholism. Adults with bipolar disorder are at very high risk of developing a substance abuse problem. Young people with bipolar disorder may have the same risk.
ADHD. Mania and ADHD share some symptoms, such as distractibility, hyperactivity, and the tendency to engage in impulsive and risky behavior. However, mania is episodic, so that the behaviors are uncharacteristic of the child. They start at a time when he or she is experiencing a dramatic change in mood. In contrast, ADHD symptoms are persistent and typical for that child, although they may wax and wane to a certain degree. Many children with bipolar disorder also have a history of ADHD.
Anxiety disorders. Anxiety disorders, such as separation anxiety and generalized anxiety disorder, also commonly co-occur with bipolar disorder, in both children and adults.
Other mental disorders. Some mental disorders cause symptoms similar to bipolar disorder. One example is major depression, sometimes called unipolar depression. Sometimes, it is extremely difficult to tell the difference between major depression and a depressive episode in bipolar disorder. For this reason, if your child has bipolar disorder and becomes depressed, be sure that the doctor is aware of any past manic symptoms or episodes your child may have had.