Bipolar Disorder in Children

Up to 65% of adults with bipolar disorder experienced symptoms prior to the age of 18. So, while the condition is often associated with adults, kids of any age can have bipolar disorder.

Childhood-onset bipolar is associated with a more severe course of illness compared to people who don’t begin to experience symptoms until adulthood. Early intervention can be the key to getting symptoms under control.

Even if you know an adult with bipolar disorder—or you have been diagnosed with it yourself—it might not look the same in a teenager.

When to Seek Help

Children and adolescents with bipolar disorder experience severe mood and behavior changes that are extreme and represent a major change from their typical mood and behavior. It might be difficult to know when the symptoms are severe enough to warrant evaluation and, potentially, diagnosis, so consider these three basic factors: functioning, feeling, and family.

Functioning

Here are some questions to ask yourself about your child's functioning:

• Are the problem behaviors of your child interfering with their daily functioning?
• Are they able to play with other children their age?
• Are they able to attend school regularly?
• Do the demands of their difficulties outweigh the needs of other family members, maybe including you?

Feeling

Here are some questions to ask yourself about your child's feelings:

• Does your child feel like there is something wrong with them?
• Do they feel overwhelmed handling normal activities other kids their age engage in?
• Does your child worry about things other kids don’t even think about?

Family

Is there a history of mental illness in your child’s family?

Symptoms to Watch For

If you've said "yes" to questions in at least two of the three items above (functioning, feeling, and family), you're probably curious about the specific symptoms of bipolar disorder. Experts disagree about the exact symptoms that may appear in childhood and adolescent bipolar disorder because they appear to manifest differently than the symptoms of adults, but some of these symptoms may include:

• Separation anxiety
• Emotional dysregulation with frequent mood swings
• Rages & explosive temper tantrums (lasting up to several hours)
• Marked irritability
• Impulsivity
• Agressive or oppositional behavior
• Distractibility
• Hyperactivity, more energy than normal
• Getting involved in many projects or activities at once
• Less need for sleep
• Restlessness/ fidgetiness
• Silliness, goofiness, giddiness
• Racing thoughts
• Talking excessively, rapid or pressured speech
• Grandiosity
• Risk-taking behaviors
• Depressed mood
• Low self-esteem
• Lethargy
• Difficulty getting up in the morning
• Night terrors
• Thoughts of death or suicide

Many of these symptoms are not specific to bipolar disorder and can reflect a variety of other concerns in children.

Diagnosing Bipolar in Children and Teens

If you think your child may have bipolar disorder (or any other mental health issue), talk to their physician. Schedule an appointment to discuss your concerns.

A physician may refer you to a mental health treatment provider for a complete evaluation. A mental health expert will likely want to interview you and your child to get a full picture of the history and current presentation of signs and symptoms.

Unfortunately, there is no simple lab test that identifies bipolar disorder.

Treatment for Childhood Bipolar

Bipolar disorder is a lifelong disorder and must be managed throughout a person’s life. Treatment may require adjustments over time as their brain continues to develop, and fluctuations in hormones and life experiences may exacerbate symptoms.

Your child’s treatment team may recommend the following:

• Medication: A psychiatrist may prescribe medication to stabilize your child's mood, which may include mood stabilizers and anti-depressants. It’s important to monitor your child’s medication and be on the lookout for side effects. Finding the right medication and the correct dosage may take some time, as there isn’t a single medication that works best for everyone with bipolar disorder.
• Talk therapy: A therapist may educate your child about bipolar and offer therapy sessions to help them gain emotional regulation strategies and healthy coping behaviors to help manage the symptoms and prevent relapse. Therapy often includes family members as well to address relationship issues, behavior management problems, or strategies to help the entire family cope with a child's mental illness.
• Self-Management: A child can learn ways to cope with the symptoms of bipolar, as well as identify their triggers and develop routines that help prevent relapse. Eating healthy, getting physical activity, and regular sleep is a great foundation for stability.
• Psychiatric hospitalization. Inpatient stays may be required at one time or another if a child poses an acute safety risk. A serious suicide attempt, thoughts of suicide with a clear plan, self-injury, or psychosis are just a few of the possible reasons a child with bipolar disorder may need to stay in a hospital.

Treatment works best when the child, parents, doctors, therapists, and other treatment providers work together as a team. So, it’s important to attend your child’s appointments, ask questions, communicate with other treatment providers, and continue to educate yourself about your child’s mental health needs.

Risks With Teens

Teens are already prone to risky behavior, but that risk is multiplied when the teenager also has bipolar disorder. Keep an eye out for substance abuse, such as drinking or taking drugs, as well as suicidal behavior.

The risk for suicide in people with bipolar disorder is among the highest for all psychiatric disorders.

One study showed that between 25% and 60% of adults with bipolar make at least one suicide attempt over the course of their lives, and between 5% to 6% of individuals with bipolar disorder die from suicide.

If your teen has been diagnosed with bipolar disorder, take the risk of suicide seriously. Work with your teen’s treatment providers to assess your teen’s risks and to develop a safety plan.

Co-Morbid Conditions

Many children with bipolar disorder have an additional mental illness, addiction, or behavior disorder. Some research has estimated that between 60% to 90% of youth with bipolar disorder may have attention deficit hyperactivity disorder as well.

Anxiety disorders, substance use, and disruptive behavior disorders are among the other most common issues children with bipolar disorder may experience.

Support at School

It’s important to work with your child’s school if they've been diagnosed with bipolar disorder. School officials can assist with a plan that best supports your child’s education, and they may qualify for a Section 504 plan or an Individualized Education Plan (IEP). Your child’s academic needs will depend on their symptoms and subsequent academic and behavioral issues.

If they struggle academically, the school may provide services to help ensure they get a solid education. For example, the school may be able to offer a modified schedule or a hall pass that lets your child visit the guidance counselor whenever necessary.

If they exhibit behavior problems at school, the teachers may create a behavior plan that will help them regulate their emotions and take appropriate disciplinary action as needed for conduct problems.

Support at Home

Bipolar disorder affects the entire family so it’s important to work together to help your child manage the symptoms.

Hold regular conversations with your child about treatment and treatment-related issues. There’s a good chance that, at some point, your child won’t want to take medication, especially if there are side effects or blood work is required. They may also want to stop going to therapy. Validate their feelings and talk about the importance of following doctors’ recommendations. Be open to discussing their options with them.

It’s essential to take care of yourself as well. Coping with the challenges of raising a child with bipolar disorder can be stressful. Consider joining a support group for parents with kids with bipolar disorder (or mental illness in general). Connecting with other parents may help you gain emotional support and practical advice about how to best support your child.

Final Thoughts

It is common for children to experience some of the symptoms listed above, and it doesn't necessarily mean they have bipolar disorder.

If your child is having difficulty with daily functioning or if your child is struggling with feeling normal—especially over an extended period of time—an evaluation by a psychiatrist may be warranted. An unbiased, professional opinion could bring you some peace of mind and perhaps a few new parenting skills. Talk to your pediatrician and seek out advice for your precious one so that you are not carrying your worries or concerns alone.