Bipolar disorder in children: Symptoms, causes, and treatment
Every parent knows that children’s mood changes can be unpredictable. One moment, they seem calm and happy and the next moment they’re throwing a tantrum.
While a certain degree of mood shifts is normal, some children experience extreme highs and lows that may be a cause for concern.
If your child goes through cycles of extreme moods – periods of unusually high energy alternating with periods of deep sadness – they may be suffering from early-onset bipolar disorder. It’s a serious disease that could severely impact a child’s everyday life, school performance, and social relationships—and cause many other difficulties.
In this article, we’re going to cover the symptoms, causes, and treatment of bipolar disorder in children.
What is bipolar disorder in children?
Bipolar disorder is a mental disorder characterized by severe mood swings. Patients experience intermittent episodes of extreme highs and extreme lows.
While bipolar disorder is most commonly diagnosed in adults, it can also occur in children and adolescents. It’s estimated that bipolar disorder affects 1-3% of youth. (1)
It’s difficult to diagnose children who may have bipolar disorder because the symptoms often overlap with those of other behavioral disorders like ADHD.
Another factor that complicates diagnosis is that the symptoms of bipolar disorder may be different in children and adults. The scientific community is still not sure how applicable the current diagnostic criteria for bipolar disorder are for children. Further research is needed to understand this.
Symptoms of bipolar disorder in children
Children suffering from bipolar disorder go through manic episodes and depressive episodes.
During a manic episode, a child may seem unusually happy and energetic. On the other hand, during a depressive episode, children with bipolar disorder may seem unusually down, with very low energy.
It’s through identifying these episodes that a child can be diagnosed with bipolar disorder.
According to the National Institute of Mental Health, these mood episodes cause symptoms that last several days or weeks, every day for almost the entire day. (2)
Here are the symptoms of bipolar disorder listed by the United States’ National Institute of Mental Health:
Signs of a child having a manic episode:
- Showing intense happiness or acting unusually silly for long periods of time
- Being extremely irritable or having a short temper
- Talking very quickly about a lot of different things
- Having trouble sleeping or seemingly needing less sleep
- Struggling to concentrate and having racing thoughts
- Seeming over-interested in risky activities and/or engaging in risky behavior
Signs of a child having a depressive episode:
- Feeling very sad without an apparent reason
- Being unusually irritable, angry, or hostile
- Complaining about headaches, stomachaches, or other types of pain
- Sleeping more than usual
- Overeating or eating too little
- Having trouble concentrating
- Having feelings of worthlessness, hopelessness, or guilt
- Struggling to communicate and maintain relationships
- Having low energy and losing interest in beloved activities
- Thinking about death and having suicidal thoughts
Children can also experience mixed episodes, which have both manic and depressive symptoms.
Types of bipolar disorder in children
There are two main types of bipolar disorder: Bipolar I and Bipolar II. What are the differences between them?
Bipolar I is also called manic-depressive illness or classic bipolar disorder. (3) This is the most serious type of bipolar disorder.
Children who suffer from Bipolar I may experience manic episodes or mixed episodes that go on for at least a week; they are so severe that they impair the child’s normal functioning; they happen close to a depressive episode that lasted more than 2 weeks or required hospitalization.
Bipolar II is less severe, but it still requires attention and treatment. Children with Bipolar II have manic episodes similar to those of Bipolar I, but less serious and only lasting for up to 4 days. “Hypomania” is the term used to describe these milder episodes. Similarly to Bipolar I, manic episodes are directly preceded or followed by depressive episodes of at least 2 weeks.
There’s also a variation called Bipolar Not Otherwise Specified (NOS), which is an even milder form of bipolar disorder. However, this is difficult to diagnose in children because there are no exact criteria.
What causes bipolar disorder?
There is not a complete understanding of what causes bipolar disorder, but there are a few different factors that could contribute to it.
Genetic factors
Some people may have a genetic predisposition to bipolar disease. Scientists have identified multiple genomic regions that could be associated with bipolar disorder, including regions of chromosomes 2, 4, 6, 8, 11, 12, 13, 16, 18, 21, 22, and X. (4) The heritability of bipolar disease is estimated to be between 60-80%. (5)
However, this does not mean that if you have bipolar disorder, your children will have it too. Family history is a risk factor, but clinicians rarely come across families where bipolar disorder affects multiple members over several generations. (5)
So, what else can increase your child’s chances of developing bipolar disorder besides genetics?
Structural differences in the brain
Research has shown that children with bipolar disorder may have structural brain differences when compared to children with no psychiatric diseases. Specifically, children with bipolar disorder may have smaller hippocampal volumes, smaller cerebral volumes, and smaller cingulate volume. (4)
While this suggests that the brains of children with bipolar disorder develop differently, we don’t understand the exact mechanisms involved. More research is needed to better understand how this works and potentially discover new treatment methods.
Environmental factors
Finally, environmental factors also play an important role. Victims of early childhood trauma and child abuse are more likely to develop bipolar disorder. (6)
Treatment for bipolar disorder in children
Medication
Medication or a combination of medications can be used to treat the symptoms of bipolar disorder in children.
These medications include mood stabilizers, antiepileptic medications, and antipsychotic medications. (7)
When a doctor prescribes a medication for your child, it’s important to double-check whether the medication has been approved by the FDA for pediatric use. For example, the mood stabilizer lithium is approved by the FDA to treat mania in children who are 12 and older, and the antipsychotics risperidone and aripiprazole are approved for children who are 10 and older. (7)
Research shows that these medications are relatively effective, generally safe, and well-tolerated by children. However, they can cause adverse side effects, such as nausea, vomiting, headaches, cognitive dulling, hypothyroidism, tremors, extrapyramidal side effects, and weight gain. (7)
If your child is suffering from bipolar disorder, it’s fundamentally important to work together with a healthcare professional to find the best medicine or combination of medicines that work for them. Children should get the fewest possible types and the lowest doses of medication possible. (2) You should never stop giving your child medication or change their doses without speaking to your doctor first.
Cognitive-behavioral and psychosocial therapy
Therapy is also an effective tool in managing the symptoms of mood disorders in children.
Through different kinds of therapy, children and families can learn how to communicate, express their emotions, adopt healthy habits, and create an environment that does not exacerbate the symptoms of bipolar disorder.
Cognitive-behavioral approaches have been successful at improving the symptoms of bipolar disorder because they help improve children’s emotion regulation and distress tolerance skills.
Psychoeducation
Learning about bipolar disorder can also contribute to its treatment.
Psychoeducational programs run by hospitals, schools, or other organizations can educate families on the symptoms of bipolar disorder, coping strategies, and strengthening support between family members.
While children may not be able to fully understand the details of bipolar disorder, they can benefit from age-appropriate information.
Assessing bipolar disorder in children
As we’ve mentioned above, bipolar disorder is difficult to diagnose because it shares some common symptoms with other psychiatric disorders, particularly ADHD, and a new diagnosis known as Disruptive Mood Dysregulation Disorder (DMDD). (8)
What’s more, bipolar disorder is often accompanied by co-occurring disorders, most commonly disruptive behavior disorders, ADHD, anxiety disorders, and substance use disorders in adolescents.
For treatment to be effective, it’s extremely important to distinguish the symptoms of different disorders and pinpoint what’s causing them.
So, how do you test for bipolar disorder?
There are no blood tests or brain scans for bipolar disorder, however, they may be required to rule out other potential diagnoses.
A healthcare professional specializing in pediatrics can evaluate your child and perform a meticulous analysis of their symptoms to find the correct diagnosis.
If you suspect that your child may have bipolar disorder, ADHD, or other behavioral or mood disorders, contact your healthcare provider immediately.
References
(1) Birmaher B. (2013). Bipolar disorder in children and adolescents. Child and adolescent mental health, 18(3), 10.1111/camh.12021. https://doi.org/10.1111/camh.12021
(2) National Institute of Mental Health: Bipolar Disorder in Children and Teens. Retrieved on 23 June 2020 from https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens/index.shtml
(3) Boston Children’s Hospital: Bipolar disorder symptoms and causes. Retrieved on 23 June 2020 from https://www.childrenshospital.org/conditions-and-treatments/conditions/b/bipolar-disorder/symptoms-and-causes
(4) Demeter, C. A., Townsend, L. D., Wilson, M., & Findling, R. L. (2008). Current research in child and adolescent bipolar disorder. Dialogues in clinical neuroscience, 10(2), 215–228.
(5) Kerner B. (2014). Genetics of bipolar disorder. The application of clinical genetics, 7, 33–42. https://doi.org/10.2147/TACG.S39297
(6) Demjaha, A., MacCabe, J. H., & Murray, R. M. (2012). How genes and environmental factors determine the different neurodevelopmental trajectories of schizophrenia and bipolar disorder. Schizophrenia bulletin, 38(2), 209–214. https://doi.org/10.1093/schbul/sbr100
(7) Renk, K., White, R., Lauer, B. A., McSwiggan, M., Puff, J., & Lowell, A. (2014). Bipolar disorder in children. Psychiatry journal, 2014, 928685. https://doi.org/10.1155/2014/928685
(8) Child Mind Institute: Is it ADHD or bipolar disorder? Retrieved on 23 June 2020 from https://childmind.org/article/is-it-adhd-or-bipolar-disorder/
