Bipolar disorder in children and teens

What is bipolar disorder?

Bipolar disorder is a mental health condition that causes shifts in mood and energy levels. Individuals with this psychiatric disorder experience mood episodes called mania and depression, both of which are more dramatic than the normal “ups and downs” of daily life that people typically experience ^[1].

When a person has bipolar disorder, they cycle between mania and depression. Sometimes, they may go years without any extreme mood swings or symptoms, but they may also have preiods of time when they have distinct episodes of mania or depression, or when they rapidly cycle between mood states ^[1].

Signs and symptoms of bipolar disorder in children and teens

The symptoms of bipolar disorder in children and teens depend upon which type of mood episode the child is experiencing at the time. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), lists diagnostic criteria and symptoms of mental health conditions, including bipolar disorder. Bipolar symptoms in children and teens align with those seen in the DSM-5, but there may be some nuances, given that symptoms may present differently in younger people ^[2].

A child or teen experiencing a manic episode will show some or many of the following symptoms ^[3]:

• Elated mood
• Grandiose behavior (extremely elevated self-esteem, sense of superiority over others, believing they are the smartest or the best athlete, even without evidence)
• Increase in goal-directed activity
• Sleeping less without experiencing fatigue or decrease in energy
• Being noticeably more active than usual
• Racing thoughts and fast talking
• Being highly productive without becoming tired
• Indulging in pleasurable activities, such as eating, or in the case of teens, sexual activity,or substance abuse

On the other hand, a depressive episode of bipolar disorder involves the following symptoms ^[3]:

• Feeling sad, down, or irritable
• Losing interest in their favorite activities
• Thoughts of suicide
• Having difficulty concentrating
• Extreme fatigue
• Changes in sleeping and eating habits (sleeping or eating either more or less than usual)
• Feeling hopeless or worthless
• Feeling either slowed down, as if you have no energy to do even simple tasks, or feeling restless

It’s important to keep in mind that for an accurate diagnosis of bipolar disorder in a child or teen, the mood episodes must represent a significant change from their normal behavior. For instance, it’s not unusual for children to present as “giddy” or “goofy,” which may be mistaken for elated or grandiose behavior. In a child with bipolar disorder, mood changes are extreme and noticeable enough that they reflect a change from the child’s usual pattern of behavior ^[2].

What causes bipolar disorder in children and teens?

There is not one single cause of bipolar disorder in children and teens. Rather, a combination of risk factors likely contributes to the development of this condition during the childhood and adolescent years. However, what is known from research is that genetics seem to play a greater role in the development of child and teen bipolar disorder, when compared to cases of bipolar disorder with a later onset ^[4].

Beyond genetics, the following factors increase the risk of bipolar disorder ^[1]:

• Differences in brain structure and functioning
• Stressful life events, such as
  • Parental divorce
  • Death in the family
  • Poverty/financial struggles
  • Illness
  • Difficult relationships

Treatment for bipolar disorder in children and teens

Children and teens with bipolar disorder are typically treated with some combination of medication and psychosocial services, including therapy and parent education. These are discussed in more detail below ^[5]:

• Medications: Bipolar disorder is often treated with a mood-stabilizer like Lithium,or a class of drugs called atypical antipsychotic medications. A psychiatrist or physician with experience in treating mental health disorders can help you to determine the best medication, based upon your child’s age and symptom presentation.
• Psychosocial services: These services can include individual and family counseling, as well as parent education. A social worker, psychologist, or mental health counselor can provide parents with education about bipolar disorderto help them develop a better understanding of symptoms and learn how to best support their child. Individual counseling can help the child to develop coping skills and improve their self-esteem. Family counseling can be beneficial for overcoming communication problems or unhelpful relationship patterns that make bipolar disorder symptoms more difficult to manage.

How to help your child with bipolar disorder

If your child lives with bipolar disorder, there are things you can do as a parent to help them manage their condition. Consider the following tips:

• Maintain open communication with your child’s school: It’s important to inform your child’s school of their mental health diagnosis, including the ways it can impact their functioning at school. Staying in contact with your child's teacher will also give you valuable information about your child’s progress. For example, if behavior and performance at school is improving, this might indicate that treatment is effective.
• Learn more about bipolar disorder: Learning about bipolar disorder will help you to become more supportive of your child. Through psychoeducation, you’ll come to better understand their symptoms, as well as how you can support your child during a mood episode.
• Be consistent with your child’s treatment: For the best outcomes, children and teens with bipolar disorder need to be consistently engaged in treatment. This means it’s essential for you to keep your child’s appointments with their doctors and counselors as well asensure that they are consistently taking medication.
• Show support: Children and teens living with bipolar disorder benefit from social support. As a parent, it’s essential for them to know that you’ll be there to support them without judgment. Maintain an open line of communication with your child, checking in periodically as necessary.

How common is bipolar disorder in children and teens?

Bipolar disorder is commonly believed to affect people beginning in early adulthood, but researchers and mental health experts have found that this condition can affect children and teens as well. The National Alliance on Mental Illness has reported an average age of onset of around 25 years for bipolar disorder ^[1].

However, research conducted with patients with bipolar disorder in several countries across the globe has revealed an earlier age of onset in some populations. In fact, it appears that there are three forms of bipolar disorder: early onset, middle onset, and late onset. Among individuals with early onset bipolar disorder, the average age of onset is 17.3 years, which suggests that it is possible for bipolar disorder to develop earlier in life ^[6].

Bipolar disorder was once thought to be extremely uncommon in youth, but recent research has shown that prevalence rates in children and teens are growing. Research with teens shows a lifetime prevalence rate of 2.5% for adolescents ^[7]. Rates of bipolar disorder in younger children, prior to the teen years, are more difficult to determine.

Different studies have shown varying prevalence rates, and many studies do not detect bipolar disorder prior to adolescence. Nonetheless, research in the United States with children ages 5 to 9 has found a prevalence rate of 27 cases per 100,000 children. While this rate is higher than that found in other countries, the fact remains that bipolar disorder is uncommon, albeit not nonexistent, in young children ^[8].