Bipolar Disorder in Children and Adolescents

Bipolar disorder with onset during childhood or early adolescence appears to be as common in prevalence as adult onset bipolar disorder and may be a different (possibly more severe) variant of the disorder. It is difficult to recognize and diagnose, because the symptoms and behaviors associated with the disorder manifest themselves differently than adult onset bipolar disorder, and often appear similar to (or can co-occur with) other more common childhood disorders such as attention deficit hyperactivity disorder (ADHD), disruptive behavior disorders, conduct disorders, or even normal "mood swings" of early and middle adolescence. Some controversy surrounds the diagnosis, and continued research is needed to improve our understanding and treatment of this mood disorder in children and adolescents.

Unlike adult bipolar disorder in which mania manifests as elevated moods or euphoria, children are more prone to heightened irritability, destructive outbursts, or highly disruptive and/or aggressive behaviors during manic states. Children may express depressed states through behaviors such physical complaints, irritability, crying spells, significant difficulty with interpersonal relationships, and extreme sensitivity to negative reactions from others. In early adolescents the appearance of the disorder is often characterized by a continuous, rapid-cycling, irritable, and mixed symptom state.

Children who have depressed moods or severe ADHD-type symptoms and also show extreme irritability, temper, mood swings, or disruptive/aggressive behaviors, should be evaluated by a psychiatrist or mental health professional familiar with bipolar disorders, especially where there is a family history of this illness.

Criteria for Bipolar Disorder in Children and Adolescents

Bipolar disorder is a serious mental illness characterized by recurrent episodes of depression, mania, and/or mixed symptom states. These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning.

Manic symptoms include:

  • Severe changes in mood—either extremely irritable or overly silly and elated
  • Overly-inflated self-esteem; grandiosity
  • Increased energy
  • Decreased need for sleep—ability to go with very little or no sleep for days without tiring
  • Increased talking—talks too much, too fast; changes topics too quickly; cannot be interrupted
  • Distractibility—attention moves constantly from one thing to the next
  • Hypersexuality—increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
  • Increased goal-directed activity or physical agitation
  • Disregard of risk—excessive involvement in risky behaviors or activities

Depressive symptoms include:

  • Persistent sad or irritable mood
  • Loss of interest in activities once enjoyed
  • Significant change in appetite or body weight
  • Difficulty sleeping or oversleeping
  • Physical agitation or slowing
  • Loss of energy
  • Feelings of worthlessness or inappropriate guilt
  • Difficulty concentrating
  • Recurrent thoughts of death or suicide

Criteria are excerpted from NIH Publication No. 00-4778.

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