Bipolar Disorder in Children

Bipolar disorder in children and teens can be challenging, but it is possible to monitor and treat this condition if you know what to look for.

Bipolar disorder in children is gaining more recognition in the field of mental health. Bipolar disorder was once relegated as a condition of adults, but pediatric bipolar disorder is now understood as a serious treatment need for those under age 18. The prevalence of bipolar disorder in children has been on the rise over several decades, prompting increased awareness and treatment options. 

Symptoms of Bipolar Disorder in Children

Symptoms of bipolar disorder in children can present differently for each individual, but often the common themes are behavioral challenges, difficulty with anger management and inconsolability during times of distress. Signs of bipolar disorder in children can vary, depending on a number of circumstances. There is a greater likelihood of bipolar disorder if a parent also has the condition, suggesting a genetic link. Children with bipolar disorder also display the vast mood changes that are common for adults with the condition. Energy levels will run very high during a manic phase, as well as less predictable behaviors. During depressive phases, energy decreases and mood might be sullen and tearful. 

Common challenges for children with bipolar disorder include: 

• School disruption
• Academic challenges 
• Social challenges
• Problems with emotion regulation 

These common symptoms of bipolar disorder in children can be troublesome, but there are management techniques and treatment options that can help. 

Manic Symptoms

In a manic phase of bipolar, moods are generally erratic and unpredictable. Symptoms of a manic episode will likely look different in a child than in an adult, given the amount of autonomy an adult has and the developmental stages that would result in varied presentations. 

In children, the manic phase of bipolar disorder can be accompanied by periods of rage, tantrum behaviors, hyperactivity and inexhaustible activity levels. Children in a manic phase may demonstrate a general state of irritability or agitation. Sleep patterns are often disrupted as a result of increased energy. Lack of sleep then feeds into irritability and behavioral issues. 

Mania is hard to describe, and even more so for children who may not have the language to express how they are feeling. Children experiencing a manic episode may have a severe level of anxiety. The manic state of mind can be unnerving, but it can also bring a sense of great elation and power. This combination of feelings can be difficult to navigate and children can often become overwhelmed by this perplexing array of emotion. 

Depressive Symptoms

Bipolar depressive symptoms are on the opposite end of the spectrum from manic symptoms. As the term bipolar suggests, the condition operates out of two poles of emotional states: manic and depressive. During a bipolar depressive episode, symptoms can greatly interfere with one’s ability to function. In adults, disruption of work routines and challenges related to maintaining obligations are typical outcomes. For children, school attendance often suffers, grades suffer and social relationships falter. 

The risk of substance use for teens with bipolar depression is higher than average, often as a result of the need to escape from the emotions that are interfering significantly with their ability to function. Bipolar depressive symptoms are often quite severe and may include hypersomnia, eating disruptions, tearfulness, suicidal ideation, self-harm and social isolation. It is imperative that children and teens with these major symptoms have access to treatment, particularly if safety has become a concern. Crisis hotlines and local crisis services are widely available. 

Diagnosing Bipolar in Children and Teens

Diagnosing bipolar in children can be difficult, as it is a condition that requires time to truly establish a solid base of evidence. Generally, bipolar is misdiagnosed for up to ten years before it is accurately identified and treated. Often people with bipolar disorder receive a diagnosis based on what phase they are experiencing. For example, a severely depressed, lethargic person with social avoidance may be misdiagnosed with major depressive disorder if one isn’t aware of the broader history of mood changes and behavioral shifts over time. 

Bipolar in teens can be less challenging to determine than bipolar in children since the mood dysregulation and behavioral shifts have had more time to establish a pattern. For bipolar disorder to be diagnosed in children or teens, it is important that a comprehensive assessment is completed that includes history, developmental experiences and behavioral patterns over time. Parental input is crucial in the diagnosis of bipolar in children of all ages, particularly with regard to history gathering and exploration of family mental health lineage. 

Bipolar and ADHD

The reason bipolar is difficult to diagnose is that it overlaps with many other diagnoses. If a child or teen presents with hyperactivity, class disruption and behavioral issues, this could be interpreted as a condition such as attention-deficit hyperactivity disorder (ADHD) or a behavioral disorder unrelated to mood. Because of the similar appearance that hyperactivity and manic phase can display, it can be difficult to distinguish ADHD from bipolar disorder. 

The difference between ADHD and bipolar disorder stems from the origins of the behavior. Bipolar is a mood disorder where energy and attention levels fluctuate as a result of the phase that one is experiencing. ADHD is a neurodevelopmental disorder involving challenges with focus. ADHD and bipolar can co-occur, which can make it even more difficult to diagnose. Often, if a provider suspects that a child has ADHD, additional neurological testing can be conducted to further assess the condition and rule-out a suspected diagnosis. 

Treating Bipolar Disorder in Children

Bipolar treatment in children is about finding the right behavioral modification approaches, combined with psychotherapy, psychoeducation and medication management as needed. A significant part of learning to manage bipolar disorder is understanding the phases of the condition. It is important for youth and their parents to learn how to predict triggers that may influence mood or dysregulation. Tracking sleep, activity levels and emotional lability can also help caregivers better understand behavioral patterns and stay on top of changes. 

What Parents Can Do To Help

Parenting a bipolar child may seem daunting, but there are ways to provide support and structure that can help a child feel safe, even when they feel out of control internally. Parents of bipolar children often benefit from learning as much as they can about the condition and helping the child recognize the signs and symptoms. 

Parents may find that tracking methods can be helpful as they work on identifying patterns and cycles of the disorder for their particular child. It can also be helpful for parents of children with bipolar to meet other parents in the same situation. Support groups for caregivers are often the best resources. Not only can attendees garner support from one another, but it can also serve as a natural place to share resources. 

Bipolar disorder can be challenging to manage in children, but once the symptoms are identified, coping strategies and preparation can help alleviate some of the more difficult aspects of the condition. If your child or teen has bipolar disorder and co-occurring substance use disorder, reach out to The Recovery Village to connect with helpful resources for treatment.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Paula Holmes, LCSW

Paula Holmes is a licensed clinical social worker, psychotherapist and freelance writer who lives and works in midcoast Maine. She received her master's degree in Social Work in 2008 from the University of Maine. Read more