What is bipolar disorder in children and teens?

Bipolar disorder can include both manic and depressive episodes. Often the first signs of bipolar disorder are being severely moody, unhappy, or depressed.

Children and teens having a manic episode may:

• Have trouble sleeping.
• Have more extreme happy or silly moods than most others their age have.
• Be irritable or have a short temper.
• Take risks and not think about the consequences.
• Have trouble staying focused.

Children and teens having a depressive episode may:

• Not find pleasure in things that they normally enjoy.
• Sleep more.
• Feel guilty or worthless.
• Withdraw from friends or family.

Watch for warning signs of suicide. This can include preoccupation with death or suicide or a recent breakup of a relationship. If you notice any signs that your child may hurt themself, get help right away.

Bipolar disorder causes cycles of mania and depression.

Manic symptoms

A manic episode lasts at least a week. It's a period of being extremely happy, irritable, or motivated. The child or teen may:

• Have little need for sleep.
• Have high energy levels.
• Have extreme self-confidence.
• Talk very fast.
• Have many thoughts at once.
• Seem very distracted and unable to focus.
• Touch their genitals, use sexual language, and approach others in a sexual way.
• Act inappropriately or intrude in social settings.
• Show risky, wild, thrill-seeking behavior.

Depressive symptoms

A depressive episode is a period of a sad, low, or cranky mood. The child or teen may:

• Not find pleasure in things that they normally enjoy.
• Have low energy or feel "slowed down."
• Have sleep and appetite changes.
• Have low self-esteem.
• Feel guilty or worthless.
• Withdraw from friends or family.
• Have trouble focusing.
• Have thoughts about death or suicide.

The mood changes that come with bipolar disorder can be a challenge. But with the right treatment, they can be managed. Treatment usually includes medicines (such as mood stabilizers) and counseling. Often a combination of both is needed.

Treatment options include:

Medicines.

Make sure your child takes their medicine. Children and teens with this disorder sometimes stop taking their medicines when they feel better. But without medicine, the symptoms usually come back.

Counseling.

Counseling works best when symptoms of bipolar disorder are controlled with medicines.

Home treatment.

This includes helping your child get regular exercise, eat healthy foods, and have a regular sleep schedule.

Hospital treatment.

If your child's behavior is suicidal, aggressive, reckless, or dangerous, or if they have symptoms of psychosis such as hallucinations, your child may need to go into the hospital for a while.

Doctors make the diagnosis by asking about health problems your child and family members have had. The doctor will ask about your child's feelings and behavior. Your child will also get a physical exam. And the doctor may ask questions to rule out conditions with similar symptoms, like disruptive mood dysregulation disorder (DMDD).

Medicines most often used to treat bipolar disorder in children and teens include mood stabilizers, antipsychotics, and antidepressants.

Before prescribing medicine to treat bipolar disorder, your child's doctor will ask questions about possible suicidal behavior.

When you and the doctor are deciding which types of medicines to use, think about:

• The side effects of each medicine.
• How often your child will need to take the medicines.
• Whether your child is being treated for other illnesses or mental health conditions. How will those medicines interact with medicines for bipolar disorder?
• Whether your child has used any of the medicines before. Did they work?

It is best to build a long-term relationship with your child's care providers so that when a depressive or manic episode occurs, the care providers can recognize the changes in the child's behavior and provide quick treatment advice.

You may wish to find a doctor who has special training in children's mental health conditions or experience treating bipolar disorder in young people. Bipolar disorder can be diagnosed and treated by a health professional such as a:

• Psychiatrist, preferably a child psychiatrist.
• Psychologist
• Pediatrician.
• Family medicine physician.
• Nurse practitioner.
• Physician assistant.

Your child may also benefit from professional counseling to help deal with mood changes and the effects bipolar disorder has on your child's life. A counselor with special training in child mood disorders or experience treating child bipolar disorder may be most helpful. Counseling for bipolar disorder can be provided by a:

• Psychiatrist.
• Psychologist.

Other health professionals who also may be trained in counseling include:

• Social workers.
• Licensed mental health counselors.
• Psychiatric nurses.

Learning as much as you can about bipolar disorder may help you recognize mood changes in your child as they start to occur. You can then take steps to help reduce your child's symptoms and control moods. Find a counselor your child trusts, and make sure they take any medicines.

Your child's risk for bipolar disorder or other mood disorders is higher if the child:

• Has a close relative such as a parent, sibling, or grandparent with bipolar disorder or another mood disorder.
• Has a family history of substance use disorder.

Counseling along with medicine can work well to manage bipolar disorder. Types of counseling include:

• Cognitive behavioral therapy. It focuses on changing certain thinking and behavior patterns.
• Family therapy. This helps educate and support the entire family.
• Dialectical-behavioral therapy. This focuses on building skills to manage mood swings.
• Interpersonal and social rhythm therapy. This focuses on social and family relationships and related problems. It teaches family members about the disorder. They learn how to recognize signs of relapse. And they learn how to manage what creates stress in each family member. This treatment also helps with setting and keeping a regular social and sleep schedule.

Even with treatment, symptoms of bipolar disorder can be hard to manage. This can make school a challenge. Regular communication with your child and with teachers, coaches, and other staff is an important part of helping your child succeed.

Work with your child and your child's teachers and school counselor to build an individualized education program (IEP). This plan takes into account your child's specific needs. It lets teachers and staff members know how they can help your child. The plan should be reviewed from time to time to keep up with any changing needs.

Several conditions regularly occur along with bipolar disorder that at first may share some of the same features. Conditions that might be present along with bipolar disorder in children and adolescents include:

Attention deficit hyperactivity disorder.

This is a behavioral condition in which people have trouble paying attention, may be more active than normal, and tend to act without thinking.

Conduct disorder.

This is a childhood or adolescent disorder that involves defiant behavior, such as violating social rules or hurting other people.

Substance use disorder.

This means using substances in a way that harms the person or leads the person to harm others.

Anxiety disorders.

These are a type of mental health condition in which severe anxiety interferes with a person's life.

Although these conditions share similar symptoms, they are separate, distinguishable disorders. Each condition requires appropriate treatment.

The cause of bipolar disorder isn't completely understood. There are likely many factors involved. It seems to run in families. Your child has a greater risk of having bipolar disorder if a close family member has it.

Bipolar disorder causes mood swings with extreme ups (mania) and downs (depression). When children with this problem are up, they have brief, intense outbursts or feel irritable or extremely happy several times almost every day. They have a lot of energy and are very active. When they're down, they feel depressed and sad.