Bipolar Disorder in Children and Adolescents

Bipolar Disorder in Children and Adolescents

Bipolar Disorder in Children and Adolescents

Written by Matthew Young and Mary A. Fristad, PhD

Bipolar disorder is a serious mental health problem that affects between 1% and 5% of children and adolescents. Bipolar disorder is classified as a mood disorder by the mental health profession, and can include two types of mood disturbances: depression and mania (joyful, elevated or severely irritable moods). Bipolar disorders can affect all aspects of a child or adolescent's life, causing them difficulties at home, in school, and in getting along with friends and classmates.

How do I know when to seek help?

If you see the signs or symptoms of bipolar disorder in your child or adolescent, it is important to seek a professional evaluation. If these symptoms are causing problems for your child, leaving them untreated can result in needless suffering. It is important to be able to recognize both types of mood disturbances--depression and mania--that can occur in bipolar disorders.

Depression, often characterized by a very sad or irritable mood, is accompanied by some or all of the following symptoms:

  • Loss of interest or pleasure in things normally enjoyed
  • Increase or decrease in appetite or weight 
  • Difficulty sleeping, or sleeping much more than usual 
  • Feeling fatigued or worn out easily 
  • Body movements slowed down, or feeling agitated (can't sit still) 
  • Feeling worthless or inappropriately guilty 
  • Trouble thinking or concentrating; difficulty making decisions 
  • Thoughts about death, suicide, or wishing one were never born

Mania includes an abnormally joyful or elevated mood--super happy, silly, laughing at things no one else finds funny--or an intensely irritable mood.

Mania can include some or all of these symptoms:

  • Inflated self-esteem or belief that one is better than others or has special powers
  • Needing much less sleep than usual to feel rested 
  • Talking more or faster than usual
  • Jumping from idea to idea, or having faster thoughts than usual
  • Distractibility (attention drawn away from things more easily than usual)
  • More involved than usual in social, work, school, or sexual activities
  • More involved in pleasurable activities that have a high risk for negative consequences (dangerous or risky behavior)

Symptoms of depression and mania can alternate back and forth, or even occur at the same time. Mood disturbances can also go away for a length of time, and then return later. It is common to see short periods of these mood problems. They can last a few days or less, or "cycle" up to several times per day.

If only depression (and not mania) has been present in your child or adolescent, he or she may not have a bipolar disorder. However, depression by itself is also a serious mental health problem that can cause severe pain and suffering. Therefore, any of the above mood problems should be evaluated by a mental health professional.

Clearly, bipolar disorders cause suffering for an affected child or adolescent, getting in the way of their relationships with family and friends, and often causing difficulties in school. Children with these disorders commonly suffer from other mental health problems as well, such as Attention Deficit-Hyperactivity Disorder (ADHD). Parents suffer too, often feeling guilty that their child has the illness, while also frustrated by their inability to "make it better." Siblings can feel jealous or forgotten when the affected child seems to get all the attention. Bipolar disorders are very strongly (though not completely) linked to genetics, so other family members may experience similar mood problems.

What kinds of treatments are commonly used?

Almost all children with bipolar disorders need to take medication to help stabilize their moods. Medications do not cure the disorders--they help reduce the symptoms. Often, more than one medication has to be tried before symptoms are stabilized. Many times, a combination of two or more medications works better, if one medication alone does not produce a satisfactory response.

Many of the medications used to treat bipolar disorders can have unwanted side effects. Common examples include weight gain or sleepiness. Parents may have to help their child take the necessary steps (diet or exercise changes, sticking to a sleep schedule, etc.) to cope with these side effects. Parents should not hesitate to ask the physician questions about medications or side effects.

Medications are usually necessary, but are not the only treatment available. Psychotherapy is often a very helpful addition to medication treatment. A therapist or counselor can help a child or adolescent learn about bipolar disorders, help them understand how to cope with the symptoms, the importance of taking medication, and how to work actively with other members of the treatment team. Psychotherapy can also help decrease chances of relapse. Family therapy is helpful too, to help all family members cope with the suffering and turmoil caused by this serious mental health problem. Many children and adolescents with bipolar disorders will need to receive special services in school. Also, parental support groups are available in many communities and on the Internet.