Common symptoms of bipolar disorder in children and factors that play into a diagnosis of childhood bipolar disorder.

Healthy children often have moments when they have difficulty staying still, controlling their impulses, or dealing with frustration. The Diagnostic and Statistical Manual IV (DSM-IV) still requires that, for a diagnosis of bipolar disorder, adult criteria must be met. There are as yet no separate criteria for diagnosing children.

Some behaviors by a child, however, should raise a red flag:

• destructive rages that continue past the age of four
• talk of wanting to die or kill themselves
• trying to jump out of a moving car

To illustrate how difficult it is to use the DSM-IV to diagnose children, the manual says that a hypomanic episode requires a "distinct period of persistently elevated, expansive, or irritable mood lasting throughout at least four days." Yet upwards of 70 percent of children with the illness have mood and energy shifts several times a day.

Since the DSM-IV is not scheduled for revision in the immediate future, experts often use some DSM-IV criteria as well as other measures. For example, a Washington University team of researchers uses a structured diagnostic interview called Wash U KIDDE-SADS, which is more sensitive to the rapid-cycling periods commonly observed in children with bipolar disorder.

In their book The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder, Demitri and Janice Papolos note the symptoms of bipolar disorder common in children:

Very Common

• Separation Anxiety
• Rages and Explosive Temper Tantrums (lasting up to several hours)
• Marked Irritability
• Oppositional Behavior
• Frequent Mood Swings
• Distractibility
• Hyperactivity
• Impulsivity
• Restlessness/ Fidgetiness
• Silliness, Goofiness, Giddiness
• Racing Thoughts
• Aggressive Behavior
• Grandiosity
• Carbohydrate Cravings
• Risk-Taking Behaviors
• Depressed Mood
• Lethargy
• Low Self-Esteem
• Difficulty Getting Up in the Morning
• Social Anxiety
• Oversensitivity to Emotional or Environmental Triggers

Common

• Bed-Wetting (especially in boys)
• Night Terrors
• Rapid or Pressured Speech
• Obsessional Behavior
• Excessive Daydreaming
• Compulsive Behavior
• Motor & Vocal Tics
• Learning Disabilities
• Poor Short-Term Memory
• Lack of Organization
• Fascination with Gore or Morbid Topics
• Hypersexuality
• Manipulative Behavior
• Bossiness
• Lying
• Suicidal Thoughts
• Destruction of Property
• Paranoia
• Hallucinations & Delusions

Less Common

• Migraine Headaches
• Bingeing
• Self-Mutilating Behaviors
• Cruelty to Animals