Bipolar Disorder in Children
Early-Onset Bipolar Disorder

What are the symptoms of bipolar disorder in children?

Bipolar disorder involves marked changes in mood and energy. In most adults with the illness, persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.

However, the illness looks different in children than it does in adults. Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.

Symptoms may include:

• an expansive or irritable mood
• depression
• rapidly changing moods lasting a few hours to a few days
• explosive, lengthy, and often destructive rages
• separation anxiety
• defiance of authority
• hyperactivity, agitation, and distractibility
• sleeping little or, alternatively, sleeping too much
• bed wetting and night terrors
• strong and frequent cravings, often for carbohydrates and sweets
• excessive involvement in multiple projects and activities
• impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
• dare-devil behaviors
• inappropriate or precocious sexual behavior
• delusions and hallucinations
• grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

Symptoms of bipolar disorder can emerge as early as infancy. Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word "no" often triggered these rages.

Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children.

What are the symptoms of bipolar disorder in adolescents?

In adolescents, bipolar disorder may resemble any of the following classical adult presentations of the illness.

Bipolar I. In this form of the disorder, the adolescent experiences alternating episodes of intense and sometimes psychotic mania and depression.

Symptoms of mania include:

Symptoms of depression include:

Any talk about wanting to die, or asking why they were born or wishing they were never born must be taken very seriously as even quite young children can hang themselves in the shower, shoot themselves or complete suicide by other means.

Periods of relative or complete wellness occur between the episodes.

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For some adolescents, a loss or other traumatic event may trigger a first episode of depression or mania. Later episodes may occur independently of any obvious stresses, or may worsen with stress. Puberty is a time of risk. In girls, the onset of menses may trigger the illness, and symptoms often vary in severity with the monthly cycle.

Once the illness starts, episodes tend to recur and worsen without treatment. Studies show that after symptoms first appear, typically there is a 10-year lag until treatment begins. Parents are encouraged to take their adolescent for an evaluation if four or more of the above symptoms persist for more than two weeks. Early intervention and treatment can make all the difference in the world during this critical time of development.

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