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How Does Bipolar Disorder Present in Children and Adolescents?

Even doctors have difficulty diagnosing bipolar disorder in children and teens because the typical symptoms of bipolar seen in adults may not be the same in children and adolescents.

Bipolar disorder is a controversial area within the field of children's mental health. Today, most doctors agree that it exists. The disagreement centers on the symptoms of bipolar disorder in young people and how they differ from those in adults.

When it comes to diagnosing young people vs. adults, bipolar disorder may look different. Children with bipolar disorder often have mood swings that shift rapidly over hours or even minutes, while adults' mood swings typically shift over days to weeks. Whereas adults with bipolar disorder generally have discrete periods of depression and discrete periods of mania, children with bipolar disorder are more likely to have moods that are not distinct. Children who develop the disorder very young are particularly likely to experience irritability and frequent mood shifts rather than discrete periods of mania and depression.

The first episode of bipolar disorder that a child or adolescent experiences may be in the form of depression, mania, or a combination of both. It may be difficult to identify a child's "first episode" of bipolar disorder if mania and depression occur at the same time, or if these moods occur chronically rather than during discrete periods of time.

During a depressive episode, children or adolescents may look frequently sad or tearful; they may be constantly irritable; or they may be tired, listless, or uninterested in favorite activities. Children or adolescents having an episode of mania often have more prominent irritability, aggression, and inconsolability than adults having an episode of mania. In a manic or mixed state they may be excessively giddy, happy, or silly; they may be intensely irritable, aggressive or inconsolable; and there may be changes in their sleep patterns. They may be restless, persistently active, and more talkative than usual; they may display behavior that is risky or hypersexual beyond what is age-appropriate; and they may have grandiose thoughts, such as the belief that they are more powerful than others; they may also hear voices. Explosive outbursts may involve physical aggression or extended, rageful tantrums.


 

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Children with bipolar disorder have moods that often seem to occur unexpectedly and appear unresponsive to normally effective parenting efforts. Parents often become discouraged and exhausted by their child's difficult and erratic behaviors. They may try almost anything to avoid or stop the severe tantrums that can last for hours, and often end up feeling helpless to alleviate their child's suffering. They may feel guilty when neither "tough love" nor consoling the child works. Worst of all, children with bipolar disorder are frightened and confused by their own moods and often feel remorseful for the hurt they cause others when "under the influence" of a powerful mood.

Covering the symptoms of bipolar disorder in children and adolescents and how they differ from those in adults.A child or adolescent who first experiences symptoms of depression may in fact turn out to have bipolar disorder. Studies of children with depression show that 20 percent or more will go on to develop bipolar disorder, depending on the characteristics of the study population and the length of time they were followed. Since it is uncertain whether a child with a first episode of depression will later develop symptoms of mania, children with depression must be carefully monitored for the emergence of mania symptoms.

Because doctors only recently began to identify bipolar disorder in children, researchers have little data with which to predict the long-term course of the illness. It is not known whether early-onset bipolar disorder with rapidly shifting moods evolves over time if untreated into the more classic, episodic form of the disorder as the child reaches adulthood, or whether this outcome can be prevented by early intervention and treatment. Puberty is a time of high risk for the disorder to develop in individuals with genetic vulnerability.

If bipolar disorder is left untreated, all major realms of the child's life (including peer relationships, school functioning, and family functioning) are likely to suffer. Early treatment with proper medication and other interventions generally improves the long-term course of the illness. A trained clinician (such as a child psychiatrist, child psychologist, or pediatric neurologist) should integrate information from home, school, and the clinical visit to make a diagnosis of bipolar disorder.

Behavior At Home

A child or adolescent with bipolar disorder can behave quite differently at home than at school or in the doctor's office. Because the child appears different in different settings, diagnosing bipolar disorder sometimes invites disagreement between parents, schools, and clinicians. Children's behavior, which reflects their brain's mood regulation, may be well controlled at school or at a doctor's office, but the same child may have severe temper outbursts at home.

In general, young people with bipolar disorder are most symptomatic at home, since moods are harder to control when the child feels tired (morning or evening), stressed by the intensity of family relationships, or pressured by the demands of daily responsibilities (such as homework and having to get ready for school on time). They are also more likely to show troubling emotions such as anger, anxiety, and frustration when they are in the security and privacy of home and immediate family.

Last Updated: 17 March 2016
Reviewed by Harry Croft, MD

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