Diagnosing and Managing Bipolar Disorder in Children
Although bipolar disorder is most often diagnosed in adulthood, it can affect children with worrying symptoms.
Unfortunately, these symptoms can vary and are sometimes difficult to define, which often complicates a diagnosis.
Hearing that your child has bipolar disorder can be scary and disheartening – typically a bipolar diagnosis is made during the late teenage years and older. However, bipolar disorder can be diagnosed as early as the age of six.
We'll take a look at what bipolar disorder is and the symptoms of bipolar disorder in children, treatment options, parenting tips, and more.
We'll also discuss Disruptive Mood Dysregulation Disorder (DMDD), a condition that is similar to bipolar disorder and how some experts consider pediatric bipolar and DMDD to be the same thing.
While bipolar disorder in children is a challenging and often dangerous condition, it can be managed. Education, support, and persistence will help you work towards an effective treatment plan that promises fewer negative symptoms and a better quality of life.
What Is Bipolar Disorder?
Bipolar disorder is also called manic depression, or manic-depressive illness is a serious brain illness where the person suffering goes through unusual mood changes.
These mood changes are characterized by mania, where the person is extremely energetic, active and happy, followed by depressive episode, where the person is feeling very down and has little energy.
The mania and depression associated with bipolar disorder are much more intense than the normal “ups and downs” that we typically feel. The mood swings are extreme and are often related to other symptoms as well.
In fact, if not controlled, the symptoms can make it hard to function – sometimes children with bipolar disorder may attempt suicide or try to hurt themselves.
As discussed previously, bipolar disorder is diagnosed as early as six. It is most commonly diagnosed in the late teen to early adult years and lasts a lifetime. The cause is unknown, but genetics are thought to play a role.
However, not everyone who has a family history of bipolar disorder goes on to develop it.
Another theory is that people with bipolar disorder have varying brain structure compared to people without bipolar disorder. However, further research has to be done on this theory.
One benefit to this continued research is that it may help doctor’s predict who will get bipolar disorder and may even help bipolar disorder from occurring in the first place.
Diagnosing Bipolar Disorder in Children
The highs and lows of bipolar disorder can hide behind rebellious and temperamental outbursts that are expected at certain stages of development.
After all, it’s normal for a child’s emotions to take over in challenging situations, but when the cycle of extreme emotions and behaviors speeds up or intensifies, there may be cause for concern.
Symptoms of Bipolar Disorder in Children
The symptoms of bipolar disorder in children and adults are similar, but children can fluctuate between the symptoms much more rapidly.
We discussed mania and depression – children can fluctuate between these episodes within a day, whereas an adult will have a longer timeframe between episodes.
Because children’s moods shift rapidly with pediatric bipolar disorder, their condition is characterized by “abrupt mood swings, periods of hyperactivity followed by lethargy, intense temper tantrums, frustration and defiant behavior. This rapid and severe cycling between moods may produce a type of chronic irritability with few clear periods of peace between episodes.”
Diagnostic criteria for both children and adults is similar; both children and adults must meet at least four diagnostic categories to reach a bipolar diagnosis.
This is not an exhaustive list of symptoms, but symptoms may include:
- Severe separation anxiety
- Rapidly changing moods
- Destructive rages
- Loss of interest in play
- Severe temper tantrums
- Bed wetting and night terrors
- Compulsive creativity
- Daredevil behavior
- Delusions and hallucinations
- Precocious sexual behavior
- Racing thoughts and pressure to keep talking
- Constant or frequent irritability
- Unnatural sleeping patterns (either regularly going without sleep or sleeping too much)
In both depressive and manic states, adolescents often:
- Abuse alcohol and/or drugs
- Experience difficulty in their personal relationships
It is important to keep in mind the developmental age of the child when making a diagnosis because certain “symptoms” can be fairly normal at certain stages of life.
For example, a child starting school may suffer from separation anxiety. A toddler may believe he or she can fly off of playground equipment.
What Is Disruptive Mood Dysregulation Disorder?
DMDD is a relatively new diagnostic term that has replaced pediatric bipolar disorder in the DSM-5.
The American Academy of Child & Adolescent Psychiatry notes, “Children with DMDD have severe and frequent temper tantrums that interfere with their ability to function at home, at school or with their friends. Some of these children were previously diagnosed with bipolar disorder, even though they often did not have all the signs and symptoms. Research has also demonstrated that children with DMDD usually do not go on to have bipolar disorder in adulthood. They are more likely to develop problems with depression or anxiety.”
The fundamental difference with DMDD is noted in the quotation above – children with DMDD are not thought to have bipolar disorder in adulthood, while children with bipolar disorder typically have it for the duration of their lives. However, this is why DMDD and bipolar disorder in children is a controversial topic.