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.
How Childhood Bipolar Develops
Several factors are thought to contribute to the development of bipolar disorder in children, and may include:
- Genetics – If a child or teen has a parent and/or sibling with the disorder, they are more likely to get the condition in comparison to other children/teens.
- Abnormal brain function – This can also include abnormal brain structure.
- Anxiety disorders – Bipolar disorder is more common in children who suffer from various anxiety disorders.
Coping With Childhood Bipolar Disorder
The quick and thorough action is the key to gaining control over the potentially devastating effects of pediatric bipolar disorder.
Begin with basic safety measures, then look to long-term approaches to help manage the symptoms:
- Child-proof your home – Regardless of age, you need to take steps to protect your household, especially if your child has problems with aggression. Lock up sharp objects, medications, and anything else that could cause trouble for your family.
- Keep good notes – It’s important to track your child’s behavior for your doctor, but also for your benefit. The more patterns you can spot, the more efficiently you can react to manic or depressive episodes. Be as detailed as possible, citing your child’s moods, sleeping patterns, medications, and anything else that seems noteworthy.
Coping With Childhood Bipolar Disorder
- Find a doctor – Bipolar disorder is a complex mental health issue and could require the help of different professionals. Ask your pediatrician to recommend a pediatric neurologist, child psychiatrist, or psychotherapist. You may want to travel to a prominent clinic or hospital to consult an expert for an initial evaluation, then find a local doctor for ongoing medical management.
- Monitor red flags – Know when to stop watching and take action. If your child speaks of dying or suicide, makes destructive/ violent rages or engages in hazardous behaviors, seek treatment immediately. Consult with your pediatrician, area mental health agency or hospital for steps to take.
At present, there is no known cure for this condition. However, children are treated similarly as adults.
Treatments help control bipolar symptoms and may include:
- Medications – Just like adults, children can respond to medications for bipolar disorder differently. Some may require more than one medication at a time as a result of their symptoms being very complex. Different types of drugs may have to be administered to determine which one works best; it is imperative that children are always given the smallest dosages of medications as possible. Be on the lookout for and report any side effects immediately. Halting any bipolar drugs can be extremely dangerous — doing so may make bipolar symptoms more severe.
- Therapy – Different kinds of "talk" therapy can be very beneficial. Therapy can assist children in effectively changing their behaviors, as well as successfully managing their daily routines. It can also help bipolar children and teenagers get along better with their friends and family members.
Tips for Parenting a Bipolar Child
Teach and Practice Relaxation
Your child will experience irritability, quickly changing moods, impulsivity, poor judgment and defiance. Relaxation techniques can improve all of these symptoms.
Your child needs you to remind her how, where, and when to use the techniques. There are many methods available, so do research, ask your mental health providers as many questions as possible, and experiment to find the best fit. Include music, lighting, water and sounds to assist in relaxation.
As a parent, you are the model for many skills in the home — communication included. Use assertive communication as much as possible.
Use "I" statements to discuss your needs and feelings. It is very tempting to match the communication style of the person you are speaking to, but you are the parent, so set the example.
Remember, listening is as important as talking; ask questions and use good non-verbal listening skills like making eye contact and nodding. Your child will notice and learn from you.
Advocate at School
Your child will likely need modifications to thrive at school. Seek out school counselors, psychologists, and principals, and ask what services are available for your child to improve their learning experience.
Get the plan in writing, so it is clear and concrete. Be sure to involve your child — many times; they'll be the ideal source of the best ideas to improve their time in school.
Focusing too much on weaknesses will be frustrating to you and your child. All children need an emotional outlet — find and develop their gifts.
Is your child interested in playing an instrument, painting, dancing or playing a sport? These can be great ways to transition their differences into gifts. Plant the seeds today that will grow into the coping skills of tomorrow.
Not only is bipolar disorder in children difficult to diagnose, but it is also often difficult to manage. Research shows that children and adolescents typically experience more severe symptoms and disease progression than adults, in the form of longer symptomatic episodes and more frequent mood changes (cycling).
An effective treatment plan will involve some changes for the whole family, so be flexible as treatment moves along, but persistent with medication, therapy, sleep regulation and emotional support.
Many parents of bipolar children report that with focus and attention to these crucial aspects, their children can manage their symptoms as they grow up, and even experience long remissions.
The bottom line – children with mental illness, require treatment, regardless of their diagnosis. It is important for parents to be there each step of the way with their children.