Childhood Bipolar Disorder - Diagnosis, Symptoms, and Other Information

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An increasing number of children have been diagnosed with bipolar disorder over the last decade. In part, this may be due to a greater awareness - in both the medical community and the general public - of the condition, leading to earlier diagnosis.

In the past, as with conditions like autism and ADHD, children with the disorder received labels as “bad seeds”, and the symptoms were attributed to poor parenting techniques or simple defiant behavioral issues. Experts now recognize bipolar disorder as a chronic brain condition which affects not only mood, energy and thinking, but may also have long term effects on cognition, metabolism, and other primary body systems.

In pediatric or childhood bipolar disorder, symptoms begin to become apparent early in life, with some documented cases in preschoolers. At this point in time, the exact prevalence of the disorder in children remains unknown, as it can be a challenging disorder to diagnose and treat.

Furthermore, childhood bipolar disorder affects individual children differently, and responses to treatments may vary a great deal. For some children, the frequency, intensity and duration of manic and depressive episodes can be debilitating, while for others, they interfere with some social interactions, but appear to be more manageable.

Some studies suggest that because the brain continues to develop until the 25th year, bipolar disorder can permanently affect the shape, size and function of certain parts of the brain and its neurotransmitter networks. In addition, as the brain matures, symptoms may also vary.

Certain disorders can also co-occur with bipolar disorder, especially in children, making diagnosis of childhood bipolar disorder even more complicated, as some can mask the underlying bipolar condition. These include: attention deficit disorder (ADD), depression, oppositional defiant disorder, conduct disorder, obsessive compulsive disorder (OCD), and seizure disorders like Tourette’s syndrome.

In fact, some experts estimate that up to 85% of children with childhood bipolar disorder also have ADHD. In addition, some children have been misdiagnosed as having ADHD with depression, post-traumatic stress disorder, or other conditions, when in fact they have bipolar disorder (previously called manic depression) and have not yet expressed a clearly manic episode. Often, these children receive stimulants or antidepressants that may actually worsen their condition.

Experts have not yet reached consensus as to whether children with chronic irritability and clear mood swings, but without mania, should be classified as having bipolar disorder. Additionally, unlike adults, children with childhood bipolar disorder tend to rapidly cycle between manic and depressive state, sometimes within the same day, while for adults, manic and depressive states can be spread out over a period of days or weeks, with depressive states lasting more than a week.

Almost all children with childhood bipolar disorder have certain personality or temperament traits in common - they can be obstinate and oppositional, can be extraordinarily irritable, and almost all experience episodes of explosive and violent rage. Tantrums occur well into the pre-teens, and the child may act out physically, punching, kicking and throwing objects.

Certain symptoms, like the need for very little sleep during manic episodes, may even be present in infancy. The infant appears excessively active, restless, and irritable when compared to other infants the same age.

As the child grows older, many parents notice that he / she displays very precocious, energetic, and creative tendencies that appear well beyond the child’s years. Intense, almost super-human creativity and rapid thought processes are hallmarks of the manic condition.

However, a bipolar child’s symptoms will share many similarities with the manic and depressive states of adult sufferers. During manic episodes of childhood bipolar disorder, the child may have the following signs and symptoms:

• Experience extreme or uncharacteristic euphoria (elevated mood) - often in inappropriate circumstances (giggling repeatedly and uncontrollably during a solemn religious service, for example)
• Feeling of grandiosity, superiority, or invincibility (for example, actually believing that they can fly and trying to jump out of windows)
• Racing thoughts or talkative / hyperactive chatter
• Irritability or hostility
• Excessive distractibility - rapidly moving from one idea to the next, unable to complete one task at a time
• Decreased need for sleep without experiencing daytime fatigue
• Excessive involvement in risky or daredevil activities; frequent lapses or demonstration of poor judgment or lack of thought to consequences of actions
• Hallucinations and psychosis
• At least three symptoms in addition to elevated mood must be present.

During depression of childhood bipolar disorder, signs and symptoms will include:

• Lack of joy and pleasure in life
• Withdrawal from formerly enjoyable activities
• Sullenness or agitation
• Overwhelming sadness and / or crying jags
• Sleeping disturbances
• Poor school performance, lack of interest
• Fatigue or loss of energy
• Aches and pains, especially manifested as headaches, backaches or stomachaches
• Preoccupied thoughts of death and suicide

Much research seems to show that childhood bipolar disorder appears to be more severe, with a longer and more complicated road to recovery than may be seen in adult-onset bipolar disorder. For many children, bipolar disorder becomes a lifelong struggle between mania and depression, becoming a continuous cycle over many months and years.

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