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Bipolar Disorder in Children and Teens

Childhood and adolescence are stages in life filled with tremendous growth and development as young people create an identity, assume responsibility and navigate relationships. Most young people experience their share of ups and downs during these years, but come through it without major difficulties. The development of bipolar disorder, however, can complicate many aspects of a young person’s life. Being aware, supportive and engaged helps them overcome obstacles and stay on track.

How common is bipolar disorder in children and teens, and who's at risk?

Over 10 million Americans have bipolar disorder. More than one-half of all cases are diagnosed between the ages 15 to 25, although it can be diagnosed in childhood. There is strong evidence that bipolar disorder tends to emerge in adolescence. The National Institute of Mental Health (NIMH) estimates that more than one-half of all cases are diagnosed between the ages of 15 to 25. Two percent of younger teens report bipolar symptoms with an increase to 3.1 percent of older teens. Within a given year 2.2 percent of all adolescents are affected by bipolar disorder.

Bipolar disorder tends to run in families, but most children with a family history of bipolar disorder will not develop the illness. However, a young person from a family with a history of bipolar disorder is up to six times more likely to develop the illness.

In a young person’s life a stressful event such as a death in the family, serious illness, or moving or changing schools can be a trigger for the first episode. In some cases, substance use can trigger the disorder. However, for some adolescents there is no cause or explanation.

What is bipolar disorder, and what are the warning signs and symptoms in children and teens?

Bipolar disorder is a mental health condition that is characterized by extreme moods alternating between a very high, manic state and a low, depressive state. These mood states are called episodes and can change or cycle multiple times a day or from days to months. Occasionally, someone may experience both mania and depression which is called a mixed episode.

Often the first signs of bipolar disorder are severe moodiness, unhappiness or others symptoms of depression. The first manic episode develops next possibly triggered by stress or trauma, but sometimes there is not a clear reason. Symptoms of bipolar disorder fall into two categories: mania and depression.
Symptoms of mania include:

  • Acting overly joyful or silly that is not normal behavior.
  • Having a short fuse or extremely short temper.
  • Appearing to be thinking or talking a mile a minute.
  • Sleeping very little without feeling tired.
  • Talking and thinking about sex more than usual.
  • Engaging in risky behavior, thrill seeking behavior or over-involvement in activities.
  • Hallucinations or delusions, which can result from severe episodes of mania.

Symptoms of depression include:

  • Feeling extremely sad or hopeless.
  • Being in an irritable mood.
  • No longer interested in activities that were once enjoyed–hobbies, sports, friendships.
  • Sleeping too much, hardly ever or trouble falling asleep.
  • Moving slowly or restlessness.
  • Changes in appetite or weight.
  • Little or no energy.
  • Problem concentrating.
  • Aches and pains for no reason.
  • Recurrent thoughts or talk of death or suicide. During a period of depression thoughts or talking about suicide must be taken seriously.

Children and teenagers often have early warning signs that show bipolar disorder might be developing.

Children may experience severe temper tantrums when told “no.” Tantrums can last for hours while the child continues to become more violent. They may also show odds displays of happy or silly moods and behaviors.

Teenagers may experience a drop in grades or suspension from school, quit a sports team or other activity, be arrested for fighting or drug use, engage in risky sexual behavior possibly resulting in pregnancy or sexually transmitted disease, or talk about death or suicide.

How is bipolar disorder diagnosed?

The process of diagnosing bipolar disorder involves an assessment including both a medical and psychological evaluations to rule out other illnesses which produce similar symptoms like hyperthyroidism or attention-deficit hyperactivity disorder. The use of substances such as alcohol and drugs can complicate an evaluation, diagnosis and treatment. A substance use disorder and bipolar disorder create a situation call co-occurring disorder or dual diagnosis. Both conditions need to be treated at the same time for best results.

A medical evaluation will involve tests, screenings and imaging studies looking for other illnesses or abnormalities in brain structure or function. Unfortunately, these tests can only rule out medical explanations for symptoms and are not able to help with specific aspects of psychiatric diagnosis.

A psychological evaluation includes an observation of appearance and behavior, talking about moods and feelings, asking about thoughts of harming self or others, evaluating thinking ability, age-appropriate behaviors, emotional wellness and possible psychotic symptoms. It may also include psychological testing.

Recently a controversy has surrounded an increase in bipolar diagnoses among school age children over the past two decades. The creation of a new mental health condition, Disruptive Mood Dysregulation Disorder (DMDD), with a different set of mood symptoms will potentially refine the diagnostic process arriving at more accurate diagnoses. DMDD better describes school age children who are intensely irritable, have temper tantrums and do not have classic symptoms of mania. Early evidence suggest this group does not have a substantial risk of developing bipolar disorder as adults, but may have other co-occurring disorders like depression.

What type of treatment works for adolescents with bipolar disorder?

It is important to have bipolar disorder diagnosed early so effective treatment can begin. Finding what works for a young person can be challenging and most often a combination of several different types of treatment including medication, psychosocial therapies, educational support and external support systems works best.

A treatment plan may include:

Medication. Medication is often effective in the stabilization and treatment of bipolar disorder. However, not everyone responds to medications in the same way. Frequently, different combinations of medication at varying dosages are tried to achieve the best result for a young person.

Psychosocial treatments. Psychosocial treatments can help a young person and their families learn how to live successfully with bipolar disorder. Cognitive behavioral therapy (CBT) is a successful form of individual therapy. It focuses on the relationships between negative or automatic thoughts, feelings and behaviors. It helps a young person learn ways to cope with stress, life challenges and manage their symptoms.

Family therapy. Family and home life are significantly affected and family therapy can be very helpful by improving communication, working out conflicts and learning to cope with the stress associated with your child’s condition.

Family education and support. Family education and support are important. NAMI offers family education programs and support groups. NAMI Basics Education Program is designed for parents and caregivers of children and teens experiencing a mental health disorder. You can locate a program near you by contacting your local NAMI Affiliate.

Support in school. An Individual Education Plan (IEP) can provide a young person with an academic environment that helps them achieve success. Talk to your child’s counselor or school psychologist to identify appropriate services and school options.

Before applying to college, it’s smart to research each college or university’s mental health support system. Careful planning and preparation can identify campuses with a supportive environment where a young person can be successful. NAMI on Campus provides information and resources to support students’ mental health. It helps to ensure that all students have positive, successful and fun college experiences.

Support from friends and family. Healthy, positive relationships with friends and family are very important to wellness. StrengthofUs is an online community developed by NAMI and young adults. It is designed to inspire young people impacted by mental health issues to think positive, stay strong and achieve their goals through peer support and resource sharing.

Hospitalization. It may be necessary to hospitalize a young person during a severe mania episode or if their safety is at risk. Your child’s psychiatrist or doctor can arrange for an admission to an appropriate hospital to help get symptoms under control.

If you are concerned about suicide or the safety of another person, call 911. It is important when you call to be prepared with necessary information and to be sure everyone understands that it is a psychiatric emergency.

What can I do to help my child and support their treatment?

Learning about bipolar disorder will help you understand what your young person is experiencing and recognize symptoms. Remember, symptoms are not willful acts, but expressions of an illness.

A young person will need to accept living with bipolar disorder and work to adjust their self-image. They may be uncomfortable talking to others about their condition, so by offering a loving, supportive ear you can make all the difference.

Here are a few tips:

  • Recognize and treat mood changes early. This may help reduce the length of manic or depressive episodes.
  • Create a quiet and peaceful environment with established routines for bedtime.
  • Control the amount of stress in your child’s life; reduce conflict and arguing, manageable activities or lessen academic requirements.
  • Encourage your child to exercise; this is important to balancing moods.
  • Getting enough consistent sleep and eating a balanced diet helps with energy level and reduces stress.
  • Substance use makes bipolar disorder worse. Be alert to warning signs and get help fast.
  • Limit beverages with caffeine–soda, coffee, tea, energy drinks.

Find support for the family. Don’t forget to provide you and your family with support as well. NAMI education and support programs give you opportunities to connect with others that share your experience as a family member of a young person living with mental illness and to learn valuable skills like problem solving, communication and coping. Your local NAMI Affiliate will put you in touch with people in your community that can help.

Reviewed by Ken Duckworth, M.D., May 2014


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