Bipolar Disorder in Children
Bipolar Disorder in Children
Table of Contents
Introduction
Though bipolar disorder is often considered common in adults, it can also occur in children and adolescents. According to data from the American Psychological Association (APA) and the Journal of Clinical Psychiatry, about 4% of people under the age of 18 can have bipolar disorder. The disorder includes children as young as age 5-years-old.1 Because bipolar disorder creates a unique set of challenges for people, especially children, the disorder must be identified and addressed as soon as possible.
What is Bipolar Disorder?
Everyone has periods where they experience sudden changes in mood and behavior. For most people, however, these cases are few and far between. These mood-swing episodes don’t negatively affect their lives or impact their work, school, or personal relationships.
For those struggling with bipolar disorder, though, their mood swings can become extreme and disruptive, consisting of either energetic episodes or slow, inactive periods. The energetic periods are called “manic episodes,” and the slower, less active periods are called “depressive episodes.” This mix of phases is why bipolar disorder is also known as “manic depression.”2
Although such ups and downs in emotion and behavior are typical in children and adolescents, bipolar disorder is unlike normal mood swings. Furthermore, while manic depression is an episodic illness, it lasts a lifetime. Identifying the signs of bipolar disorder in children as soon as the symptoms start to appear can help those individuals manage future challenges.
Signs and Symptoms of Bipolar Disorder in Children
Like most psychiatric conditions, the signs and symptoms of bipolar disorder in children can overlap or be mistaken for other disorders. For example, attention-deficit/hyperactivity disorder (ADHD), conduct problems, and anxiety disorder can have the same hallmarks as bipolar disorder. To obtain the correct diagnosis, one requires an in-depth assessment from an experienced mental healthcare specialist.
Symptoms of a manic episode:
- Pressured speech or fast-talking
- Speaking rapidly about different subjects
- Short temper and easy irritation
- Inability to sleep or feel tired
- Restless and fidgeting
- Racing thoughts
- Difficulty focusing
- Reckless behavior or poor judgment
- Impulsiveness
- Intense happiness or exuberance
Symptoms of a depressive episode:
- Increasing amounts of sleep
- Less focus on appearance and hygiene
- Feelings of hopeless
- Feelings of worthless
- Difficulty in maintaining concentration
- Feelings of sadness
- Complaints about physical pain, like headaches or stomach pains
- Changes in eating habits (too much or too little)
- Decreased communicative with others
- Difficulty maintaining relationships
- Thoughts about death or dying
- Thoughts about suicide
The Risk of Suicidal Thoughts for Children with Bipolar Disorder
It’s heartbreaking for an adult to imagine a child thinking about suicide, but it does happen. Bipolar children can experience suicidal ideation, otherwise known as suicidal thoughts, especially during a depressive episode. To keep children safe from harming themselves, caregivers must know the signs of suicidal thinking.3
Hallucinations
Feelings of guilt
Talking about suicide
Making comments such as:
- “I shouldn’t have been born.”
- “I wish I could sleep forever.”
- “I hear voices telling me to hurt myself.”
- “No one will miss me when I’m gone.”
- “There’s no reason for me to live.”
- “I keep seeing myself dead.”
Suicidal thoughts and behaviors are serious and shouldn’t be ignored. If a child exhibits signs of suicidal thinking, remain with the child to keep them safe and engaged, and consult with a healthcare professional for treatment.
How is Bipolar Disorder in Children Diagnosed?
DSM-V
Although formerly known as manic depression, this disorder is now labeled as “bipolar disorder” in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).4 There are three categories of the disorder:
Bipolar I: Defined by cycles of major depression and full mania with impaired functioning.
Bipolar II: Consist of severe periods of depression, alternating with briefer periods of hypomania (less-impairing mania).
Cyclothymic disorder: The individual shows short manic or depressive episodes, or the individual’s episodes don’t meet the criteria.
When mental healthcare professionals diagnose a client, even a child, they use the same diagnostic criteria from the DSM-V. Clinicians begin with a symptom checklist to perform a complete mental assessment, including a question-and-answer bipolar test. Teachers, school counselors, and caregivers may also provide feedback to clinicians regarding the child’s history. In some cases, professionals may recommend the client or parent to start a mood chart. A mood chart helps to track any mood changes, like manic or depressive episodes. Healthcare professionals may also perform a physical exam to rule out any physical causes.
ICD 10 Test
Bipolar disorder in children and adolescents is an internationally recognized illness. The tenth version of the International Classification of Diseases codes ( ICD-10) lists bipolar disorder as code F-31, including for children. The DSM-V and ICD codes ensure that clients seeking mental health are diagnosed and billed appropriately, and that hospital records and medical charts align.5
Correctly diagnosing and addressing bipolar signs in children is the essential first step to getting these children the help they need. Children or adolescents who have a parent with bipolar disorder are at a higher risk for developing the disorder.6 Detecting and treating the illness before significant symptoms develop can prevent adverse effects of symptoms. When it comes to bipolar disorder in children, early intervention can make all the difference.
How is Bipolar Disorder in Children Treated?
Once signs of bipolar disorder in children are identified and diagnosed, treatments must begin. Like adults who have the disorder, bipolar children and teenagers can receive treatment through a mental health professional. These clinicians work with clients and family members to develop a treatment plan. The plans outline the necessary steps for the patient to manage the disorder. The following are treatment options used for bipolar children.
Medication
Fortunately, several types of medications are available to reduce bipolar symptoms. It may take some time to find the most effective dosages and combinations, depending on the child’s response to the medication and how complex their symptoms are. Once started, clients should not stop medications abruptly, as this can worsen bipolar symptoms.
Therapy
A mix of psychosocial therapies can help bipolar children and their families cope with the disorder. Cognitive-behavioral approaches teach children how to recognize their moods, regulate their emotions, and enhance their social interactions. Family-focused therapies provide families with the skills to manage day-to-day life with bipolar children and develop interpersonal resiliency.
Bipolar Disorder in Children and the Risk of Addiction
The symptoms of bipolar disorder, such as impulsivity and risk-taking behaviors, increase the likelihood of drug use and addiction as adolescents and adults. Additionally, drug use can exacerbate symptoms and push a person into a depressive or manic episode. Early diagnosis and treatment can mitigate and curb a child’s lifelong risk of addiction.
Addiction Treatment with a Dual Diagnosis of Bipolar Disorder
When addiction occurs alongside a mental illness like bipolar disorder, the National Alliance on Mental Illness (NAMI) recommends integrated intervention — treating both the mental disorder and addiction simultaneously.7 Because one illness is related to the other, drug abuse and a mental illness are called dual diagnosis or co-occurring disorders. A client can address both issues and reduce the chances of one illness compromising the other by treating both at the same time.
Detox
Depending on the client’s situation, treatments for dual diagnosis typically include detoxification and inpatient or outpatient rehabilitation. Detoxification involves around-the-clock monitoring to eliminate drugs and toxins from a client’s body. This process may include medication to manage withdrawal symptoms and wean a person off drugs or alcohol.
Rehabilitation
Rehabilitation may include inpatient and outpatient treatment, or a mix of both. Inpatient treatment requires the client to reside at a facility where trained staff can work with them twenty-four hours a day. In outpatient treatment, the client may stay at home and come into the clinic for sessions with their support staff. Both treatments offer behavioral therapy and education alongside regular visits with clinicians to monitor progress and medications.
It’s important to remember that children and adolescents are very resilient and eager to learn. A diagnosis of bipolar disorder is a challenge, but it can be managed through early interventions. With treatment and support, children and teens with bipolar disorder can grow into happy and successful adults.
Resources
- https://www.psychiatrist.com/JCP/article/Pages/2019/v80/18r12180.aspx
- https://www.apa.org/monitor/2020/10/ce-corner-bipolar
- https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens/index.shtml
- https://doi.org/10.1111/bdi.12789
- https://icd.who.int/browse10/2016/en#/F30-F39
- https://www.sciencedirect.com/science/article/pii/S0165032719321998
- https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Substance-Use-Disorders
