What Causes Bipolar Disorder In Children
It is not yet known what causes bipolar disorder. However, there are several factors that may be associated with it:
- Family History: Children with a parent or sibling with bipolar disorder are more likely to get the illness. This is approximately five times more likely when a first degree relative has a bipolar disorder.
- Anxiety Disorder: Many children with bipolar disorder also experience significant anxiety.
- Neurotransmitters: Bipolar disorder is a disorder of brain development that likely involves differences in neurotransmitters, brain structures and/or the function of specific brain structures.
- Environment: Stress, loss of a loved one and/or abuse may trigger bipolar disorder. Both negative and positive stresses can serve as a contributing trigger to bipolar disorder symptoms.
Bipolar Symptoms In Children: Presentation
Every childs symptoms differ, but during a manic phase, you may see signs like:
- Acting hyper, exuberantly happy, or incredibly silly behavior seemingly at random and in a way that is unusual to the childs personality
- Talking quickly or switching topics mid-sentence
- Hyperfocusing on a single subject or project that seems to come out of nowhere
- Erupting in extreme upset when obstacles arise or they are told no
- Highly imaginative coming up with complex storylines
- Angering quickly and becoming violent over small slights
- Not feeling tired or requiring much sleep, and showing little interest in napping, resting, or going to bed at night getting up frequently during the night
- Becoming preoccupied with sex or sexual thoughts talking about sex at inappropriate times
- Acting on sexual desires in public, dangerous, or age-inappropriate ways masturbating excessively or engaging in risky sex at a young age
- Seeing or hearing things that arent there
During a depressive phase, you might see symptoms like:
- Acting unusually weepy and sad
- Complaining of frequent stomachaches and headaches
- Sleeping longer than usual
- Eating too little or too much might gain or lose weight very rapidly
- Showing little interest in regular activities
- Talking about being a bad child, or wondering aloud if everyone hates them
- Becoming preoccupied with death talking about suicide or, for very young children, how it would be better for everyone if they went away forever or were never born
Destructive Behaviors Caused By Bipolar In Children
Its particularly important to look at patterns of destructive behaviors. Suicide is of the greatest concerns, along with substance abuse, other acts of self-harm, and maybe even parental abuse. These behaviors are more easily addressed and treated if bipolar disorder is identified and treated under professional supervision.
Here are some typical problems associated with bipolar disorder that can be addressed and possibly improved with good treatment:
- Substance use
- Depression
- Aggression
- Age-inappropriate sexual activity
- Disciplinary problems
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Recognizing Bipolar Symptoms In Children
Because bipolar symptoms present themselves differently in children and teens, it is often misdiagnosed as ADHD, major depression, anxiety, and conduct disorders, says Weinstein.
Common symptoms of ADHD and bipolar disorder include hyperactivity, irritability, distractibility, impulsivity, and difficulty sleeping. However, with ADHD, these symptoms will persist, whereas a child with bipolar disorder may exhibit them for a period of time before they disappear as the episode ends.
While every child and teen may experience mood swings brought on by factors such as puberty, changes in mood due to bipolar disorder will be more extreme and widespread. For bipolar disorder, Lis says mood swings should be consistent and ongoing and are associated with risk behaviors like skipping school and misusing drugs and alcohol.
Episodes are also associated with grandiosity that goes beyond “just a little teenage showing off.” A child or teen with bipolar disorder will direct moodiness to people beyond their parents, such as to teachers or friends.
Due to the symptoms of bipolar disorder overlapping with other disorders common in children like ADHD and anxiety, Weinstein explains an extensive evaluation must be completed by a mental health professional to ensure a correct diagnosis.
How Is Bipolar Disorder Different In Children Than In Adults
Children with bipolar disorder may switch moods more often than adults. For example, a child may exhibit periods of giddiness and silliness, anger outbursts, and crying all in one day. Children with bipolar disorder also tend to show less clear episodes and instead may show chronic irritability or mixed moods that involve a combination of mania and depression symptoms.
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How Do Doctors Treat It
Although there’s no cure for bipolar disorder, treatment can help stabilize moods and help the person manage and control symptoms. Like other teens with long-lasting medical conditions , teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat it.
This team of medical professionals, together with the teen and family, develop what is called a treatment plan. Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor. A psychologist or other type of counselor will provide counseling or psychotherapy for the teen and his or her family. Doctors will watch the symptoms closely and offer additional treatment advice if necessary.
Bipolar Disorder And Disruptive Mood Dysregulation Disorder
In the latest version of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, writers added a new pediatric mood disorder called Disruptive Mood Dysregulation Disorder . Children can be diagnosed with DMDD between the ages of 6 and 18, and many of the symptoms of DMDD are similar to bipolar disorder. These include temper outbursts, irritability, and anger. A child cannot receive a diagnosis of both bipolar disorder and DMDD, so a clinician must determine which diagnosis most accurately captures a childs symptoms.4
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Other Illnesses In A Bipolar Child
Bipolar kids may be misdiagnosed or have co-occurring illnesses. Even when a child’s behavior is unquestionably not normal, correct diagnosis remains challenging. Bipolar disorder is often accompanied by symptoms of other psychiatric disorders. Attention deficit/hyperactivity disorder appears to be the most common in bipolar children with almost 90% of children with bipolar disorder also having ADHD.
Additional diagnoses that mask or sometimes occur along with bipolar in children include:
- Depression
What Is Disruptive Mood Dysregulation Disorder
If a child is prone to severe irritability with explosive outbursts, but the behavior is not episodic, its possible that he may fit the criteria for the new diagnosis, disruptive mood dysregulation disorder, or DMDD. DMDD was added to the list of diagnoses in DSM-5 when it was published in 2013, to identify children with severe mood dysregulation who would previously have been diagnosed with pediatric bipolar disorder. The problem was that children who fit this description often did not go on to develop adult bipolar disorder.
Children with DMDD are prone to outbursts that are out of proportion to the trigger, and are irritable in between outbursts, but this behavior differs from bipolar mania in that it does not alternate with periods of depression or normal mood.
If a child fits the criteria for DMDD, he may still have ADHD, in fact Dr. Carlson estimates that about 75 to 80 percent of children in clinical samples do have ADHD, and treating the ADHD that underpins the explosive behavior may be the most important opportunity to help them. However, emotion dysregulation may be a severe problem with its own burdens leading to emergency room visits and psychiatric hospitalizations. Many children do not respond either to ADHD medications or to mood stabilizing medications. Finding appropriate interventions for these children, Dr. Carlson adds, is a high priority.
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Transcranial Direct Current Stimulation
Transcranial direct current stimulation is another noninvasive method used to stimulate small regions of the brain with the help of a weak electric current. Increasing evidence has been gathered for its efficiency as a depression treatment. A meta-analysis was published in 2020 summarising results across nine studies concluded that active tDCS was significantly superior to sham for response , remission and depression improvement. According to a 2016 meta analysis, 34% of people treated with tDCS showed at least 50% symptom reduction compared to 19% sham-treated across 6 randomised controlled trials.
Treatment Of Bipolar Disorder In Children
Treatment for bipolar disorder involves mood stabilizing medications and therapy designed to help the child and family heal from the effects of bipolar, and ultimately meet the childs self-esteem, academic and social needs. Pediatric psychiatrists and therapists trained in treating bipolar disorder in young people can be good first choices in developing a treatment team.
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When Should You Call Your Doctor
911, your provincial health information line, or other emergency services right away if:
- Your child is thinking seriously of suicide or has recently tried to suicide. Serious signs include these thoughts:
- Has decided how to kill himself or herself, such as with a weapon or medicines.
- Has set a time and has a plan.
- Thinks there is no other way to solve the problem or end the pain.
- Your child hears voices.
- Your child has been thinking about death or suicide a lot but does not have a plan for suicide.
- Your child is worried a lot that the feelings of depression or thoughts of suicide are not going away.
Seek care soon if:
- Your child has symptoms of depression, such as:
- Feeling sad or hopeless.
- Feeling guilty.
- Feeling anxious or worried.
Where Do I Go For Help
If youre not sure where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your childs symptoms.
You can learn more about getting help and finding a health care provider on the National Institute of Mental Health website. Hospital health care providers can help in an emergency. The Substance Abuse and Mental Health Services Administration has an online tool to help you find mental health services in your area.
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Bipolar Disorder In Children And Teens
Does your child go through extreme changes in mood and behavior? Does your child get much more excited or much more irritable than other kids? Do you notice that your child goes through cycles of extreme highs and lows more often than other children? Do these mood changes affect how your child acts at school or at home?
Some children and teens with these symptoms may have bipolar disorder, a brain disorder that causes unusual shifts in mood, energy, activity levels, and day-to-day functioning. With treatment, children and teens with bipolar disorder can get better over time.
What Increases Your Risk
Your child’s risk for bipolar disorder or other mood disorders is higher if the child:
- Has a close relative such as a parent, sibling, or grandparent with bipolar disorder or another mood disorder.
- Has a family history of problems with alcohol or drugs. Such family members may be using alcohol or drugs as a way to deal with a psychological disorder.
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Adhd And Bipolar Disorder
Sometimes the symptoms of ADHD and mania or hypomania associated with bipolar disorder can be very similar. Kids might exhibit distractibility, talkativeness, difficulty maintaining attention, and loss of social functioning. Clinicians must assess whether it is one condition or whether the disorders are co-occurring. A child may have both ADHD and bipolar disorder if they experience behavioral outbursts, severe mood swings, and impulsive behaviors. If your child has already been diagnosed with ADHD and they exhibit an inflated sense of self, risky sexual behavior, lack of need for sleep, and self-harming behaviors, then they also may be experiencing mania associated with bipolar disorder. A child psychiatrist can help rule out other diagnoses and suggest treatment options.5
Symptoms Of Pediatric Bipolar At School
Bipolar disorder will sometimes look a little different at school, where your child is around peers and adults to whom they are not related. During a manic phase, symptoms at school might include:
- Appearing at times to be a social butterfly making new friends easily and charming adults with a precocious personality
- Acting overly bossy with friends getting irrationally upset over slight disagreements or friends not taking orders
- Disobeying teachers and other authority figures acting out of control exhibiting excessive hyperactivity
- Behaving inappropriately removing clothing in the classroom or singing loudly during class
- Being unable to sleep during naptime or settle down to quietly read
- Being unable to make transitions becoming upset or violent when unwelcome change occurs
- Difficulty focusing on schoolwork often seeming unable to sit still
- Jumping between acting goofy even when other students arent playing along to being angry and aggressive, often with seemingly no provocation
- Acting in ways that are dangerously impulsive throwing themselves off the jungle gym, climbing the highest tree, or trying to escape from school, for instance
During a depressive phase, you might see signs at school like:
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What Is Bipolar Disorder And How Does It Affect Children
Bipolar disorder is a mental illness that causes children to be very irritable and have significant swings in mood. Bipolar disorder was previously called manic-depressive disorder.
Children with this illness experience unusual mood changes, moving from feeling very happy and joyful to feeling deeply sad. Other children experience chronic irritability, sometimes accompanied by mood shifts. Additional symptoms include grandiose behavior, pressured speech, racing thoughts, decreased need for sleep, risky behavior and hypersexuality.
If the illness goes untreated, school, relationships and daily life may become difficult. Youth with bipolar disorder are also at increased risk for suicide and/or delinquent behavior with incarceration.
Its important to note that even if you see some of these symptoms in your child, the diagnosis isnt necessarily bipolar disorder. There is some disagreement in the childrens mental health field over how symptoms differ between children and adults, and when bipolar disorder should be diagnosed. A mental health professional can help you identify the problem.
How Can I Help My Child Or Teen
Help begins with the right diagnosis and treatment. Talk to your family health care provider about any symptoms you notice.
If your child has bipolar disorder, here are some basic things you can do:
- Be patient.
- Encourage your child to talk, and listen to your child carefully.
- Pay attention to your childs moods, and be alert to any major changes.
- Understand triggers, and learn strategies for managing intense emotions and irritability.
- Help your child have fun.
- Remember that treatment takes time: sticking with the treatment plan can help your child get better and stay better.
- Help your child understand that treatment can make life better.
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Living With Bipolar Disorder
Teens normally face ups and downs with school, family, work, and friends. Dealing with bipolar disorder at the same time is a very difficult challenge. One 16-year-old reader who was diagnosed with bipolar disorder at 14 wrote to us about the experience:
“I had mood swings that were the worst anyone could have ever seen. My poor parents thought I hated them, but really I was sick and didn’t even realize it. But now I am on medications for my disorder and I live a pretty normal life. My family and friends support me, and they, along with my therapist, have helped me get to the point where I am today. I just want other teens to know that even though it is hard at times to be bipolar, things will get better.”
If you’ve been diagnosed with bipolar disorder, taking your medications as prescribed, reporting any changes in how you feel or function, and participating in therapy will be key to living a successful life. In addition to treatment, making a few lifestyle changes, such as reducing stress, eating well, and getting enough sleep and exercise can help someone who is living with the condition. And many teens find it helps to join a support network such as a local support group for people with bipolar disorder.
How Does It Affect People
Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.
Recent research suggests that kids and teens with bipolar disorder don’t always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.
Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just “snap out of it,” as if a person who is sick can become well simply by wanting to.
Bipolar disorder isn’t a sign of weakness or a character flaw it’s a serious medical condition that requires treatment, just like any other condition.
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Bipolar Disorder Vs Disruptive Mood Dysregulation Disorder
The definition of mania in children has been a significant source of disagreement among professionals. Some professionals wanted to include irritability and other emotional problems as traits of mania. Others thought that mania should be more narrowly defined like it is for adults. As a result, the American Psychiatric Association introduced a diagnosis in 2013 called disruptive mood dysregulation disorder that describes chronically irritable and explosive children that are likely not bipolar.
Risk factors of bipolar disorder | Risk factors
Its unclear what exactly causes bipolar disorder in children. A number of factors may increase a childs risk for developing this disorder, however:
- Genetics: A family history of bipolar disorder is likely the greatest single risk. If you or another family member has bipolar disorder, your child is more likely to develop the condition.
- Neurological causes: Differences in brain structures or functions can place a child at risk for developing bipolar disorder.
- Environment: If your child is already at risk for bipolar disorder, stressors in the environment may increase their risk.
- Adversechildhood events: Having multiple adverse childhood events increases risk. Adverse childhood events may include things like family separation, abuse, or parental imprisonment.