Parenting is both rewarding and difficult, and our duties as caregivers to our children or adolescents evolve as they learn, grow, and mature. One of our more basic responsibilities as a parent or guardian is to prioritize the health and well-being of our children. When they are unwell, it is up to us to recognize the problem, seek appropriate treatment, provide the best possible follow-up care, and educate them on how to take age-appropriate steps toward self-care.
Assessing a physical illness or chronic condition may be somewhat less complicated than recognizing and seeking a diagnosis for conditions that primarily affect the mind and emotions. With mood disorders, finding the best path to stability is often challenging — especially when it’s our children who may be facing a complex mix of symptoms like rapid mood changes, debilitating depression, anxiety, sleep disturbances, anger, and extreme variations in energy and activity.
Overall, the diagnostic symptoms of bipolar disorder, based on hypomania or mania and depressive episodes, are the same as for adults. However, diagnosis in children and adolescents is complicated by typical mood swings, and other more common psychiatric illnesses with overlapping symptoms. In addition, the intermixing of manic and depressive symptoms is more common in children and adolescents, as are changes in “polarity” (i.e. direction) between manic and depressive symptoms.
Here, we highlight 8 key symptoms of concern that may suggest the presence of bipolar disorder in children and teens. Identifying these indicators early can help our kids get the right support when they need it.
Some signs your child may be experiencing mania, according to the American Academy of Child & Adolescent Psychiatry (AACAP), include the following: unrealistic highs in self-esteem, such as feelings of having special superhero powers; increases in energy and decreased need for sleep, or being able to go with little sleep for days without feeling tired; rapid thinking (known as flight of ideas), and forced speech; a preoccupation with sex or sexual matters; and repeated high-risk behaviors.
When a child or adolescent experiences a combination of these symptoms together, and they are associated with behavior and decisions that are uncharacteristic and/or risky, it’s important to seek timely assessment.
According to the AACAP, in children, teens, or young adults, depressive episodes are characterized by low energy, persistent irritability, poor concentration, and decreased enjoyment of favorite activities; decreased appetite or major change in eating habits; complaints of physical illnesses (such as stomachaches and headaches); and, sometimes, thoughts of death.
Any of these symptoms alone can be alarming and should be recognized and treated effectively. There are numerous options for treatment including medication, talk therapy, exercise and other lifestyle changes, or a combination of these options. When a child displays multiple signs of depression, whether bipolar or major depressive disorder, it is imperative to resist the urge to brush off these symptoms as a young person being “dramatic” or “hormonal.”
Depression is a brain-based health disorder that is real and requires professional care to manage. In fact, according to an older analysis published in The Lancet, depression is the leading worldwide cause of functional disability in young people ages 10 to 24 years. In addition, it is important to note that suicide is the second-leading cause of death in teens and young adults in the United States, and depression, particularly if untreated, is a major risk factor for suicide.
All children get angry periodically, and intense anger and irritability are among the most common reasons for seeking mental health care in children. There are a variety of psychiatric disorders in children and adolescents that are associated with anger and irritability, including anxiety disorders, disruptive behavior disorders, and mood disorders. Intense irritability is a symptom of both mania and depression, and children and adolescents with bipolar disorder are more likely to also have irritability and other intense mood swings even when they’re not experiencing manic or depressive episodes.
Keep in mind that even when anger and irritability are intense, they aren’t enough on their own for a diagnosis of bipolar disorder. Assessing for the previously mentioned symptoms can help determine whether or not anger and rage are related to bipolar disorder. Careful diagnostic assessment is important to determine which treatment approach to take to address irritability; options include individual therapy, family therapy, and medications.
Children with bipolar are more likely to experience changes in mood polarity, moving back and forth between a depressed mood and a hypomanic or manic mood over a shorter time period — even within the same day. Mood episodes that include this type of rapid mood switching, or even an ongoing mixture of simultaneous manic and depressive symptoms, are described as having “mixed features,” and can be challenging to manage.
The frequency of mood cycling and mixed states is a distinguishing feature of bipolar disorder in children and teens. In the largest prospective study of children and teens with bipolar, and published in Archives of General Psychiatry, researchers compared the frequency of various mood states to those observed in a similar adult study. They discovered that while children and teenagers with bipolar disorder spend about the same amount of time in either purely manic or depressive states as adults do, they experience mood cycling and mixed states significantly more often.
Just like with adults, young people with bipolar disorder often struggle more with sleep issues than those without the disorder. This can include difficulty falling asleep, restless sleep, nightmares, and morning headaches. These problems with sleep are worse for those who are feeling more depressed or whose emotions change rapidly.
A study published in 2020 in Frontiers in Psychiatry focused on sleep problems during both manic and depressive episodes in children and teens with bipolar disorder. Interestingly, researchers found an increased occurrence of bed-wetting during depressive episodes as compared to manic episodes in this demographic.
Another study published in the Journal of the Canadian Academy of Child and Adolescent Psychiatry in 2022, found that young people with bipolar disorder generally had more trouble with sleep than those without the diagnosis. More research is needed to understand these connections better.
A person’s chance of developing bipolar disorder is increased if their parents or siblings have it. But the role of genetics is not absolute, and the vast majority of children from families with a history of bipolar disorder will never develop the condition. However, children from families with bipolar disorder have high rates of attention deficit hyperactivity disorder (ADHD), anxiety, and depression, according to a longitudinal study published in JAMA Psychiatry in 2022.
Medications used to treat these conditions can sometimes trigger a manic episode, particularly if there is a family history of bipolar disorder. Being aware of the various psychological diagnoses within your immediate family and previous generations can help you to recognize whether you and your children have an increased risk for mood disorders or other psychiatric conditions, and can help guide treatment selection and monitoring.
Children with a parent diagnosed with bipolar might show early signs of the disorder, like mood swings, brief happiness or anger, depression, trouble paying attention, and problems getting along with others.
While the symptoms of bipolar disorder affect the functioning of individuals of all ages, there are some signs that are relatively unique to children and teens. According to the National Institute of Mental Health (NIMH), teens may experience a drop in grades, quit sports teams or other activities, be suspended from school or arrested for fighting or drug use, engage in risky sexual behavior, or talk about death or even taking their own lives.
If you are seeing warning signs that may indicate bipolar in your child, seek assistance from your child’s school. Talk with your child’s teacher or guidance counselor to determine if they are observing similar behaviors at school compared to what you’re seeing at home.
A high prevalence of children or teens with bipolar will have a comorbid psychiatric condition, such as anxiety disorders, ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD). This can be highly challenging to mental health professionals who may need to sift out bipolar disorder from other look-alike overlapping symptoms of different psychiatric diagnoses.
For example, ADHD and pediatric bipolar disorder have similar symptoms, like irritability, mood swings, and difficulty sleeping. While ADHD is more common and ongoing, bipolar usually has episodes of “normal” mood, depression, mania, or hypomania. It can be difficult to tell the difference between the two, especially in teens experiencing typical moodiness. According to an article from McGovern Medical School’s Psychiatry and Behavioral Sciences department, as many as 40 – 80 percent of kids with bipolar disorder also have ADHD.
Bipolar disorder is a life-long psychiatric condition that can greatly impact a child’s life and well-being. Kids with bipolar may face academic and social issues, substance abuse, and even suicide. Early diagnosis and treatment can help prevent or lessen these negative outcomes, per the American Psychological Association. For most cases of pediatric bipolar disorder, treatment includes a combination of medication and psychotherapy. Mental health professionals can also assist families in coping with the diagnosis.
In one cutting-edge study published in JAMA Psychiatry in 2017, researchers created an individual-level risk tool to help predict whether a young person with a family risk for bipolar disorder would develop the condition within 5 years. Researchers looked at a group of children of parents with bipolar disorder. These children were part of a long-term study called the Pittsburgh Bipolar Offspring Study (BIOS) and they hadn’t developed BPSD at the start of the study. Doctors can use this tool to decide how often to check on these young individuals and what treatment might be best for them.
Going forward, consider these signs as possible indications of bipolar in your child’s life, then bring your observations and questions to a certified mental health professional if a mood disorder like bipolar seems to fit with your lived experiences.
Updated from November 2016
Editorial Sources & Fact-Checking:
Bipolar Disorder in Children. Cleveland Clinic.
Bipolar Disorder in Children and Teens. American Academy of Child & Adolescent Psychiatry.
Gore FM, Bloem PJN, Patton GC, Ferguson J, et al. Global Burden of Disease in Young People Aged 10–24 Years: a Systematic Analysis. The Lancet. June 2011.
Birmaher B, Axelson D, Strober M, G MK, et al Clinical Course of Children and Adolescents With Bipolar Spectrum Disorders. Archives of General Psychiatry February 2006.
Lopes MC, Boarati MA, Fu-I L. Sleep and Daytime Complaints During Manic and Depressive Episodes in Children and Adolescents With Bipolar Disorder. Frontiers in Psychiatry January 2020.
Barton J, Mio M, Timmins V, Mitchell R HB, et al. Factors Associated With Sleep Disturbance Amongst Youth With Bipolar Disorder. Journal of the Canadian Academy of Child and Adolescent Psychiatry. November 2022.
Birmaher B, Hafemann D, Merranko J, et al. Role of Polygenic Risk Score in the Familial Transmission of Bipolar Disorder in Youth. JAMA Psychiatry. February 2022.
Bipolar Disorder in Children and Teens. National Institute of Mental Health.
Frías Á, Palma C, Farriols N. Comorbidity in Pediatric Bipolar Disorder: Prevalence, Clinical Impact, Etiology and Treatment. Journal of Affective Disorders. March 2015.
ADHD vs. Bipolar: Diagnosing the Difference in Kids. Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School. August 2018.
Treating Bipolar Disorder in Kids and Teens. American Psychological Association. October 2020.
Hafeman DH, Merranko J, Goldstein TR, et al. Assessment of a Person-Level Risk Calculator to Predict New-Onset Bipolar Spectrum Disorder in Youth at Familial Risk. JAMA Psychiatry. August 2017.
BIOS Family Study. Child and Adolescent Bipolar Spectrum Services, University of Pittsburgh. April 2023.
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This is about my niece who is 10 years old. She was born into a world of drug using parents who fought everyday. My sister had to take custody of her at three years of age. Her mother has supervised visitation every other Sunday for two hours. Her Dad lives with her but doesn’t work and is in and out of jail. He doesn’t have that much to do with her but she worships him. She has a lot of disapplin
I’ve witnessed overworked and undertrained elementary school counselors and psychologists diagnose children with ADD, ODD, OC, etc based on 30 minutes of conversation and observation. As the child’s teacher, I observe that child in the classroom for 7 hours a day. I have great respect for my colleagues and am usually the person who has referred the child for testing.
I recommend to parents that they attend every IEP meeting and make sure that the child’s teacher is present. Teacher observation has value. I had the advantage of suffering from bipolar I disorder and intense familiarity with mental health issues. At least twice after an IEP meeting I was able to chase down the in-shock parents after a school diagnosis and medication recommendations to suggest they take them for a private evaluation.
When in doubt, do your due diligence, don’t jump to conclusions but trust your gut.
My 5 year old son has always had a thing for eyes, like he would try to grab my eye, poke me in the eyes, stuff like that like before he turned one. I thought maybe it’s because my eyes are so blue .. but then when he was 3 I had another baby , && at 2yrs old, while I was pregnant he was always trying to kick me in the stomach, jump on my stomach, also tried to punch my belly all the time. now my sons are 3&5 and my youngest has a lazy eye now just out of the blue when he was around 1 is when we noticed it & I truthfully believe my oldest son had something to do with it. Still to this day I’m constantly yelling at him bc he punches pokes smacks him in the eye. He’s always trying to shoot him in the eye with nerf guns which I had to take away, always trying to shine flashlights in his eyes , in the pool he’s constantly splashing my youngest in the eyes.. and all my youngest wants is for his big brother to love him. & then the way my oldest does me… he’s awkwardly obsessed with me. He tells me all the time he wants to marry me and that he’s my boyfriend, he tells me he’s a man not a kid. He seriously stresses me out so bad. He’s always talking crazy like about his “dad” and this “blue house” he lives in with his dad. If I teach him something he always says “my dad taught me that” and if I say no son mommy just taught you that then he will literally go into a whole story starting off with what we was talking about then he completely goes off track & turns it into something that has to do with someone being killed or something off the wall & honestly it’s scary. I personally feel like he’s schizophrenic because I honestly don’t think he knows the difference between what’s real and what’s not. His attitude fluctuates immensely, like if we are playing a game and if HE wins & gets in his head that he wanted me to win then it’s completely game over bc he will sit there like he’s so upset that he just won. Or he will get mad over little things and destroy the game set up. But then he’s like mom, I just love you too much. So I had to tell him you dont love me too much you love me so much. Like I’m going through some real serious mommy burnout right now. I hate myself bc I can’t stand my own child. And no mother should feel like that. He’s so mean to my other son. He don’t listen to anything he’s told. He don’t sleep regularly at night. I have to fight him and I give in and I lay with him but he will talk to me about completely insane stuff until 6 am then my other son is up being a cry baby at 8-9am and honestly I’m losing my mind and I have no one… absolutely no one. So here I am , venting , hoping someone has some advice & that I didn’t Type too much to the point I can’t post this. I don’t know what to do or where to go or how to start making my family and home not miserable Help me !
I am so so sorry you are going through this. I have a version of your story, but reduced in frequency and agression by about 75%. I can’t imagine but I can.
Can I ask what has happened since your original post?
To Eleven, The first place to go for help us your older son’s primary care physician and ask for a referral to a psychiatrist so that your son can have a psychiatric evaluation. Do this immediately! You will get help. Behavioral Health Agencies can put a team together to help your family. Your first step is to alert your son’s pediatrician that you need help. Good luck.
Hi. Im not sure if my niece falls under this category but im a bit confused by her behaviour. Shes 5 years old.. different times of the day shes a different person. She can be playfull and sweet one moment then the next shes screaming at us.she throws heavy tantrums. Like seriouse heavy tantrums. She slaps nd bites her mom for effection nd she honestly nd trully gets it..but its never ebough.. if reprimanded she goes in this rag of fite then next second turns nd gives these manic laughs as if nothing just happend then she repeats it again.. she does not even sleep 8 hours at night.. but shes almost never tired nd when she does get tired sh is moody for hours..maybe shes just being a child maybe im overthinking it. But wow.. what i read here sounds very fimiliar as in my home
So my kid is almost 3 and she will be in a great playful mood then the slightest thing will throw her off and she’ll lay on the floor or sit there and start crying and getting mad and crying for things she wants that’s right in front of her or not wanting anything screaming no and I don’t want to and nothing I say will make her feel better if I talk to her she screams if I walk away she gets more upset I have to wait for her to calm down which seems like forever and then when she does she’s fine but I feel like any little thing is going to set her on edge is this normal for a 3 year old
My son is 3yrs old. We will be playing outside, but as soon as it’s time to come in for an t reason, he will scream and slap. Yesterday this happened and he was so violent that he goulged at my husbands arms, eyes and bit down on his hand, almost drawing blood. Once he calmed he was scarily happy. It’s sad to say I’m scared of my own son.