By Adelaide Sherwood Robb, MD
Bipolar disorder affects approximately 1–3 percent of the US population, including children and teens ages 10–17. Researchers have identified cases of bipolar disorder in every age group studied—including preschoolers.
Children and teens may have a different set of symptoms than adults. They may have higher rates of what used to be called a “mixed-mood presentation,” with symptoms of both depression or sadness as well as mania, which includes grandiosity, pressured speech, and a decreased need for sleep. Kids are also much more likely to have rapid cycling, moving back and forth between a depressed mood and a manic mood over a shorter period of time or even within the same day.
Adults with bipolar disorder frequently present early on with a new mood episode, whether it’s depressed or manic. In contrast, kids may present much later in the course of an episode—so rather than having only mild to moderate symptoms of mania when first seeing a doctor, the child may present with a full-blown severe manic episode with psychotic features. At times it is the presenting psychotic features that first come to the attention of the family, and these often lead clinicians to diagnose a psychotic disorder rather than the underlying mood disorder. Clarity comes when medication to reduce the psychotic symptoms begins to take effect; then the grandiose underlying mood becomes more obvious.
Symptoms in kids are, most importantly, developmentally appropriate. For example, a second-grader in peewee football truly believes he is ready to start in the NFL tomorrow because he’s the best football player ever. Or a teenager who sings in a church choir honestly thinks she is ready to sign with a record label and win a Grammy. Other symptoms include increased motor movement, talking too much and flitting from topic to topic, and frequently interrupting others (which may be mistaken for ADHD symptoms).
It’s always important for clinicians thinking about bipolar disorder in kids to be thorough and ask about mood symptoms. The most prominent symptoms of bipolar in children and teens include uncharacteristic euphoria or irritability, grandiosity, a decreased need for sleep, racing thoughts, and hypersexuality (excessive thoughts about or indulgence in sexual activity).
There is a large group of young people who have ADHD plus bipolar disorder. When treating these disorders together, it is important to first stabilize the mood and then consider adding treatment for ADHD.
Anxiety is another common co-occurring disorder, and this becomes more difficult to treat in conjunction with bipolar. Many of the approved treatments for anxiety include serotonin selective reuptake inhibitors, which are also antidepressants and may destabilize mood. For children with co-occurring anxiety and bipolar, my first choice would be to add CBT (cognitive behavioral therapy), targeted at controlling the anxiety symptoms, and use medications to take care of the bipolar symptoms.
Substance abuse can become a difficulty for many youth with psychiatric disorders. It is most important to treat the underlying bipolar disorder first, to lessen the likelihood of self-medicating with drugs and alcohol. As part of every office visit for a child or teen being treated for bp, it is important to ask about whether that individual is smoking, drinking alcohol, or using illicit drugs. We know from epidemiologic studies that treating bipolar disorder early can delay or prevent the development of substance abuse.
Bipolar is a lifespan disorder, but it can be treated. With parents, doctors, and the child all working together, youth with bp can manage their symptoms and go on to lead full and productive lives.
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According to thebalancedmind.org, factors that contribute to a better outcome include:
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Code: bphopekids
Printed as: “bp Kids: Help and hope for our kids,” Fall 2015
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Hey. Just wanted to say this article was very insightful. I was diagnosed bipolar at age 15, after being put on antidepressants for depression and anxiety, then becoming hypomanic for several weeks.
My main symptoms started when I was probably around 11. The hypersexuality was one–I wouldn’t be able to stop thinking about sex for days on end and wouldn’t even sleep because of it. I had a lot of mixed states–laughing hysterically then sobbing in the same minute. Also the grandiose thoughts. At age 13, genuinely thinking I was an alien being from outer space or something.
My advice–please take your kids to a psychiatrist if you suspect anything is wrong, even if it just seems to be a little anxiety. A therapist can help them cope, and medication isn’t as scary as it seems.
Our daughter was diagnosed with bipolar disorder and meds help but she doesn’t have grandiose episodes. She is either down, hyper or has self esteem/worth. Without the grandiose symptom could her diagnosis be correct?
I am concerned regarding a 6 year old who has been diagnosed with oppositional defiant disorder. Please note: The primary symptoms are attention-seeking behavior followed by anger. She has already begun to receive therapy. Her Mom is against her child “being put on medication”. She insists that her behavior is contollable. Her Mom said that her grandmother thinks she is an angel because she doesn’t misbehave when she is with her. She has also stayed overnight a few times with us just to give them a mental reprieve. She still misbehaves when she is with us. It stops as I tell her that her behavior is unacceptable and that it will not be tolerated. My <3 truly goes out to her parents who both need to work full-time.
Thanks for bringing this important issue to light.
I have more than 25 years experience helping adults with mental health disorders, including BD, but totally missed it in my own family because childhood bipolar disorder looks so different from adult BD and is so easy to confuse with other problems. We wasted years trying to find the right diagnosis and approach to treatment. Wish I’d known where to look from the start.
Along with some of the other things mentioned, the biggest sign for our daughter was the CONFUSION. She went from a honor roll bookworm to not being able to understand anything she read and not passing one of her classes. She was also very paranoid of other students in school.