Michael G. Pipich MS, LMFT

Owning Bipolar

How to Recognize Bipolar Disorder in Children

Drastic changes in mood and behavior can't be ignored, even early in life

Posted Nov 15, 2018

Does your child display excessive emotional changes? Outbursts of anger, excitability, anxiety or rage, followed by periods of depression and despondency? These mood swings can be the first expressions of bipolar disorder, a serious psychiatric condition that often begins in adolescence or early childhood.

Bipolar disorder is marked by drastic shifts into mania and depression. People with the disorder can experience manic episodes involving euphoria, inflated self-image, high irritability and agitation, decreased desire to sleep, racing thoughts or impulsive, often destructive behaviors. They also can go through periods of profound depression, which can include feelings of low self-esteem, hopelessness and suicidal thoughts or actions. Despite these strong symptoms, bipolar disorder often goes unidentified and untreated. As I have stated before, a person with bipolar waits an average of nearly ten years between a first-time bipolar mood episode and receiving a treatment specifically for bipolar disorder (Drancourt, et al., 2012). While many who have bipolar are first diagnosed as adults, the presentation of bipolar symptoms are often traced back to childhood. Since about one-fourth of all deaths by suicide may be related to bipolar disorder (APA, 2013), it’s critical that professionals and parents clearly understand when young children and adolescents are exhibiting the first signs of bipolar mood swings. If we can develop an early intervention treatment plan together, we can spare children and their families years of suffering from the effects of bipolar.

It’s important to know that bipolar disorder is a mental illness that has genetic and neurological foundations. That means bipolar is hereditary, and is essentially coded in the individual’s DNA. As the brain develops, these genetic factors affect how the brain handles emotional regulation. So, a person with bipolar did not acquire the disorder simply through life circumstances; they began life with a predisposition to it. Commonly, the first signs of bipolar disorder occur during adolescence or early adulthood. This is likely related to hormonal changes, as well as increased social and academic pressures that can all become catalysts for bipolar symptoms. But pre-pubescent children can also express symptoms of bipolar.

For example, Luby, Tandon & Belden (2009) found increased emotional reactivity in preschoolers who were diagnosed with bipolar disorder, as compared to their non-bipolar counterparts. In other words, young children with bipolar react to stimuli that produced positive feelings with longer and more intense periods of joy, while reacting to stimuli that produced negative feelings with longer and more intense periods of sadness and anger. Emotional dysfunction in general certainly can be indicative of several different problems in childhood, but young people with bipolar typically respond to emotional situations with reactions that are by-and-large outside of expected parameters for their developmental stages. And these reactions essentially can go in either direction from a mood standpoint, reflecting how mania and depression could manifest in their lives as they get older.

Some symptoms of bipolar can appear similar to other childhood disorders, especially attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). With adults, differentiating bipolar from other disorders is a complex task; but with kids, it’s even more difficult. One key factor to keep in mind involves how bipolar symptoms swing from one episode to another. That is to say, bipolar symptoms come-and-go in mood swings, while other disorders, like ADHD, tend to be more consistent if left untreated. Thus, bipolar disorder can be described as “episodic” and other disorders are considered to be “pervasive,” in that there is little if any respite from the diagnosable symptoms like one might see with bipolar.

From a manic perspective, children tend to show increase energy, distractibility, pressured speech, grandiose self-image, decrease need or desire to sleep, elation/euphoria and poor judgment. They may also experience delusions or hallucinations along with these symptoms (Kowatch, et al., 2005). I have found that children who demonstrate manic grandiosity are not simply role-playing or engaging in age-appropriate fantasy. Instead, grandiose self-image and elated feelings become a disturbing part of the overall manic display that won’t stop when playtime is over. And they may frequently change personal preferences in play and interests with wild abandon.

Along with periods of high excitability and irritability, it’s also critical to look for drastic and even destructive forms of depression. Stark changes in energy levels and distractibility are typical in bipolar disorder. Most importantly, any signs of suicidal thoughts or gestures should be taken seriously. When children have bipolar disorder, they frequently display cycles involving suicidal expressions and even attempts. Self-harm and early problems with substance abuse are also common, and should be immediately addressed with the proper treatment professionals.

A bipolar mood episode in adults can last several days, and extend into weeks. But with children and teenagers with bipolar, their first mood episodes can swing suddenly, even within a single day. In spite of these wild changes in emotion and behavior, there can also be periods of relative quiet between mood episodes. That doesn’t mean that bipolar disorder has gone away. It just means that there’s a certain calm before the next storm of uncontrolled emotions. In fact, that moment of calm is often the best opportunity to get started with bipolar treatment before another bipolar crisis breaks loose.

The problem with identifying bipolar early in life is that mood shifts can occur for other psychiatric or life-adjustment reasons. Children and teenagers can certainly go through mood changes as they progress through development, but bipolar results in severe difficulties in emotional management, even at a very young age. So if you suspect your child could have bipolar, it’s good to find a professional experienced in childhood bipolar disorder to accurately assess for the condition.

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 child’s self-esteem, academic and social needs. Parents are understandably concerned about the long-term effects of psychiatric medications. But research has shown that proper care for bipolar actually protects the brain from the damaging effects of bipolar mood swings (McElroy, Keck, & Post, 2008). Good treatment can also prevent drug and alcohol abuse, along with the impulsive behaviors that can create long-lasting trouble for child and family. Early intervention for bipolar disorder can predictability result in better academic performance and social decision-making.

Because it’s a genetic in its origins, having bipolar disorder is nobody’s fault. But good care and attention to the disorder in young people can save and enhance lives, while improving the quality of relationships within the family.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Drancourt, N., Etain, B., Lajnef, M., Henry, C., Raust, A., Cochet. B., et al. (2012). Duration of untreated bipolar disorder: Missed opportunities on the long road to optimal treatment. Acta Psychiatrica Scandinavica, 127(2), 136-144.

Kowatch, RA., Youngstrom, EA., Danielyn A., Findling, RL. (2005). Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disorders, 7(6), 483-496.

Luby, JL, Tandon, M, Belden, A. (2009). Preschool bipolar disorder. Child and Adolescent Clinics of North America, 18(2), 391-403.

McElroy, S.L., Keck, P.E., Post, R.M. (Ed.) (2008). Antiepileptic drugs to treat psychiatric disorders. New York NY: Informa Healthcare USA, Inc. 390-391.

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