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Bipolar Disorder In Children: Symptoms, Diagnosis, And Treatment

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Bipolar disorder, also known as manic depressive illness, is characterized by noticeable bouts of mania and major depression. The American Academy of Child and Adolescent Psychiatry describes bipolar disorder as “an illness of the brain that causes extreme changes in a person’s mood, energy level, thinking, and behavior (1).”

The manic phase of bipolar disorder is when the child feels happy, euphoric, and highly active, while the depressive phase is when they feel extremely sad, low, and withdrawn (2).

Bipolar disorder affects about three percent of all children and can be diagnosed in children as young as five years. When young children experience the symptoms, it is termed early-onset bipolar disorder (3).

Read this post to know about the types, causes, symptoms, diagnosis, and treatment for bipolar disorder in children.

Types Of Bipolar Disorder In Children

Bipolar disorder in children is classified into three different types (1)(3).

1. Bipolar I

  • It is also referred to as manic-depressive illness or classic bipolar disorder.
  • It is the most severe form of the disease.
  • Children with bipolar 1 type may have manic or mixed episodes that may last for about a week at a time
  • It severely affects the child’s sleep and ability to function well in all areas, i.e. both school and at home
  • A bipolar manic episode may happen just before or after a depressive episode that may have lasted for two weeks or longer and/or have been severe enough to have warranted hospitalization.

2. Bipolar II

  • It is a similar but milder form of bipolar type I.
  • The episodes may last only for about four days.
  • The milder manic symptoms in biolar II are also known as hypomania.
  • It sometimes warrants intensive medical care.

3. Bipolar Not Otherwise Specified (NOS)

  • The symptoms are less severe than bipolar I or II, and the mood swing episodes do not last long.
  • The diagnostic criteria for bipolar NOS in children are not clear, making the diagnosis difficult.

Causes Of Bipolar Disorder In Children

The exact cause of bipolar disorder in children is not known. However, researchers believe that the following factors may increase a child’s risk for developing bipolar disorder (2) (3).

1. Genetic factors

  • Studies suggest that genetic factors increase the risk of developing bipolar disorder by about 50 percent.
  • Six percent of children with either parent having bipolar disorder are known to develop the disorder
  • A specific bipolar gene has not been identified. Several faulty genes are responsible for bipolar disorder.

2. Environmental factors

The following risk factors for depression in children may also increase a child’s risk for developing bipolar disorder.

  • Poverty
  • Drug or alcohol abuse
  • Family history of depression
  • Environmental stressors such as
    • A mentally ill parent
    • A parent who abuses substances
    • An abusive parent
    • Violence
    • Other trauma
    • Emotional neglect

3. Developmental factors

Genetic as well as environmental factors impact brain chemistry and development. The human brain uses chemicals called neurotransmitters, which transport signals and control all the brain’s activities, including emotions.

Serotonin, norepinephrine, and dopamine are neurotransmitters involved in mental health, and any imbalance in them can lead to the onset of bipolar disorder. Moreover, recent studies have revealed alterations in the structure and function of the brains of people with bipolar disorder compared with those who do not.

Symptoms Of Bipolar Disorder In Children

The primary symptoms of bipolar disorder include dramatic mood changes and alterations in sleep patterns, activity levels, thought processes, and behavior. During a particular episode of bipolar disorder, the child can have a manic episode, depressive episode, or a mixed episode.

Warning signs of bipolar disorder in a child include the following (1) (2) (3)

  • Have manic, depressive, or mixed episodes.
  • Have manic episodes that last for most of the day, every day, for at least one week in the case of bipolar I.
  • Have manic episodes that last for most of the day, every day, for at least four days in the case of bipolar II.
  • Experience depressive phases that continue for up to two weeks at a time.
  • Experience these manic and depressive phases in continuous, increasing, or decreasing patterns as time passes.

The child may also exhibit some of the following symptoms under each category. 

Symptoms Of A Manic Episode

  • Extreme happiness or silliness for a prolonged period
  • Animated behavior or acting as though they are “high”
  • Irritable or short-tempered
  • Difficulty staying focused
  • Talking quickly and changing topics frequently
  • Engrossed in a single or several new and time-consuming projects
  • Inability to sleep
  • Unrealistic levels of self-confidence
  • Reduced ability to recognize risky situations
  • Impulsive choices or decisions

Symptoms of a Depressive Episode

  • Feeling sad, tired, or hopeless
  • Angry or hostile reactions
  • Pain in different parts of the body, including stomach and head
  • Disinterest in their otherwise favorite activities
  • Problems with concentrating and memorizing things
  • Irritability
  • Restlessness or lethargy
  • Excessive drowsiness or sleepiness
  • Reduced or increased appetite
  • Suicidal tendencies
  • Withdrawing from interactions with other people

Symptoms of a Mixed Episode

  • Upset most of the time
  • Problems falling or staying asleep
  • Increased or reduced appetite
  • Suicidal thoughts
  • Experiences any combination of the symptoms mentioned above (manic or depressive symptoms)

Diagnosis Of Bipolar Disorder In Children

No specific blood tests or scans can help confirm the diagnosis of bipolar disorder in children. Instead, the doctor will ask questions about the child’s mood, sleeping patterns, energy levels, and behavior. It is important that doctors “rule out” other medical conditions with symptoms which can be similar to bipolar disorder, such as new onset thyroid disease or diabetes.

Doctors will also enquire about a child and family’s medical history to know see if any other family members have mental health conditions, such as depression, or problems with substance abuse or alcoholism (2). In most cases, a doctor will recommend that the parents consult a child and adolescent psychiatrist for diagnosis and treatment.

Treatment For Bipolar Disorder In Children

There is no cure for bipolar disorder. However, medications along with psychosocial treatment can help manage a child’s symptoms and improve their quality of life. It is essential to continue the treatment even when a child with bipolar disorder stops exhibiting any symptoms. Consistent treatment yields better results than the on-and-off approach. The two treatment options for bipolar disorder include medication and psychosocial therapy.

1. Medication

Children with bipolar disorder may need to take medications for several years to manage their symptoms. Each child may react differently to medications and some children may need a combination of drugs. The medications may cause side effects, but the benefits of treatments largely outweigh the risks.

A doctor will usually start by prescribing the least possible number of medications in the smallest doses, and they may try a few combinations before determining which medications and dosages are appropriate for your child.

The following are the different types of medications that may be used for treating bipolar disorder in children.

  • Mood-stabilizers

These medicines help in the rapid shifting of mood, primarily during manic episodes.

  • Lithium
  • Valproic acid
  • Lamotrigine
  • Carbamazepine
  • Oxcarbazepine
  • Antipsychotic medications

These medicines serve the dual purpose of acting as mood stabilizers and managing psychosis in children. Psychosis is a condition in which the mood swings are so severe that an individual finds it challenging to distinguish between reality and illusion. Antipsychotic medicines include:

  • Quetiapine
  • Aripiprazole
  • Risperidone
  • Olanzapine
  • Ziprasidone
  • Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used in bipolar disorder. They work by increasing serotonin levels in the brain. Serotonin is a neurotransmitter that regulates appetite, sleep, and mood. The SSRIs commonly prescribed include:

  • Fluoxetine
  • Escitalopram
  • Sertraline

2. Psychosocial therapy

Several psychosocial treatment options can be used to help children and their families manage the symptoms of bipolar disorder. Psychotherapy (talk therapy), educational intervention, psychodynamic therapy, cognitive behavioral therapy, and family therapy are different forms of psychosocial treatment (5).

These therapies are all based on extensive scientific research (evidence-based) and can be used to teach children to (2) (4)

  • Identify and manage the occurrence of these mood episodes by enhancing emotional regulation.
  • Acknowledge that the mood episodes occur to them due to bipolar disorder.
  • Work on changing the negative and potentially harmful thought processes and feelings associated with being bipolar.
  • Foster new and healthy methods to relate with family, teachers, and peers.
  • Understand that they are more than their disease by building and enhancing self-esteem.
  • Improve skills.
  • Improve social interaction

Many types of mental health professionals, including counselors, psychiatrists, and psychologists, can provide psychosocial therapy for children. Mental health professionals may also suggest family counseling for the families of children affected by bipolar disorder to help them better understand their child’s and enable them to cope with the situation.

Family Support For Children With Bipolar Disorder

Psychosocial therapy can help parents and caregivers learn the necessary techniques to recognize and redirect their child’s mood swings. Family support plays a vital role in managing bipolar disorder in children.

If your child has bipolar disorder, you can do the following things to help them(1) (2).

  • Be patient.
  • Weigh all your options and do your research before deciding on and commencing a treatment plan for your child.
  • Be committed to the treatment plan and remind yourself that it is a time-consuming process.
  • You may write down about your child’s progress, problems, and observations regularly.
  • Try to identify your child’s triggers for episodes and possible ways to avoid them.
  • Ask your doctor about possible ways to handle extreme emotions.
  • Administer the medicines yourself or ask someone else who is responsible to do it. Do not leave it to your child, as taking medications consistently is the key to managing bipolar disorder.
  • Keep an eye out for sudden weight gain. Weight gain is a known side effect of many antipsychotic medications.
  • Teach your child the importance of taking medications on time.
  • You may explain to them that just as wearing glasses helps one see better, taking medicines can help them manage their emotions.
  • Introduce them to good books that help children understand bipolar disorder and the importance of taking medications regularly.
  • Although it is a personal choice, you might want to inform the school authorities about the child’s condition. They may help you understand your child’s triggers, mood swings, and behavioral issues.

Seek help from family, friends, and support groups if needed as it can be overwhelming for you to manage everything yourself.

Frequently Asked Questions

1. Can bipolar disorder be misdiagnosed?

Yes, bipolar disorder can be mistaken for childhood depression (unipolar depression), attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), autism, or anxiety disorders as the symptoms of these conditions may overlap with those of bipolar disorder in children (1). You must consult a specialist for an accurate diagnosis. 

2. What are the other disorders that may accompany bipolar disorder?

Research states that about two-thirds of children diagnosed with bipolar disorder have at least one other mental health condition or learning disorder. Having more than one such condition is known as having a comorbid condition. ADHD, ODD, and CD are the common comorbidities with bipolar disorder. More than half of all children with bipolar disorder may also have ADHD (1).

3. Should I ask my child if they are feeling suicidal?

Yes, you may ask your child if they have any self-destructive thoughts, especially when they are sad. Your child’s doctor may help you create a plan that has all safety guidelines and recommendations to manage suicidal thoughts in children with bipolar disorder (1).

4. How does bipolar disorder affect my child’s learning and schooling?

Bipolar disorder does not impact intelligence but can affect a child’s ability to learn. It can also cause problems with cognitive development due to impaired concentration, memory, and thinking.

Bipolar disorder affects sleep, and hence, may cause problems with attention in the classroom. Trained teachers can help your child by using well-designed instructional and behavioral strategies in the classroom (1).

While bipolar disorder cannot be prevented, it can be well-managed via early diagnosis and a proactive treatment approach. It may be a lifelong condition, and thus, it can be emotionally tiring for you as a parent. You may join online and offline support groups to get some ideas on caring for your child with bipolar disorder. Use the tips given here and always consult an expert for an accurate diagnosis and the best management options for your child’s condition.

References:

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Manjari Srivastava

Manjari Srivastava is a graduate of psychology. She also holds certificates in Basics In Clinical Psychology and Identifying Early Signs Of Psychosis In Adolescents And Young Adults.  Previously, she volunteered with an NGO specializing in positive psychology, where she took up individual counseling sessions for students. She also taught English to underprivileged children and helped them with their studies. At MomJunction,... more