Signs & Symptoms of Pediatric Bipolar Disorder

As of August 2009, the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, did not include separate diagnostic criteria for pediatric bipolar disorder. For many years, the standard belief was that children could not be diagnosed with bipolar disorder. However, over the last 15 years researchers have documented the existence, and the signs and symptoms, of early-onset bipolar disorder.

Cycling

• One of the most significant differences between adult and pediatric bipolar disorder is the length of episodes and the rate at which the moods cycle. While the Diagnostic and Statistical Manual of Mental Disorders states that adult episodes must last at least one week for mania and two weeks for depression, children typically experience rapid cycling. In "The Bipolar Child," psychiatrist Demitri Papolos writes that "the majority of bipolar children cycle rapidly from depression to mania and back again. Some cycle over a period of days; others seem to alternate mood states several times throughout the day." The episodes can cycle so rapidly that they overlap, causing a mixed phase in which mania and depression occur at the same time.

Pediatric Mania

• During a manic phase children are more active, in fact they often fidgety and constantly in motion. So many thoughts fly through their head that they can't adequately express what they're thinking. They may talk incessantly, giggle and act unusually silly. They may feel like they're better than others, more creative and able to do anything. Mania is also often expressed as a constant state of irritation or anger. Minor issues trigger unusual defiance and aggression. All of this energy makes it difficult, if not impossible, to sleep. Feeling powerful and even invincible, they may engage in unsafe activities. Depending on their age, this may range from taking unnecessary risks outside to use of drugs or alcohol. Some children in an extremely severe manic phase may become paranoid or delusional.

Pediatric Depression

• Children with depression have very low energy. This will be most evident in their school work and social life. They have a hard time getting up in the morning. They won't keep up with assignments because they lack the energy or desire and their mind can't focus on tasks. Many children will be over-sensitive to issues that normally wouldn't bother them. Negative thoughts will become all-consuming. They will lose the desire to play or get together with friends. Older children may become overwhelmed with hopelessness and start to think about death or suicide. Stomachaches and headaches are common physical symptoms during depression.

Behaviors

• Papolos identified some common behaviors in children with bipolar disorder. As described in his book noted above, his patients frequently have separation anxiety, rages are often triggered by a simple "no" and explosive temper tantrums lasting for hours. Oppositional behavior is also common. Any request can represent such stress that they block it out. Many children with bipolar disorder experience night terrors or report frightening nightmares. An extreme sensitivity to anything---unexpected or loud sounds, the scent of certain foods, the seams in clothing---is often reported. Sometimes children with bipolar disorder experience strong cravings for carbohydrates and sweets.

Identification

• The challenge of identifying pediatric bipolar signs and symptoms is that they can be hard to distinguish from the normal moods and emotional issues of children at various stages. Consider how much the symptoms interfere with daily functioning, what is typical for that age and the individual, and what triggers the mood. Think about whether their behavior is reasonable for the circumstance or whether it is extreme and long-lived. Are they able to gain control of their behavior or do they simply spin out of control for hours? Watch the intensity and duration of moods and keep records so that you can visualize how frequently the moods change and what behaviors you noticed during each phase. Also, keep track of other events that may have an influence such as illness, medications or unusual circumstances.