Bipolar Disorder in Children

Is it bipolar or normal mood swings?
Suzanne Koup-Larsen,

Bipolar disorder is characterized by mood swings that cycle from high-energy mania to low-energy depressive states. While it is not an uncommon diagnosis, bipolar disorder in children is an “extremely controversial topic,” says Jordan Weisman, PsyD, vice president of clinical operations at the Philadelphia Mental Health Center in Newtown, PA. “Some believe it’s not a pediatric disorder.”

A New Bipolar Definition

“There was a thought that bipolar was being overdiagnosed,” says Dr. Nazli Gulab of pediatric cases of bipolar disorder. As a result, DSM-5 introduced a new disorder called Disruptive Mood Dysregulation Disorder. DMDD is a less severe diagnosis, characterized by a lot of irritability. The main distinction from bipolar disorder is that children with DMDD do not develop manic episodes.

Nevertheless, there has been a 40-fold increase in the number of children diagnosed with bipolar disorder over the past 20 years, according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). A certain amount of moodiness and acting out is normal as kids grow, so how can you tell when emotional swings result from this serious mental condition? 

Emma’s bipolar story

Emma (not her real name), a 13-year-old from Wilmington, DE, was a good student and sweet kid, but shortly after the beginning of 7th grade, her mother registered an extreme shift in behavior. Emma started failing at school, stayed in her room most of the time and refused to go out with friends. She was very irritable, speaking only in angry one-word retorts. Emma met with a therapist, who diagnosed her as bipolar when she admitted to having feelings of not fitting in. After only six weeks of getting extra support from her parents and working with the therapist to learn coping skills, Emma was feeling much better. 

Bipolar or mood swings?

“Everybody can be moody,” says Dr. Weisman. But with bipolar disorder, moods change more rapidly, often with no trigger event. While adults with bipolar disorder typically take weeks to cycle through manic and depressed phases, kids do this much more rapidly, in as quickly as one day. 

“Bipolar is an extreme change,” says Dr. Weisman. It significantly impacts school performance and social interaction for sustained periods. It can also affect eating habits and sleep patterns. The key is to recognize the change in behavior and face the challenge head-on. 

NEXT PAGE: Bipolar symptoms by age and treatment help

 

Teens and bipolar disorder

Moody by nature, teens have bipolar symptoms similar to adults, says Cynthia Wiles, PhD, a licensed psychologist with Christiana Care Health System’s Wilmington Hospital Health Center. For example, bipolar teens might get really motivated to clean up their room and do all their homework one day, then the next they don’t want to get out of bed. The advantage is that “Teens can recognize that their moods are extreme,” says Dr. Wiles. Younger kids, however, don’t typically know that they’re depressed.

School life after diagnosis

After a child is diagnosed with bipolar disorder, parents must decide whether or not to share the diagnosis with teachers at school. Experts agree that it is up to the parents to make individual decisions based on their child’s situation. There are pros and cons to both sides of the debate. For younger kids, it may be a good idea to share, because teachers are often more nurturing at this age and they can give valuable feedback on behaviors exhibited at school. “It’s good for the school to have some idea so they can support them,” says Dr. Gulab. But some parents decide not to confide in teachers because biases and stigmas about bipolar disorder still exist. “If it’s being managed well with treatment, the teacher doesn’t need to know,” says Dr. Wiles.

Younger kids and bipolar disorder

Prepubescent kids with bipolar disorder are harder to diagnose because many of their symptoms overlap with other conditions, such as ADHD and oppositional defiant disorder. “They’re not very focused in school, they’re distracted and they’re defiant,” says Dr. Wiles. While these traits can manifest in many children for short periods, she says, bipolar kids tend to have a harder time getting along with adults and their peers.

 “Mania is not typical adult mania,” says Nazli Gulab, MD, medical director at Kennedy University Hospital’s Child & Adolescent Psychiatric Unit. “There is a lot of irritability.” 

According to Dr. Gulab, bipolar symptoms in younger kids include:

  • Distractibility
  • Difficulty sleeping (yet lots of energy despite not sleeping)
  • Risk-taking activities, like getting into fights, playing with matches or fire, climbing trees or up on the roof, jumping out windows and/or stealing 

Where to turn for bipolar help

“With younger kids, it’s best to start with the pediatrician,” says Dr. Wiles of first steps for addressing kids’ mental health concerns. Pediatricians can rule out medical conditions that may be causing symptoms, such as a thyroid disorder. Because teens have an idea that they may be depressed, they can go directly to a therapist for help.
“If you get appropriate treatment in place early on, it’s generally effective,” says Dr. Wiles.

While medication (mood stabilizers) is the primary treatment, many forms of therapy can be used in conjunction or separately. “Because bipolar disorder is a lifelong illness,” says Dr. Gulab, “family support is essential” to long-term success. 

Suzanne Koup-Larsen is a contributing writer to MetroKids.

This article appears in the November 2014 issue of MetroKids.
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