Bipolar Disorder during Childhood
Bipolar disorder once known as manic-depression is a psychiatric diagnosis referring to a mental health condition
defined by periods of extreme, often inappropriate, and sometimes unpredictable mood states. Bipolar disorder is
a serious mental illness that affects the child’s or adolescent’s behavior. Young people with bipolar disorder have
moods with extreme ups and downs. Bipolar disorder is also associated with a variety of cognitive deficits, in
particular, difficulty in organizing and planning. The disorder may also confuse the ability to determine other
people’s mind-set, and alters sense of awareness.

In the past, a diagnosis of bipolar disorder was rarely made for children. Based on more recent research, bipolar
disorder in children is now better recognized and can be treated. Currently, it is unknown exactly how common
bipolar disorder is in children and adolescents. Estimates are that over one million children and adolescents have
bipolar disorder. Bipolar disorder is a serious illness that can interfere with a child’s functioning in the family, at
school and with friends.

Symptoms of Bipolar Disorder

Persons with bipolar disorder have dramatic changes in their moods, alternating between feeling very depressed
and feeling high or manic. Sometimes they have bouts of mania and may have lots of energy or feel irritated. At
other times their mood swings to depression, and they feel sad. They may have more normal moods between
these episodes. The periods of depression or mania can last for days, weeks or even months. Experts used to
think only adults developed bipolar disorder. They now believe even a young child can develop bipolar disorder,
although with different symptoms than adults.

In children younger than age 9, bipolar disorder frequently appears as depression or irritability.  During a
depressive episode, a young child may become withdrawn, have a short attention span, feel guilty for no reason,
and have low energy that can last for hours, days, or weeks. Your child may throw temper tantrums, become
easily frustrated, and become explosively angry. Irritability and temper tantrums can also be part of manic
episodes.

In children, it can be difficult to tell the difference between a depressive and a manic episode, especially if cycles
are rapid or symptoms of depression and mania occur together. Irritability may progress into severe, seizure-like
temper tantrums when the child is told "no." A bipolar child may kick, bite, hit, and make hateful comments,
including threats and curses.  During tantrums, which may last for hours, a child may destroy property or
become increasingly violent.

Symptoms of depression include:

•        Intense feelings of sadness, despair and worthlessness
•        Lack of interest in playing with friends
•        An increase or decrease in sleeping and/or eating
•        Feeling tired all the time
•        Thoughts of death and/or suicide
•        Extreme sensitivity to rejection or failure
•        Crying spells
•        Irritability and/or fighting
•        Physical complaints, like muscle aches and headaches or stomachaches
•        Failing grades in school
•        Difficulty concentrating
•        In young children, having great difficulty separating from parents

Symptoms of mania include:

•        Defiance and rage
•        Severe changes in mood, either extremely irritable or overly silly
•        Increased energy
•        Decreased need for sleep, ability to go with very little or no sleep for days without tiring
•        Increased talking, talks too much, too fast; changes topics too quickly; cannot be interrupted
•        Distractibility, attention moves constantly from one thing to the next
•        Physical agitation
•        Disregard of risk, excessive involvement in risky behaviors or activities

Causes of Bipolar Disorder

The cause of bipolar disorder is not well understood. It’s hereditary and is believed to be associated to an
imbalance of brain chemicals (neurotransmitters) which help regulate mood. The chances of a child or adolescent
having Bipolar are much greater if their parents and/or grandparents have it. The start of bipolar disorder can be
triggered by extreme stress, such as the death of a loved one, substance abuse or an illness. Bipolar disorder may
also occur without any apparent cause.

Symptoms of bipolar disorder in children are often confused with attention-deficit hyperactivity disorder
(ADHD); the two conditions can coincide. Bipolar disorder frequently occurs within families, although genetic
factors account for only about 60% of cases. Family members of patients with bipolar disorder also have a
higher than average incidence of other psychiatric problems. They include schizophrenia, anxiety disorders,
attention deficit hyperactivity disorder (ADHD), and major depression.

Treatment for Bipolar Disorder

There are many treatments that can reduce the depression and mania and allow the child or adolescent to enjoy
their family and friends, to learn, and to prepare to have productive adult lives. Treatments include play therapy
for children, and one on one therapy like counseling for older children and adolescents, and medications.
Counseling with parents helps them to understand their child’s difficulties and manage the symptoms. Although
mood changes and other symptoms associated with bipolar disorder are challenging, they can be managed
effectively. Treatment usually includes medications (such as mood stabilizers) and professional counseling, and
often a combination of both is most effective.

Bipolar illness is a serious disorder that has a big impact on both the child and his or her family. Successful
treatment requires that the child and family members understand what happens in bipolar disorder and that the
family members help make sure that the child follows the treatment. You and your child's doctor can discuss
which treatment is right for your child. Older children and teenagers may want to participate in their own
treatment decisions.

In determining appropriate medication the child should be evaluated and treated based on the severity of his or her
symptoms. Many medications can make the symptoms of bipolar disorder worse, and if your child is taking one
of these, he or she may need to taper off and stop the medication. This should only be done under the supervision
of a doctor.

While medications to treat bipolar disorder have been well studied for use in adults, there are few long-term
studies that confirm the effectiveness and safety of mood stabilizers in children and adolescents with bipolar
disorder. Be sure to use all medications exactly as your child's doctor has prescribed them. If your child develops
intolerable side effects from any medication, call your health professional immediately.

Medications most often used include:

•        Mood stabilizers - such as lithium carbonate
•        Anti-psychotics - which your doctor may combine with a mood stabilizer for more effective control of
manic episodes.
•        Selective serotonin reuptake inhibitors (SSRIs) - types of antidepressants to control episodes of depression.
While antidepressants can be helpful for some children, they might also trigger mania. A doctor will usually
prescribe antidepressants with other medications that help regulate mood, and he or she must carefully monitor
the child.

Professional counseling works best when symptoms of bipolar disorder are controlled with medications. Several
types of therapy may be helpful, depending on the age of the child. These include:

•        Cognitive-behavioral therapy - which focuses on modifying certain thinking and behavior patterns.
•        Social-interaction therapy - which focuses on social and personal relationships and related problems.
•        Problem-solving therapy - a brief type of cognitive therapy that helps you find immediate solutions to
problems.
•        Family therapy - which can help educate and comfort the entire family.
•        Play therapy for very young children.

There are steps you can take at home to reduce your child's symptoms of bipolar disorder.

•        Keep your child's room quiet, and have your child go to bed at the same time every night.
•        Control the amount of stress in your child's life. You may need to seek ways to help your child reduce
academic requirements during severe mood swings.
•        Learn to recognize the early warning signs of your child's manic and depressive mood episodes.

Steps your child can take to help control moods include:

•        Getting enough exercise. During a depressive episode, your child may feel like doing only gentle exercises,
such as taking a walk or swimming.
•        Getting enough sleep and keeping a consistent sleep schedule.
•        Eating a balanced diet.
•        Avoiding the use of alcohol or drugs. Substance abuse makes bipolar disorder worse.
•        Avoiding beverages that contain caffeine, including coffee, tea, colas, and energy drinks.
•        Asking for help from friends and family when needed.

Prognosis for Bipolar Disorder

The problem with bipolar disorder is that children and adolescents often go years before they get the treatment
they need. A child or adolescent who appears to be depressed or shows signs of manic or hyperactive behavior,
excessive temper outbursts and mood changes should be evaluated by a psychiatrist, psychologist or social
worker who has experience treating bipolar disorder.

Most children who have bipolar disorder need medication. However, other forms of treatment used along with
medications play an important role in balancing mood and improving quality of life. Counseling, education about
the disorder, and stress reduction can help children with bipolar disorder.

A good prognosis results from good treatment which, in turn, results from an accurate diagnosis. Because bipolar
disorder continues to have a high rate of both under diagnosis and mis-diagnosis, it is often difficult for
individuals with the illness to receive timely and competent treatment.

Bipolar disorder is a severely disabling medical condition. However, with appropriate treatment, many individuals
with bipolar disorder can live full and satisfying lives. Persons with bipolar disorder are likely to have periods of
normal or near normal functioning between episodes.
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