Signs of Bipolar Disorder in Children and Teens

Does your child seem to have mood swings that are much more dramatic than others their age. Are these rollercoaster emotions characterized by intense highs and lows? Do they cycle through high-energy periods followed by depressive episodes that last hours, days, weeks, or months? Are these ups and downs causing problems in their relationships or school studies, or making it difficult for them to complete everyday tasks? Does their recent behavior seem out of character? While most children and teens experience occasional moodiness and even temper tantrums, extreme mood swings may point to a deeper mental health issue. Bipolar disorder (BD), also called bipolar spectrum disorder (BSD), can feel like an unpredictable and difficult condition to manage in your child. But with the right diagnosis and treatment, there is hope for recovery. People with bipolar disorder are 15 times more likely to die by suicide and overall have a shorter life expectancy than the general population by more than 9 years.

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WHAT IS BIPOLAR DISORDER?

Bipolar disorder is a type of cyclical mood disorder, which means that symptoms can come and go. Mood disorders are also called affective disorders. Because symptoms may occur at varying levels of intensity, bipolar is considered a spectrum disorder. In the past, BD was known as manic depression, because it features symptoms of both mania and depression. Nearly 6 million adults in America have bipolar disorder, and symptoms of BD most commonly start in young adulthood, from the late teens to mid-20s. But children and adolescents can also be affected. Data from the National Comorbidity Survey, carried out in 2001-2004, showed that an estimated 2.9% of adolescents had bipolar disorder, with 2.6% of them experiencing severe impairment. Prevalence among adolescents was higher for females (3.3%) than for males (2.6%). However, since those statistics were gathered, mental health conditions have been growing among our young people, alongside increased societal awareness of these issues. The COVID-19 pandemic also had devastating impacts on the mental health of our nation’s youth. In addition, bipolar often occurs with other conditions, according to a clinical synthesis about BD in children and adolescents published in the psychiatry journal Focus. The report pointed out that symptoms of mania may overlap with those of ADHD, oppositional defiant disorder (also called conduct disorder), depression, and anxiety. ADHD is bipolar’s most common co-occurring disorder, present in 70%-95% of pre-adolescents and in 50% of adolescents with BSD.

WHAT CAUSES BIPOLAR DISORDER?

While BSD has a hereditary link, various environmental factors can also contribute to its development, including:

• Emotional trauma
• Traumatic brain injury (TBI)
• High stress levels
• Substance abuse
• Changes in the structure and function of the brain
• Infections (such as Lyme disease) or other medical issues
• Co-occurring mental health disorders
• Poor sleep

CONSEQUENCES OF BIPOLAR DISORDER

BD can improve through lifestyle changes and other treatments, such as therapy and peer support groups. But left untreated, bipolar can lead to a lifetime of struggle, particularly when it affects young people. Kids with bipolar may not perform as well in school or drop out altogether. Later in life, they can encounter similar issues in the workplace. They’re also prone to experiencing low self-esteem, relationship issues, and substance abuse. Most alarmingly, people with bipolar are 15 times more likely to die by suicide. And overall, they have a shorter life expectancy than the general population by more than 9 years. 

SIGNS OF BIPOLAR DISORDER IN TEENS AND CHILDREN

Children and teens are notoriously susceptible to mood swings, but bipolar disorder symptoms are persistent and chronic, occurring in a cyclical pattern over longer periods of time. However, not all BSD looks the same. There are two types of bipolar disorder: bipolar 1 and bipolar 2. A less-severe type of BSD is called cyclothymia. In addition, the cyclical nature of the disorder means that symptoms can look dramatically different, based on whether the episode is manic or depressive. Episodes can last for hours, days, weeks, or months. It’s also important to note that symptoms may be absent for stretches of time. Mixed episodes, in which symptoms of manic and depressive episodes occur at the same time or in rapid succession, are also possible. Manic episodes are characterized by an elevated, euphoric, or energized emotional state. Telltale signs include:

• Abnormally elevated mood (giddiness, silliness, or excessive happiness)
• Inflated self-esteem, with grandiose notions or plans
• Decreased need for sleep
• Increase in goal-oriented activity
• Talkativeness or pressurized speech
• Racing thoughts or inability to “turn off” the mind
• Poor judgment, leading to risk-taking behavior
• Excessive appetite
• Lack of focus
• Inappropriate social behavior
• Irritability or aggression
• Delusions or hallucinations

During depressive episodes, you will likely notice a dramatic slowdown in your child. Symptoms include:

• Persistent sad or negative mood
• Low energy or fatigue
• Loss of interest in previously enjoyable activities
• Sleeping too much or too little
• Feelings of guilt, worthlessness, helplessness, and hopelessness
• Difficulty concentrating
• Thoughts of death or suicide, or suicide attempts

Keep in mind that young people may also show subtle symptoms of mental health conditions. They can have physical aches and pains, changes in their eating habits, or unusually argumentative or aggressive behavior. Meanwhile, extreme mood swings may show up as emotional outbursts, excessive crying, or temper tantrums.

THE BIPOLAR BRAIN

Like all mental health conditions, BSD is not a weakness or character defect, and children cannot simply “snap out of it.” Bipolar disorder indicates a brain that works differently. Putting symptoms in this perspective for your child or teen can help counteract possible feelings of unworthiness, guilt, or shame around their condition. At Amen Clinics, functional brain imaging using single photon emission computed tomography (SPECT) shows that those with bipolar disorder typically have heightened activity in the limbic system. This system includes the amygdala, hippocampus, and cingulate gyrus, which impact emotion, memory, sensory information, and fear. Brain scans show that cyclic mood disorders like bipolar are also associated with too much activity across the surface of the brain. For young people with extreme mood swings, getting a brain scan can be life-changing. That’s because mental health professionals may misdiagnose BSD as depression, ADD/ADHD, or even schizophrenia. When adolescents are misdiagnosed or don’t get the proper treatment for bipolar disorder, symptoms can worsen. Brain imaging helps establish not only an accurate diagnosis, but an effective treatment plan. Proper treatment can help balance areas of the brain that are either overactive or underactive. Moreover, a brain scan can pinpoint or rule out other potential factors contributing to mood issues. For example, brain scans can detect a traumatic brain injury—such as from a fall or traffic accident—which is a relatively common hidden trigger for BSD. Studies have estimated that people with TBI are 28 times more likely to have bipolar disorder, especially if the head injury occurred between ages 11-15.

THE ROAD TO RECOVERY FOR BIPOLAR YOUTH

Receiving a mental health diagnosis at a young age can seem devastating, for both children and their parents. But it’s actually the first step toward a healthier, happier, more productive future. There is no single or simple cure for bipolar disorder. By following a comprehensive treatment plan that includes lifestyle changes, natural interventions, and medication (when necessary), the road to recovery can begin. Through managing their symptoms, children will experience a better quality of life, while parents can find relief in their child’s journey toward a more stable sense of well-being. Bipolar disorder and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.