Medical science is learning more about bipolar disorder in children and teens. But the condition is still difficult to diagnose. That's especially true for teenagers in whom irritability and moodiness commonly co-exist as part of a normal adolescence. A preteen or teenager with mood swings may be going through a difficult but normal developmental stage. Or they may have bipolar disorder with periodic mood changes that shift from depression to mania.
Symptoms of ADHD can have some overlap with symptoms of bipolar disorder. With ADHD, a child or teen may have rapid or impulsive speech, physical restlessness, trouble focusing, irritability, and, sometimes, defiant or oppositional behavior.
According to one study, today's children and teens are 40 times more likely to be diagnosed with bipolar disorder than they were 10 years ago. The reason isn't entirely clear. The higher rate could be the result of more awareness on the part of health professionals. There are those, though, who say it could be a result of a lack of parenting that leads to behaviors that are tagged as mental illness or other conditions misdiagnosed as bipolar disorder.
Some studies have shown that children and teens diagnosed with bipolar disorder are more likely than adults to also be diagnosed with ADHD.
Childhood Bipolar Disorder
Bipolar disorder is a persistent and difficult mental illness. When it happens in childhood or adolescence, it can completely disrupt a family's life. Bipolar disorder that's undiagnosed, misdiagnosed, or poorly treated is linked with:
- Higher rates of suicide attempts and completions
- Poorer academic performance
- Difficult relationships
- Higher rates of substance abuse
- Multiple hospitalizations
In adults, bipolar disorder is marked by mood changes that go from depression to mania. Adult mania is characterized by less need for sleep, rapid speech, euphoria, grandiosity, irritability, racing thoughts, and frenetic activity.
The definition of mania is not so clear for bipolar disorder in childhood. Some experts say that being irritable, cranky, and negative may be the only signs of mania in children with bipolar disorder. And other experts argue that childhood bipolar disorder may not even be the same disease as adult bipolar disorder.
What is clear, though, is that bipolar disorder is an increasingly common diagnosis in children -- including children of preschool age.
Warning Signs in Children and Teens
With bipolar disorder, there are both manic symptoms and depressive symptoms. If your child or teenager has five or more symptoms that last for at least a week, call your doctor to get help. With medications and/or psychotherapy, mental health professionals can help stabilize your child's moods. Treatment can also lessen or get rid of the depressed or manic thoughts and behaviors.
Manic symptoms include:
- Severe changes in mood, either extremely irritable or overly silly and elated
- Overly-inflated self-esteem, grandiosity
- More energy
- Can go with very little or no sleep for days without tiring
- Talks too much and too fast, changes topics too quickly, or can't be interrupted
- Distracted, attention moves constantly from one thing to the next
- Hypersexuality, with more sexual thoughts, feelings, or behaviors; uses explicit sexual language
- More goal-directed activity or physical agitation
- Doesn't care about risk, takes on risky behaviors or activities
Depressive symptoms include:
- Sad or irritable mood that doesn't go away
- Loss of interest in activities they once enjoyed
- Big change in appetite or body weight
- Difficulty sleeping or oversleeping
- Physical agitation or slowing
- Loss of energy
- Feelings of worthlessness or inappropriate guilt
- Difficulty concentrating
- Recurrent thoughts of death or suicide
How Is ADHD Different?
Bipolar disorder is primarily a mood disorder. ADHD affects attention and behavior; it causes symptoms of inattention, hyperactivity, and impulsivity.
While ADHD is chronic or ongoing, bipolar disorder is usually episodic, with periods of normal mood interspersed with depression, mania, or hypomania.
Bipolar Disorder Treatment
Doctors usually treat bipolar disorder in young people the same way they treat it in adults. They use medications called mood stabilizers, which include anticonvulsants such as:
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
- Lithium (Eskalith, Lithobod)
- Oxcarbazepine (Trileptal)
- Valproate (Depakote)
Atypical antipsychotic medications can also stabilize mood. They include:
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Lurasidone (Latuda)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
Sometimes, doctors prescribe a combination of drugs, such as a mood stabilizer and an antidepressant.
- Amphetamine and dextroamphetamine (Adderall, Adderall XR)
- Atomoxetine (Strattera)
- Bupropion (Wellbutrin)
- Dexmethylphenidate (Focalin, Focalin XR)
- Guanfacine (Intuniv)
- Lisdexamfetamine dimesylate (Vyvanse)
- Methylphenidate (Concerta, Ritalin)
- Mixed salts of a single-entity amphetamine product (Mydayis)
Get the Right Diagnosis and Treatment
If your doctor suspects your child has bipolar disorder or ADHD, ask how the diagnosis was made and review all of the information that went into it.
Have the doctor evaluate your child over a period of time, not during just one visit. Make sure they talk with teachers or got written reports from them.
Before you decide on treatment, get a second opinion from an expert in child and adolescent psychiatry.
See your doctor often to check how the medication is working and for side effects.