Although bipolar disorder more commonly develops in older teenagers and young adults, it can appear in children as young as 6. In recent years, it's become a controversial diagnosis. Some experts believe it is rare and being overdiagnosed; others think the opposite. At this point, it's hard to be sure just how common it is.
Another diagnosis, called Disruptive Mood Dysregulation Disorder (DMDD) also has been established to describe children ages 6-18 who have severe and persistent irritability and temper outbursts that don't meet conventional definitions of bipolar disorder.
So it's important not to jump to conclusions. If your child is diagnosed with bipolar disorder, you might want to get a second opinion before embarking on a treatment plan. Make sure you're comfortable with your child's health care provider.
Bipolar Disorder in Young Children
Diagnosing bipolar disorder in young children is difficult, because many of the symptoms are similar to those of attention deficit hyperactivity disorder (ADHD) or conduct disorders -- or even just normal, childhood behavior. One problem is that medications used for ADHD are often stimulants, which can potentially trigger mania in children with bipolar disorder.
Young children in a manic phase might be more irritable than adults; they may be more likely to have psychotic symptoms, hearing and seeing things that aren't real. During a depressive episode, they might be more likely to complain of physical symptoms, like aches and pains.
One of the most notable differences is that bipolar disorder in children cycles much more quickly. While manic and depressive periods may be separated by weeks, months, or years in adults, they can happen within a single day in children.
How Can I Help my Bipolar Child?
As the parent of a child with bipolar disorder, there's a lot you can do to keep your child well. Here are some suggestions.
- Follow the medication schedule. You absolutely must make sure that your child gets the medication they need for bipolar disorder. Use timers, pillboxes, notes, or whatever it takes for you to remember. If your child needs medication at school, talk to their teacher or school nurse -- schools may not allow students to take medication on their own.
- Monitor side effects. Most drugs used for bipolar disorder (including mood-stabilizers, antipsychotic medications, and even antidepressants) were originally tested in adults, and only a few have been well-studied in children and adolescents. Some children are more prone to side effects from some of these drugs, such as weight gain and changes in blood sugar and cholesterol caused by some atypical antipsychotics. Ask your child's health care provider what symptoms to watch for and you may need to routinely monitor bloodwork. The FDA has issued a warning that using some types of antidepressants or other medicines used to treat depression may increase the risk of suicide in children, adolescents and young adults up to 24 years old.
- Talk to your child's teachers. In some cases, a child with bipolar disorder may need special allowances at school. They may need extra breaks or less homework during difficult times. So work out an agreement with your child's teachers or the school principal. In some cases, you may need to take your child out of school for a while, at least until their bipolar symptoms stabilize.
- Keep a routine. Children with bipolar disorder can really benefit from a daily schedule. Help them get up, eat meals, exercise, and go to bed at roughly the same times each day. Do what you can to reduce stress in the household.
- Consider family therapy. Having a child with bipolar disorder can be disruptive to the whole family. It can put extra stress on your marriage. Your other children may not understand what's wrong with their sibling, or they may be resentful of all the attention they are getting. Going to family therapy can help you all recognize and deal with these issues.
- Take suicidal threats seriously. No parent wants to think about their children hurting themselves. But unfortunately, it can happen, even with young children. So if your child begins to express a desire to die, or engages in life-threatening behavior, don't ignore it. Remove any weapons or dangerous drugs from the house. And get help right away.
Teenagers With Bipolar Disorder
In older teenagers, the symptoms and treatment of bipolar disorder are much more similar to those seen in adults. But having a teenager with this condition presents a lot of distinct problems.
As they get older, teenagers might be resentful if they feel that you're imposing treatment on them. So let them into the conversation. Talk frankly -- along with your child's doctor or therapist -- about treatment options. Try not to develop an adversarial relationship with your child over their treatment or medication.
As with adults, it's key that teenagers with bipolar disorder avoid alcohol and drugs, which can interact with medications or bring on or worsen mood episodes. The risks of developing a substance abuse problem are much higher in teens with bipolar disorder than in their peers. It's also important to maintain regular routines around sleep and wake times, and to develop effective coping strategies for managing stress and distress.