Is My Child Bipolar or Just Being a Kid?

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Boy (4-5) sitting on window sill, side viewAre there times when your adolescent’s behavior or mood is excitable and silly, then plummets into sadness and isolation? Do you worry that his or her mood swings from overly excited to very depressed? Is your child or adolescent having social or academic problems because of these mood swings?

Changes in mood are a normal part of adolescent development. The body is going through biological changes due to hormones, and moods can vacillate from irritability to sadness to excitability, even in the same day. But when radical mood fluctuations cause social or academic issues, there may be something else going on.

Definition

Bipolar is a brain issue that causes extreme changes in a person’s mood and behavior. Moods can swing from “mania,” or extreme highs, to very low lows; these are called “manic episodes” and “depressive episodes,” respectively. There are also “mixed episodes,” a combination of manic and depressive symptoms. Many adolescents experience mixed episodes, more so than adults.

People are typically diagnosed as bipolar in their late teens or early twenties. However, children and adolescents experiencing these symptoms are diagnosed with “early-onset bipolar” and can be diagnosed as young as 6 years old. Symptoms can look different in children and adolescents than they do in adults.

Symptoms

Adolescents experiencing a manic episode may:

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  • Act silly or hyper
  • Feel irritable or aggressive
  • Experience inflated self-esteem or grandiosity
  • Have increased energy
  • Need less sleep
  • Talk fast or change topics quickly
  • Take more risks (drive recklessly, disobey rules at home or school, use drugs or alcohol, etc.)
  • Have trouble concentrating
  • Think or talk more about sex

Adolescents experiencing a depressive episode may:

  • Cry more and have persistent sadness
  • Sleep significantly more or less
  • Have less energy or slowed movements
  • Eat significantly more or less (as noted by changes in weight)
  • Feel worthless or hopeless
  • Have difficulty concentrating
  • Isolate themselves from friends and family
  • Have somatic complaints (stomachache, headache, etc.)
  • Think or talk more about death or suicide

Diagnosis

It can be very difficult for mental health professionals to distinguish between bipolar and other adolescent issues, such as attention-deficit hyperactivity (ADHD), depression, anxiety, or drug use. It is important to observe the adolescent’s behavior over a period of time before making this diagnosis in order to rule out other possible issues.

There are no blood tests or brain scans that can help diagnose bipolar. A psychiatrist, mental health counselor, or psychologist will ask questions about the child or adolescent’s sleep, behavior, and mood. Because mental health conditions can run in families, professionals might also ask parents abouta family history of bipolar, drug use, or depression.

Treatment

Getting treatment for your child or adolescent is of the utmost importance, especially when suicidal thoughts are present. Medication can help stabilize moods, and several medications have been approved for adolescents. A psychiatrist can help determine which medication would be most effective. Therapy can help your adolescent understand bipolar and learn how to manage its ups and downs. Therapy can also help parents and other family members learn about the issue and how to better help the adolescent.

If you notice several of the above symptoms in your child or adolescent, seek professional help. Being diagnosed with bipolar doesn’t mean the end of the world for the adolescent or for the parents. Many people diagnosed with bipolar live successful, stable lives. Working with knowledgeable professionals can lead to a proper diagnosis and effective treatments.

References:

  1. “Bipolar disorder in children and teens. (2014). Retrieved from http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-easy-to-read/index.shtml
  2. Bipolar disorder in children and teens. (2008). Retrieved from http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Bipolar_Disorder_In_Children_And_Teens_38.aspx
  3. Bipolar disorder or ADHD? (2013). Retrieved from http://www.webmd.com/bipolar-disorder/guide/bipolar_disorder_or_adhd

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrea M. Risi, LPC, Family Problems Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 16 comments
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  • robbin

    August 19th, 2014 at 12:13 PM

    I know that it is important to receive an early diagnosis but how soon is too soon to slap this kind of label on a child?

    Reply

  • Ashlyn

    August 20th, 2014 at 3:42 AM

    If I felt like my child was on this wild roller coaster ride of emotions then I would definitely want the help and advice of someone who is trained to deal with issues like this and who could get us the best help possible.

    The thought of having my child on medication at an early age for anything is quite scary, but so is the thouight of him being undiagnosed with mental illness that could potenially be stabilized via the help of that medication. It would be a tough decision for any parent but not one that should ever be ignored.

    Reply

  • Andrea Risi

    August 20th, 2014 at 8:29 AM

    Good question, Robbin! Diagnosing children with any mental health diagnosis can be a difficult task. Early onset bipolar disorder is rare, however over the past 20 years, there has been a 40% increase in childhood bipolar disorder diagnoses, which most clinicians find troubling.

    The latest version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduces the diagnosis of “disruptive mood dysregulation disorder” which tries to differentiate childhood illnesses like bipolar disorder, ADHD and depression. We hope this helps clinicians make a more appropriate diagnosis.

    You can read more about the DSM-5 criteria for disruptive dysregulation disorder article here: healthline.com/health-blogs/bipolar-bites/does-new-dsm-5-diagnosis-decrease-childhood-bipolar-diagnosis#1

    Ultimately, clinicians diagnosis in order to identify the best treatments, whether that be therapy or medication, or a combination of both.

    Reply

  • Andrea Risi

    August 20th, 2014 at 9:16 AM

    Ashlyn – I think most parents share your concerns about using medication at an early age. That’s why the diagnosis is so important…to be sure we’re treating the problem in the most effective way. Finding a knowledgeable team is an important part of the process.

    Reply

  • Sloane

    August 20th, 2014 at 2:22 PM

    Before jumping to any sort of conclusion I would definitely seek out a lot of different opinions. Talk to those who can see this from a different perspective than what you can and maybe their objective point of view will help you reach some conclusions that you haven’t been able to make alone. We all want to have that picture perfect child but you know that things don’t always work out that way. Maybe your child is just very emotional or maybe he or she just has a hard time handling the emotions that they feel, and that’s okay. It’s great to try to get a grip on some of this early and possibly working with others can help to change some of that behavior and if not then at leats point you toward what an appropriate diagnosis actually is for your child.

    Reply

  • Andrea Risi

    August 21st, 2014 at 7:41 AM

    Good points Sloane! When working with children, we don’t want to jump to any conclusions quickly. Including different kinds of professionals can help make the proper diagnosis.

    Reply

  • daphne

    August 23rd, 2014 at 11:24 AM

    It seems that there are too many who wish to attach a label to everything. What happened to a kid being a kid? I know that when they get into the classroom setting that things can be a little more difficult and the things that are easily managed or even ignored at home can no longer be ignored. But I do think that there are times when we very quickly affix this label or this diagnosis to someone and instead of looking at alternative treatments and techniques we very quickly just look for the quick fix that is not always going to be the best fit for the individual.

    Reply

  • Andrea Risi

    August 24th, 2014 at 9:35 AM

    Daphne – I appreciate your thoughts. The nature of this article was to examine your sentiments…how to determine if a child is “just being a kid” or if there is something more significant going on. Parents and professionals alike need to approach diagnosing children with caution and take the necessary time to make a proper diagnosis.

    Reply

  • Laura

    March 30th, 2015 at 11:01 PM

    More public awareness is needed. People need not fear medications, that’s like being afraid if using insulin when you’re diabetic… The insulin is not fun, but isn’t it better than not having your health.
    Caution and due care to get proper diagnosis is so important. But so is not being afraid of getting the diagnosis.

    Reply

  • Andrea M. Risi, LPC

    March 31st, 2015 at 9:56 AM

    Thank you for that analogy, Laura…that is one I use with my clients too! Bipolar Disorder is a chemical imbalance, and the right meds can help balance moods. No one wants to be dependent on medication, but in some situations, meds can help people live a more healthy and happy life.

    Reply

  • John

    May 19th, 2015 at 6:09 PM

    I’m not sure the article answered its own question. Even professionals have a hard time distinguishing childhood bipolar disorder from other issues that might account for a normal response to abnormal situations like child abuse. Many get it wrong. Does it really matter? If you diagnose a child with ADHD because of these kinds of behavior problems and it turns out it’s a mood disorder, like a problem with mood regulation, then the meds are going to be very different and probably not effective. I see too many kids diagnosed with ADHD who simply need to manage moods and emotions more effectively.

    Reply

  • Susannah

    May 19th, 2015 at 7:42 PM

    Do children have more difficulty regulating their emotions these days? Definitely. Is this because they have a mood disorder? Waaaaaaay less likely than the APA and the DSM V dudes would have us believe. My professional experience would indicate that labile family situations, parents with low EI, trauma, attachment issues, and things like screen time, sensory overload, and a world that no longer permits time for developmental free play or reflective, quiet time, all contribute significantly to a child’s mood dysregulation.
    It is very disturbing to me as a clinician of 25+ years that instead of looking at the way that life & developmental experiences have changed negatively impacting childhood, the APA defaults to a disorder for which (…wait for it) the answer is likely medication. A basic comparison between the way this issue is handled in North America and Europe makes it clear that the APA’s choice to start down the slippery slope of labeling children with mental health disorders is by no means universally accepted as clinically defensible.
    Having said that, if you have a child who is struggling with mood dysregulation, don’t wait. Find a reputable child therapist, preferably one with some form of play therapy or expressive therapy certification, and plan to do some family therapy at the same time.

    Reply

  • Andrea M. Risi, LPC

    May 20th, 2015 at 4:23 PM

    Thank you for your feedback, John and Susannah! I agree that making a diagnosis in childhood is extremely challenging and not always spot-on. There can be many factors at play including developmental changes, medical issues, or other underlying factors like parenting problems, sensory issues, trauma, etc. as Susannah stated, that can make it difficult to determine a diagnosis.

    So is it necessary to make a diagnosis in childhood? Sometimes it can be very useful and reassuring to parents who need answers…it can help give direction for treatment options. Think of this: if your child had signs of diabetes, would you want to know that diabetes was indeed the diagnosis? Would knowing that diagnosis help you find the right kinds of therapies to treat it? I bet we agree that it would! Likewise, bipolar disorder is a chemical imbalance that can be managed very well with the right medications and therapy.

    Please understand that I am not advocating for diagnosing or medicating children unnecessarily. However, there are times when a clinical diagnosis can help parents choose the right kinds of treatments for their child. Ultimately supporting a struggling child with therapy seems like the best place to start.

    Reply

  • Laura

    May 20th, 2015 at 7:25 PM

    I am very happy to see such a great rresponse! Thanks!

    Reply

  • Lesliepooh

    August 1st, 2015 at 8:37 PM

    Clinicians diagnose because they need a diagnosis to get paid by insurance. Cut and dry. I am a clinician and a parent of a child diagnosed with ADHD and Mood Disorder NOS. Before I knew better, my child was on Risperdal. After working in the field for five years and educating myself on psych medications, I have chosen to keep him med-free due to the long-term side effects. I advocate for the use of meds only in severe cases. The side effects can be severe. The mood swings and hyperactivity have gradually gotten better as he has gotten older. Behavioral interventions have worked fairly well, but there are days he gets pretty out of control. Distress tolerance techniques and removal from environmental stimulation help. Kids are kids, and I ask how many adults would be able to sit quietly in their seat about 7 hours a day with minimal breaks? That’s what our kids are being asked to do. I know this because of the amount of worksheets they bring home every day. Kids need more time to explore and expend energy instead of being medicated so they can sit still all day.

    Reply

  • Kevin

    June 8th, 2018 at 12:26 AM

    Thanks for sharing a valuable information with us, i want share some information, Children and teens may have a different set of symptoms than adults. They may have higher rates of what used to be called a “mixed-mood presentation,” with symptoms of both depression or sadness as well as mania, which includes grandiosity, pressured speech, and a decreased need for sleep.

    Reply

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