Bipolar disorder can be hard to manage at any age. But when a sufferer is young, it can be even more so in a variety of different areas - harder to identify, harder to treat, harder to cope with.
Bipolar disorder in children is sometimes called early onset bipolar disorder or juvenile bipolar disorder and there is some disagreement on how the illness manifests itself in young patients.
Despite debate, with proper awareness, attention and treatment, both children with this disorder and their families can adjust and succeed.
How Bipolar Disorder is Displayed in Children
Bipolar disorder is marked by periods of extreme behavior on both ends of the spectrum. These mood episodes are marked by “up” periods of mania or “down” depressive times.
According to the National Institute of Mental Health (NIMH), when experiencing a manic episode, children may find it difficult to stay focused. They might talk a mile a minute and act very happy or silly in a way that is unusual to their normal behavior.
Some can become very quick to anger and find it difficult to sleep, yet not feel tired. Often risky behavior is displayed and the patient may seem to dwell on or talk about sex more often.
During a depressive episode on the other hand, the child may experience feelings of sadness, guilt and a low sense of self-worth.
They often have very little energy and do not display interest in activities they would normally find fun. Sleeping too little or too much is common.
Furthermore, the child may frequently complain about pain or discomfort (like headaches, stomach aches, etc.) during a depressive episode and they might think about death or suicide.
"Mixed episodes" during which aspects of both mania and depression are present are also possible, and might be more common in children with the disorder than in bipolar adults.
These intense mood episodes can last a week or longer, and symptoms linger for most of the day, every day during these periods. During mood episodes the changes in behavior are marked and extreme.
However, these symptoms are not always crystal clear when it comes down to real life child patients.
According to the Juvenile Bipolar Research Foundation (JBRF), sometimes the symptoms of bipolar children differ than those of adults and those described in the Diagnostic and Statistical Manual (DSM), leading to some debate on the topic.
JBRF reports that the episodes of mania in children are often less defined and “lack the grandiose behavior typical of adults” in favor of perhaps lighter symptoms like mood changes and irritability. This has led some to argue whether such displays in children are, in fact, signs of bipolar disorder, or are signs of a totally separate condition.
According to JBRF, the subcategory of the disorder known as Bipolar Disorder-Not Otherwise Specified (BP-NOS) was created in part to help classify this type of disorder in children.
“Under this subcategory, while research continued, children who were severely impaired by mood disorder but did not meet adult criteria could still qualify for insurance and accommodation. At this point, most children receive the NOS diagnosis,” reports JBRF.
Bipolar disorder in children can be difficult to diagnose for a number of other reasons, the first of which being that mania in children has not been recognized in the mental health community for long.
It is also often very challenging to distinguish between behavior in children that signals bipolar disorder and behavior that is difficult to manage, but still normal and healthy developmentally.
JBRF also reports that “a clinician may be reluctant to diagnose bipolar diagnosis as it confers a severe, life-long impairment for which strong medications are often in order.”
Often, before bipolar disorder is diagnosed, it can be unclear what is causing the difficulties seen in the child patient.
According to the JBRF, “research studies have found that from the time of initial manifestation of symptoms, it takes an average of ten years before a diagnosis is made.”
In this time between initial symptoms and diagnosis, another disorder is usually thought to be the cause. These misdiagnoses may be treated with antidepressants or stimulants, prescriptions which can sometimes intensify bipolar disorder.
According to NIMH, bipolar disorder can also often appear in conjunction with other issues in child and teenage patients. For one, problems with substance abuse can often occur, as a likelihood to drink or use drugs increases with bipolar disorder.
Bipolar children may have attention deficit/hyperactivity disorder (ADHD) and be additionally challenged with staying focused.
Anxiety disorders may also occur. These can include issues like separation anxiety and can result in more visits to the hospital for anxious patients.
Depression and other mental illnesses can often accompany bipolar disorder. The JBRF reports that most bipolar children receive additional mental disorder diagnoses.
Once a bipolar diagnosis is decided upon by professionals, how does the family move forward to get their child help?
Doctors typically focus on treating symptoms of the disorder and recommend continuous treatment for these young patients.
One option is psychotherapy, in which the child (and sometimes entire family) talks to a therapist. NIMH reports that this treatment aims to help patients manage symptoms, change behaviors and improve relationships.
Medication is another common treatment option, though the type and amount that will be effective varies from child to child. NIMH recommends “starting low and going slow” when it comes to managing prescriptions for early onset bipolar disorder.
With patience and dedication, as well as an understanding of the debate and complex nature of bipolar disorder in children, a path for each individual can be found.
Though not a simple diagnosis, research and understanding of early onset bipolar disorder is expanding and will surely continue to do so.