Bipolar Disorder Symptoms in Children: Signs and Behaviors

Bipolar is a brain disorder that causes unusual, extreme shifts in mood, energy, and day-to-day functioning. Until a few decades ago, it was widely believed that only adults could have bipolar disorder. Studies conducted since then indicate that many adults with the disorder did exhibit symptoms in childhood. In fact, about 30 percent of adults with bipolar disorder report experiencing symptom onset before the age of 13.¹ One study estimates an overall prevalence of 1.8% of bipolar disorder in children and adolescents.²

Core bipolar symptoms include manic episodes, where the individual is abnormally and persistently elated and energetic for weeks on end, and the opposite: depressive episodes. The clinical presentation of bipolar disorder in children, while controversial, is significantly different than it is in adults. A lack of child-specific criteria in the DSM-5 is one reason for the diagnostic challenges in identifying pediatric bipolar disorder.

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Bipolar Symptoms in Children: Presentation

Every child’s symptoms differ, but during a manic phase, you may see signs like:

• Acting hyper, exuberantly happy, or incredibly silly behavior — seemingly at random and in a way that is unusual to the child’s personality
• Talking quickly or switching topics mid-sentence (seemingly without noticing)
• Hyperfocusing on a single subject or project that seems to come out of nowhere
• Erupting in extreme upset when obstacles arise or they are told “no”
• Highly imaginative; coming up with complex storylines
• Angering quickly and becoming violent over small slights
• Not feeling tired or requiring much sleep, and showing little interest in napping, resting, or going to bed at night; getting up frequently during the night
• Becoming preoccupied with sex or sexual thoughts; talking about sex at inappropriate times
• Acting on sexual desires in public, dangerous, or age-inappropriate ways; masturbating excessively or engaging in risky sex at a young age
• Seeing or hearing things that aren’t there

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During a depressive phase, you might see symptoms like:

• Acting unusually weepy and sad
• Complaining of frequent stomachaches and headaches
• Sleeping longer than usual
• Eating too little or too much; might gain or lose weight very rapidly
• Showing little interest in regular activities
• Talking about being a “bad” child, or wondering aloud if everyone hates them
• Becoming preoccupied with death; talking about suicide or, for very young children, how it would be better for everyone if they “went away forever” or “were never born”

Symptoms of Pediatric Bipolar at School

Bipolar disorder will sometimes look a little different at school, where your child is around peers and adults to whom they are not related. During a manic phase, symptoms at school might include:

• Appearing at times to be a “social butterfly;” making new friends easily and charming adults with a “precocious” personality
• Acting overly bossy with friends; getting irrationally upset over slight disagreements or friends not taking orders
• Disobeying teachers and other authority figures; acting “out of control;” exhibiting excessive hyperactivity
• Behaving inappropriately — removing clothing in the classroom or singing loudly during class
• Being unable to sleep during naptime or settle down to quietly read
• Being unable to make transitions; becoming upset or violent when unwelcome change occurs
• Difficulty focusing on schoolwork; often seeming unable to sit still
• Jumping between acting “goofy” — even when other students aren’t playing along — to being angry and aggressive, often with seemingly no provocation
• Acting in ways that are dangerously impulsive; throwing themselves off the jungle gym, climbing the highest tree, or trying to “escape” from school, for instance

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During a depressive phase, you might see signs at school like:

• Becoming uninterested in friends or regular playtime activities; sitting alone during recess instead of joining in the fun
• Demonstrating antisocial behavior or developing a fear of classmates; suddenly clinging to parent’s leg when being dropped off, for instance
• Believing that nobody likes him
• Complaining about aches and pains to the teacher frequently; often asking to be excused to the nurse’s office or picked up by a parent
• Becoming fixated on death, often bringing it up to other students or to the teacher
• Being unable to focus on schoolwork; seeming “zoned out”

For most children with bipolar disorder, the cycling between mania and depression occurs at a much more rapid pace than it would for adults. While it’s common for cycles to happen over the course of weeks, months, or years for adults, in extreme cases, your child may cycle between these different symptoms several times in one day.

Pediatric Bipolar Disorder vs. ADHD

ADHD and bipolar disorder share similar symptoms including impulsivity, irritability, and hyperactivity, among others. ADHD and bipolar disorder commonly co-occur, but rates of comorbidity vary considerably across studies. This dynamic explains why a careful differential diagnosis (where a doctor differentiates between conditions that could explain a child’s symptoms) is crucial:

• ADHD symptoms tend to appear in early childhood, whereas bipolar disorder typically develops later in childhood.
• As the child progresses through school, increased academic demands can exacerbate ADHD symptoms, which should not be confused for the start of the mood disorder.³
• A child with ADHD may exhibit disinhibited behavior – not to be confused with the elated mood bipolar disorder can bring ³
• Children with ADHD may resist bedtime, whereas children with bipolar disorder (especially during manic episodes) may have a reduced need for sleep.⁴
• Family history of mood disorders is important, as bipolar disorder has a clear genetic component.³ When one parent has bipolar disorder, the risk to each child is 15 to 30 percent.¹

 

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