Bipolar in children

Spotting bipolar early matters, but so does avoiding a label that doesn’t fit. Experts say both under- and over-diagnosis are real concerns.

Diagnosis needs a careful, thorough evaluation by a trained, experienced mental health professional.

Rates are much higher in teens than in younger children. If your child is 13 or older, the teens guide will fit better.

Children with bipolar sometimes feel very happy or “up” and are much more energetic and active than usual. They may have trouble sleeping but not feel tired.

It can also look like a very short temper, racing thoughts or risky behaviour.

Children may feel very sad or “down” and be much less active than usual. Some complain a lot about stomachaches or headaches.

Some children have thoughts of death. This always needs prompt help.

With bipolar, mood comes in episodes that are a clear change from the child’s usual self. That is different from a child who is irritable or angry most of the time.

NIMH lists ADHD as one of the conditions that can overlap with bipolar in children. In one U.S. study, about a third of youth visits with a bipolar diagnosis also listed ADHD.

ADHD signs are usually steady over time, while bipolar comes in episodes. Some children have both.

Disruptive mood dysregulation disorder (DMDD) is a childhood mood condition with ongoing irritability, anger and frequent, intense temper outbursts. It was added to diagnostic manuals in 2013.

Children with DMDD are diagnosed between ages 6 and 10, after symptoms have lasted 12 months or more.

It can be hard to tell bipolar apart from depression without highs. Anxiety and other mood difficulties are also common in children.

Big changes, frightening experiences or ongoing poor sleep can all affect a child’s mood and behaviour. A good assessment asks about what’s been happening in the child’s life.

In a U.S. study, about 1 in 10 school-aged children who had a parent with bipolar had a bipolar-type condition, compared with fewer than 1 in 100 other children.

In that study, most children who did develop it had their first mood episode before age 12, which is why family history is worth sharing with your child’s doctor.

Professionals look at symptoms over time and at family history when assessing bipolar. Let your child’s doctor know about relatives with bipolar or other mood conditions.

Programs supporting families where a parent has a mental illness lowered children’s risk of developing a mental health condition by about 40%.

Family-focused therapy has also been studied with young people at high risk of bipolar.

Because assessment looks at patterns over time, your notes about sleep, energy and mood can help a lot.

Because signs overlap with other conditions, a professional may want to see how things change before giving a diagnosis. That can feel slow, but it helps get it right.

NIMH says treatment is more effective when health care providers, caregivers and young people work together. Support often includes family education and therapy, such as family-focused therapy.

For anything medical, talk with your child’s clinical provider.

In U.S. public schools, a 504 plan provides accommodations for students with a condition that substantially limits a major life activity, like concentrating or sleeping. An IEP provides special education services.

Examples of support

• A calm place to take a break
• Extra time on tests
• Shorter assignments during hard patches

You decide how much to share. Many families find it helps to tell one key person, like the teacher, counselor or nurse, what early signs look like and who to call.

DBSA has resources for parents on working with educators.

Hard patches can strain friendships. Small, low-pressure play dates and activities your child enjoys can help keep friendships going.

Regular bedtimes, wake times and meals give children a sense of safety. Trouble sleeping without feeling tired can be an early sign worth noting.

Family-focused therapy teaches calmer communication and problem-solving, which can help the whole household.

Try “You seem really wound up tonight. Let’s slow down together,” rather than “What’s wrong with you?”

Siblings may feel worried, confused or left out. A simple, honest explanation and some one-to-one time help them feel included.

DBSA runs free weekly, 90-minute online support groups for parents and caregivers, including a group for parents of children 17 and under.

NAMI Family-to-Family is a free, 8-session class for families of people with mental health conditions, taught by family members.

Many genes are involved in bipolar, and life stress plays a part. Nothing you did caused it.