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Bipolar Disorder

As they grow, all children go through a variety of changes. Sometimes it can be difficult for parents to determine the difference between normal developmental changes and signs of something more serious that needs to be addressed. Until recently, Bipolar Disorder (also known as manic-depression) was almost never diagnosed until middle to late adolescence. In recent years, doctors have begun to recognize that this illness can sometimes be identified much earlier. The difficulty has been in differentiating symptoms of Bipolar Disorder from symptoms of other psychological conditions present during childhood and also from normal fluctuations in mood that would be expected from children.

Bipolar Disorder is a mood disorder that, to the lay person, is most often associated with “big mood swings.” This is consistent with the name and somewhat accurate; people with Bipolar Disorder typically do go through periods of feeling highly elated and periods of depression. While extreme changes in mood are certainly a part of Bipolar Disorder, the defining characteristic of the condition is the presence of one or more of what we call “manic episodes” or “mania.” Mania is an extreme state of mood that often presents as extreme elation, a significant increase in energy, racing thoughts, extremely fast speech that is often “all over the place” with ideas that are difficult for others to follow, getting significantly less sleep yet not feeling tired, feelings of invincibility, and extreme behavioral changes (often involving risk-taking).
A typical manic episode lasts around a week. These symptoms are more consistent with the adult presentation of Bipolar Disorder, and a skilled clinician can spot them relatively easily. With children and adolescents, the presentation of mania is slightly different and harder to identify. For parents, it’s a good idea to look for changes in the child’s behavior that represent a significant difference from how they normally act. Periods of extreme irritability or extreme silliness, being more on the go and jumping from thing to thing in an unusual way, talking a lot more than usual, sleeping less, and an increase in risky behaviors are things to look out for.

The other “pole” of Bipolar Disorder is depression. In kids, depression can also look different than it does with adults. Sadness may be present, but with kids it is often not the most observable symptom. Irritability, loss of interest in activities they like, lethargy, changes in appetite and/or concentration, and thoughts of suicide are indications that your child may be depressed.

Diagnosing Bipolar Disorder in children and adolescents requires ruling out other disorders that can mimic these symptoms. Some of those conditions include Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorders (Autistic Disorder, Asperger’s Disorder, Pervasive Developmental Disorder NOS), Anxiety Disorders, and Learning Disorders can all present with symptoms similar to mania or depression. If your child is presenting with these difficulties, it is important to get a careful evaluation from a psychologist that is skilled in assessment of these conditions.

Treatment options are available. A psychologist can help with teaching strategies and coping skills to help improve or stabilize mood. With Bipolar Disorder, this is frequently done in conjunction with a psychiatrist who can prescribe medication to help with the process. The psychologist will also frequently work with the family to help educate about the illness and provide suggestions on what the caretakers and/or siblings can do to help.