Bipolar Disorder in Children
Bipolar disorder is a brain disorder characterized by extreme changes in mood, irritability, and energy. Researchers estimate that about 1 percent of children meet the criteria for the disorder and that it usually begins in late adolescence and early adulthood, says Ron Steingard, M.D., associate medical director of the Child Mind Institute in New York City, and a prominent expert on bipolar disorder in children.
SIGNS & SYMPTOMS
There are two types of bipolar disorder:
- Bipolar 1 disorder. Children with this type experience mania -- a persistent high-energy state. "They feel giddy and happy, and they may be irritable and explosive. They talk a lot, don't sleep, and don't miss the sleep they're not getting. They may have grandiose thoughts, feeling they can do things kids their age can't do," says Dr. Steingard. "This lasts for at least a week without relief and may require hospitalization." All that's needed for a diagnosis of Bipolar 1 disorder is a single manic episode.
- Bipolar 2 disorder. A child with this type experiences hypomania, which is a less severe form of mania that causes an elevation in mood, energy, and/or irritability that lasts at least four days. In addition, the child has had at least one major depressive state, accompanied by other symptoms such as decreased sleep and energy, diminished interest in activities, and feelings of worthlessness and hopelessness.
Dr. Steingard emphasizes that all children experience mood swings, sleeplessness, and irritability from time to time. In order to be diagnosed as bipolar disorder, however, the symptoms must be persistent, they must be very different from a child's typical behavior, and they must appear in multiple settings. "They don't come and go," he says. "And if you're seeing them in school, you're also seeing them at home."
Researchers are unsure of the exact causes of bipolar disorder. But they do know there's a strong familial component. "Family history is the greatest predictor for the onset of this disorder in children and adolescents," says Dr. Steingard.
But that's not the only cause -- nor does every child with a bipolar parent or sibling develop the disorder. Abnormalities in brain function and structure may also be a factor. Some experts also believe that major life stress can trigger bipolar disorder in those who are genetically predisposed.
"Early recognition and careful management and treatment are very important for children with bipolar disorder," says Dr. Steingard. If you're concerned about your child, he recommends an evaluation by a mental-health provider with experience in diagnosing and treating bipolar disorder.
The disorder is typically treated with medication. "With other mental health conditions, I'm often advocating for behavioral intervention or behavioral intervention with medication," says Dr. Steingard, "but this is one condition where I support early treatment with medication." Often a mood stabilizer such as lithium is prescribed, sometimes in combination with other drugs. Cognitive behavioral therapy and family therapy may also be used to help the child, parents, and siblings understand and cope with the disorder.
The goal of treatment, he says, is to first reduce symptoms and then to move on to maintenance and prevention of future symptoms. Some children who are treated go into full remission, and others see a decrease in the frequency and severity of symptoms.
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