Bipolar Disorder in ChildrenSydney E Clooney
Arizona State University
Bipolar Disorder in ChildrenChildren with a Bipolar Disorder experience a variety of symptoms that can negatively affect various aspects of their lives. It can be challenging to diagnose a child with a Bipolar Disorder for several reasons. There are two well-known treatments for prepubertal children. Symptoms of Bipolar Disorders manifest in numerous ways. Children and adults can manifest symptoms in a very different manner. However, depression is a common symptom of a Bipolar Disorder in all ages.
There are four different types of Bipolar Disorders, Bipolar I, Bipolar II, Cyclothymia, and Unspecified Bipolar Disorder (Dunleavy, 2018). Bipolar I Disorder requires that the individual experiences episodes of mania. The diagnosis of Bipolar II Disorder requires “at least one major depressive episode and at least one episode of hypomania” (Dunleavy, 2018). In cyclothymia, an individual does not experience full episodes of hypomania or depression, but the individual will experience periods of each of these (Dunleavy, 2018). The last form of Bipolar Disorder is Unspecified Bipolar Disorder, which is diagnosed “when a person doesn’t meet the criteria for any of the other types of Bipolar Disorders but still experiences periods of a significant, abnormal elevation in mood” (Dunleavy, 2018). This diagnosis validates the symptoms that the individual is experiencing, but it does not recognize the disorder as being as serious as the other three types of Bipolar Disorders.
Although people do not typically associate a Bipolar Disorder with children, people of any age can be diagnosed with the disorder. Bipolar Disorders are extremely underrecognized in children. The biggest reason for this is the lack of awareness people have about Bipolar Disorders. This disorder is also comorbid with a great deal of disorders, which makes it more difficult to diagnose. Some of the disorders that Bipolar Disorders can be comorbid with are anxiety disorders, attention-deficit/hyperactivity disorder, and conduct disorder (Sala et al., 2010). Anxiety disorder symptoms actually manifest before the symptoms of a Bipolar Disorder (Sala et al., 2010). There are also several disorders, such as oppositional defiant disorder and major depression, that cause Bipolar-like symptoms, which can make this disorder even more difficult to diagnose (Mohr, 2001). Doctors see symptoms from a range of disorders, and sometimes it can be challenging to pinpoint these symptoms as a Bipolar Disorder specifically. Children diagnosed with a Bipolar Disorder can show a very different “clinical picture” than adults diagnosed with the disorder, which is another reason that it is so tough to diagnose (Hall-Flavin, 2017). All people can exemplify symptoms of the disorder in diverse ways, but the way that it manifests symptoms in children is vastly different than the manifestation in adults. The sooner the disorder can be diagnosed, the quicker it can be managed to prevent more serious consequences as time goes on (Hall-Flavin).
Causes and Treatments
No one knows exactly what causes Bipolar Disorders yet. However, there have been studies that show genes, brain structure, and brain function can invoke the onset of this disorder (Olson). The relationship between the brain and the behavior of the person can also be affected by “genetics, developmental failure, or environmental influences,” and this can enforce the onset of symptoms of a Bipolar Disorder (Olson). There is also a gender difference found in Bipolar Disorders. “Early-onset cases are more frequently male,” meaning that males under the age of thirteen are more often diagnosed with a Bipolar Disorder than females (Dusetzina, 2010). This field requires more research to determine the exact cause, how to better treat the disorder, or even how to prevent the disorder. “Negative family verbal interactions predict poor symptomatic and social functioning” as well (Thomas, 2009). The family environment is a significant factor in the functioning of the child.
The most well-known treatments for Bipolar Disorders are psychotherapy and medications. Psychotherapy, also known as “talk therapy,” is a psychological approach to treat a disorder. Psychotherapy involves a trusting relationship and communication to talk and work through issues. The medications involved in treating people with a Bipolar Disorder are mood stabilizers, antidepressants, and antipsychotics. If the person also has an anxiety disorder, anti-anxiety medication may be prescribed as well. Although psychotherapy and medications can help a person with a Bipolar Disorder a great deal, having a supporting family can make an even bigger difference to help them feel “normal” and comfortable in themselves.
Symptoms and Manifestation
Bipolar Disorders have a variety of symptoms that can manifest in a person. To be diagnosed with Bipolar I Disorder, it is not necessary to experience depression. However, children with Bipolar II Disorder go through both manic and depressive episodes, and these manifest in numerous ways. One study found that almost one third “of children with major depression develop manic symptoms later in life,” so a diagnosis of which type of a Bipolar Disorder someone has can change throughout his or her life. (Mondimore, 2006). When a child experiences mania, some of the symptoms can include distractibility, grandiosity, and hyperactivity. An example of this is talking rapidly about several different topics. This is significantly varied from the symptoms a child can experience during a depressive episode, such as feelings of hopelessness and a persistent sadness. For example, a person in a depressive episode may experience anhedonia, which is the loss of pleasure in activities that were once enjoyed. Severe mood swings are one of the most common symptoms, but it must differ from the person’s typical mood swings to be diagnosed with a Bipolar Disorder (Hall-Flavin, 2017). Another symptom is a person exhibiting hyperactive, impulsive, aggressive, risky, reckless or socially inappropriate behavior (Hall-Flavin, 2017). Bipolar Disorders are often referred to as a “mood disorder.” These inappropriate behaviors are a huge part of the disorder, and it is something that can be easily spotted. For example, if a person begins to abuse drugs, this is risky and reckless behavior that can be recognized in order to set up the proper intervention. A person who has a Bipolar Disorder may also show an inflated view of his or her own self and capabilities (Hall-Flavin, 2017). This can manifest as a person believing in the spotlight effect, meaning he or she believes everyone else is watching him or her at all times because he or she is so great. However, this could also appear as personal fable, which is when a person feels that he or she is untouchable and can do anything without consequences. “Insomnia or significantly decreased need for sleep” is another symptom of Bipolar Disorders (Hall-Flavin, 2017). Another symptom is depressed mood (Hall-Flavin, 2017). This mood can take over the person completely if it hits while he or she is in a depressive episode. It is necessary to monitor mood and mood swings in a person who has a Bipolar Disorder to ensure that his or her mood is under control. The depressed mood can trigger suicidal thoughts or behaviors, so it is imperative to keep the mood extremities under control.
Difference in Children and Adults
Typically, Bipolar Disorders will be diagnosed in teenagers (Hall-Flavin). However, the disorder has been diagnosed in children as young as six years old. “Approximately one third of patients with Bipolar Disorder are diagnosed before the age of 15,” meaning that there is a significant amount of people being diagnosed with a Bipolar Disorder at young ages (Thomas, 2009). The differences between how a Bipolar Disorder appears in adults versus children are fairly small distinctions. However, they are key to understanding Bipolar Disorders in children. Teenagers show symptoms more like those of adults with a Bipolar Disorder than children. One thing that distinguishes a Bipolar Disorder in prepubertal children versus adults and teenagers is that it involves rapid cycling (Mohr, 2001). Children can be very high-energy, and this is reflected in the manifestation of this disorder. They go through cycles of mania and depression very quickly. One study comparing amygdala responses of children and adults with a Bipolar Disorder found that children who have been diagnosed with a Bipolar Disorder show “abnormal amygdala activation during face processing” when shown fearful faces (Kim, 2012). This is not a groundbreaking discovery, but it allows and encourages a better understanding of the distinction of this disorder in different age groups.
Bipolar Disorder and Depression
Depression is a significant symptom that can appear in Bipolar Disorders. It is very common. As stated prior, people who are diagnosed with a Bipolar Disorder may experience periods or episodes of depression. Depression is a medical illness that can negatively affect your thoughts and actions. It is both a psychological and physical illness. It is comorbid with a great deal of disorders. It can manifest in people of all ages, including young children. Depression is an important symptom of Bipolar Disorderx that factors into the diagnosis of what type of Bipolar Disorder a person has. A major depressive episode is defined as having a “sad, empty, or irritable mood or a markedly diminished interest or pleasure in all, or almost all, previously enjoyable activities that lasts most of the day, nearly every day, for a 2-week period or longer. The depressed mood is accompanied by three or four additional symptoms including insomnia or hypersomnia, significant weight gain or loss, fatigue, psychomotor agitation or retardation, difficulty concentrating, feelings of worthlessness or excessive guilt, indecisiveness, and recurrent thoughts of death or suicide. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning” (APA, 2000, p. 349-351). Experiencing a major depressive episode not only affects the child, but it affects the child’s family, friends, and the child’s relationship with them. Depressive episodes can damage or even destroy relationships with people who could have otherwise been support systems.
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