Adolescent and Teen Bipolar Disorder: Signs of Bipolar in Children

When diagnosing bipolar disorder in teens, it is important to understand that it is an umbrella term for different conditions. There are three primary categories that clinicians look for:

• Bipolar I Disorder – This is the most serious form of the condition. It includes at least one manic episode, which may contain psychotic symptoms like hallucinations or delusions.
• Bipolar II Disorder – Characteristics of this form include depressive episodes and hypomania, a less severe form of mania.
• Cyclothymic Disorder – This type involves chronic mood episodes that are less severe than those of the other bipolar disorders.
• Rapid cycling – Involves four or more episodes, either depressive or manic, in one year. While bipolar disorder is a mental health condition, there can be triggers such as illness or substance abuse.

According to the National Institute of Mental Health (NIH), people tend to think bipolar disorder only applies to adults, usually in their 20s. Many are diagnosed in adolescence or young adulthood, but the signs can appear earlier.

HealthyChildren.org estimates that between 1% and 2% of the population under the age of 18 suffers from some form of bipolar disorder. It is easy to confuse the symptoms of bipolar disorder with other mental health conditions or developmental disorders, such as:

• Attention deficit hyperactivity disorder (ADHD)
• Disruptive mood dysregulation disorder (DMDD)
• Major depression
• Anxiety disorder
• Substance use disorder

The similarities in symptoms, specifically in mood, can make it hard to get a bipolar disorder diagnosis even by a mental health professional. Without the correct diagnosis, proper treatment may be impossible.

Children and adults will both experience the mood changes that define bipolar disorder. The symptoms can be less noticeable in children than in older teens and adults.

Mood episodes in children with bipolar disorder may also be more like meltdowns and less predictable. There can be rapid shifts between different moods, too. Mania can manifest as a very short temper tantrum, irritable mood, and impulsivity instead of intense happiness. Depressive episodes may be less about sadness and more about anger.

The symptoms of bipolar disorder will depend on the episode: manic or depressive. Manic symptoms include:

• Giddy laughter
• General silliness
• Impatience
• Irritability
• Needs less sleep
• Trouble focusing
• Interest in risky or reckless things
• Poor judgement
• Decisions that are out of character
• Losing things of value
• Frequent conflicts

During bipolar depression, they may experience:

• Unprovoked sadness and hopelessness
• Anger and irritability
• Excessive sleep
• Physical pain, like headaches or stomach aches
• Brain fog
• Low energy
• Pushing away people close to them
• Eating more or less than normal
• Suicidal thoughts and talk about death

They may even attempt suicide during this stage of the disorder.

The differences in the symptoms of bipolar disorder and the chances of other childhood conditions, such as ADHD and anxiety disorders, make it tricky to diagnose bipolar disorder in children. No blood or imaging test exists to confirm the diagnosis.

When diagnosing the condition, a doctor will start by ruling out other conditions that might be responsible for the symptoms. Blood tests and imaging might be helpful in determining that there are no other causes of the child’s moods.

A careful assessment by an experienced mental health professional is critical to ensure the right treatment plan is put in place. During this evaluation process, the therapist will interview the parents to understand the child’s symptoms. It can be helpful to interview other people, too, like siblings and teachers, and get a feel for the child’s state of mind.

The mental health practitioner might rely on tools such as questionnaires and logs to help monitor the child’s mood changes. This can allow them to pinpoint the child’s signs of bipolar disorder if they exist. 3

It is challenging for parents to recognize bipolar disorder in teens because the symptoms can be unique. If you are seeing extreme shifts in mood and behavior, ask yourself a few questions, such as:

• How are these shifts affecting my child’s life? Are they doing well in school and maintaining their grades? Are they managing their personal care like brushing their teeth? Are there changes in sleep patterns?
• How dramatic are the highs and lows? Are there changes in their behavior, decision-making, and thought patterns? Do they cause stressful life events?
• Are other people noticing the mood shifts and commenting on them?

Focusing on your child’s moods and their impact helps parents better understand their mental health.