What is it?
A person with bipolar disorder has extreme changes or swings in moods, from mania to depression. Because of the two “poles” of mood, this illness is called "bipolar" disorder.
Bipolar disorder is sometimes called manic-depression because people experience both mania and depression. The word "manic" means a person feels overly excited and confident. The person may then quickly change to feeling confused, irritable, angry, and even full of rage.
A person with depression feels very sad or may lose interest in things they used to enjoy. Sometimes people with bipolar disorder are diagnosed as having major depression by mistake.
The symptoms of mania and depression can also happen at the same time. These periods are called mixed episodes. In between episodes of mood swings, they may experience normal moods.
We do not know the exact cause of bipolar disorder. It seems to involve several factors that are both genetic and environmental. Children and youth with this disorder tend to get worse over time if they do not get the proper treatment. They may have difficulties with substance use, not do well in school, or get into accidents. They are also at risk for coming in contact with the justice system or committing suicide.
There is no cure for bipolar disorder. However, the symptoms can be managed with proper treatment, understanding, and life changes.
When does it start?
People often develop bipolar disorder during puberty. In a survey of adults with bipolar disorder:
- 59% said they had symptoms during or before adolescence
- 50% reported having it before the age of 17
- 20% reported it happening between the ages of 10 and 14
- 10% had it for the first time between ages 5 and 9*
It is becoming more common for children and youth to be diagnosed with bipolar disorder. Between 1-2% of all people are affected by bipolar disorder. A trained professional (such as a psychiatrist, psychologist, or pediatric neurologist) can use information from the child or youth’s home, school, and clinical visit to make a diagnosis of bipolar disorder.
*James Chandler, MD, FRCPC Bipolar Affective Disorder (Manic Depressive disorder) in Children and Adolescents
How do I know?
When children and youth first get a bipolar disorder, they may have depression or mania or a combination of both. They do not have to have depression to be diagnosed with a bipolar disorder. It may be hard to identify their first episode. Children and youth who have symptoms of depression first may actually turn out to have a bipolar disorder. They should be carefully monitored to see if mania symptoms develop.
When children and youth are depressed they may:
- look sad or tearful
- be constantly irritable
- be tired or listless
- not be interested in their favourite activities
Children and youth with mania experience a change in their mood and energy. The following changes are visible:
- being very irritable or aggressive
- difficult to comfort or console
- being very happy, silly or giddy
- sleeping less, being restless and/or very active
- talking more than normal
- being easily distracted
- risky behaviours or sexual behaviours beyond what is normal for their age
- strange thoughts; for example they may believe they are more powerful than other people or they may think they have superpowers
- may hear voices
- explosive outbursts that may involve physical aggression or long, raging tantrums
Children and youth with a bipolar disorder have mood swings that often seem to happen without warning. They often do not respond to normal parenting efforts. Parents can become discouraged and exhausted. They may try almost anything to avoid or stop a child or youth’s severe tantrums and feel helpless and guilty when nothing seems to work. Children and youth may be frightened and confused by moods they can’t control. They often feel bad for the hurt they cause others.
Children and youth have most bipolar symptoms at home. Their moods are harder to control when they feel tired or they are stressed by family relationships. They may feel pressured by the things they have to do like homework and getting ready for school on time. Children and youth are also more likely to show troubling emotions such as anger, anxiety, and frustration in the safety and privacy of their own home and family.
At home, children and youth may show some of these symptoms:
- moods that swing rapidly
- depressed or sad moods
- loss of interest in things they used to enjoy
- talk of suicide, self-harm behaviours, or hurting themselves or others
- overexcited or giddy mood
- feelings of being the best, think they can succeed in superhuman efforts or risky behaviours
- extra sensitive to what they think is criticism; easily frustrated
- less able to plan, organize, concentrate, and use abstract reasoning
- extremely irritable
- rages, tantrums, crying spells, or explosive outbursts that can last for hours, many times each day or week for little reason (such as being told "no"). These can last longer, be stronger, be triggered more easily and take more time to get over than other children
- unusually aggressive to the closest person; parents and siblings are often the main targets
- restless or fidgety, often with no order or plan
- changes in sleep patterns, too much or too little sleep or difficulty falling asleep
- unusual sexualized behaviours or comments
- beliefs that are not real ("People are talking in my closet") or fears ("Everyone at school hates me, so I'm not going")
At school, children and youth may show some of these symptoms:
- changes in alertness and in their ability to think and concentrate
- difficulty with planning, organizing, concentrating, and reasoning
- extra sensitive to what they think is criticism
- hostile or defiant and easily provoked
- crying for no real reason, being upset out of proportion to actual events, can’t be reasoned with or consoled when upset
- extremely high levels of anxiety that interferes with their ability to make sense of a situation
- easily frustrated or discouraged, tasks seem much more difficult than for a typical child
The differences in behaviour at home and at school can be dramatic. It is hard to predict how a child will react to the stresses of schoolwork, classroom noise, and travelling between classes and activities. Over time, symptoms may get worse if the child is not treated or new problems develop.
Children and youth with bipolar disorder may have other conditions that make learning more challenging such as:
If a child or youth still has trouble learning after their bipolar disorder is treated, they may need to be tested for a learning disability. A child that doesn't want to go to school may also have a learning disability.
What can be done?
If you are concerned about a child or youth’s behaviour, it’s important to have a trained person (such as a psychiatrist, psychologist, or pediatric neurologist) evaluate the child. This needs to happen immediately if the child seems to be thinking about suicide. The best person to see is a professional that knows the symptoms and treatment of early-onset bipolar disorder. Right now, there is no blood test or brain scan to diagnose bipolar disorder.
Before the evaluation, it will help to take daily notes of the child or youth’s:
- sleep patterns
- unusual events
- things the child says that are of concern
Share these notes with the doctor or professional making the evaluation and with the professional who eventually treats the child. Children and youth with bipolar disorder can be charming and may seem to be functioning well during the first appointment. A good evaluation should take at least two appointments and include a detailed family history.
There are medications for bipolar disorder. Children and youth taking these medications sometimes have side effects. They may:
- feel really tired
- feel very thirsty
- have an upset stomach
- have trouble thinking and performing at school
It is important for the school to have information about the child or youth's medications. Learn more about medications used to treat bipolar disorder.
Can Bipolar Disorder be prevented?
Right now we don't know what causes bipolar disorder and there is no way to prevent it. But we do know that 85% of people with a mental illness that are treated can expect to have a normal life. It is important to know the symptoms of bipolar disorder so there is a better chance of finding early, effective treatment and ways to deal with the disorder. This may prevent long periods of illness and hospital stays, and even suicide.
Where to from here?
- Talk to your doctor, and ask if they can provide a referral to a specialist (like a psychiatrist) that can evaluate your child
- Get a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community).
- Contacting a private psychologist who is able to evaluate your child:
For additional information about options for support and treatment in BC, visit the Find Help section of our site.