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Bipolar Disorder in Children and Adolescents

At least half of all adults with Bipolar Disorder recall that their condition started during their childhood or adolescence [ref], and thus a conservative estimate is that about 0.5-1% of all youths under 18 have this condition [ref]. However, there is good evidence that 2.5% of adolescents ages 13-18 have Bipolar Disorder [ref], suggesting that this condition in fact begins in adolescence for most people.

Like adults, children and adolescents with Bipolar Disorder can experience Major Depressive, Manic, Hypomanic or Mixed episodes.  

Bipolar Disorder tends to take on somewhat different forms in children and adolescents compared with adults. Some youths may have very rapid, brief, and recurrent mood episodes lasting only a few hours or a few days [ref]. Others can have episodes that last much longer than in adults, sometimes for over a year, and sometime to the point where Hypomania can be the individual's baseline way of being [ref, ref]. These features can make it difficult to identify youths with Bipolar Disorder, especially since the standard way of defining this disorder is based on how it is seen in adults.

(To help identify children or adolescents who may have Bipolar Disorder, parents can complete the Child Mania Rating Scale; a score above 20 indicates a reasonable chance that the youth may have this condition.)

Major Depressive Disorder versus Bipolar Disorder in Youth

Among children or adolescents who experience Depressive Episodes, in 30% of these cases they will eventually turn out to have Bipolar Disorder [ref], while in the rest of the cases they will have Major Depressive Disorder.  Bipolar Disorder is more likely in these cases when [ref]:

Manic Episodes in Children and Adolescents

Manic Episodes may not be as easily recognizable in children and adolescents as they are in adults [ref].   For example, the elevation in mood, the mental excitement or the agitation may be erratic and not sustained, and the child or adolescent will tend to experience irritability and belligerence more than true euphoria [ref].  Often these Manic Episodes will bring a severe deterioration in behaviour at school and also lead to fighting, dangerous play, recklessness, and inappropriate sexual behaviour [ref].  Psychotic symptoms tend to occur and to be mood-incongruent, paranoid, and include a marked thought disorder (ie. disorganized and incoherent thoughts and speech) [ref]. 

Comorbidity of Bipolar Disorder in Youth

Another major difficulty in diagnosing Bipolar Disorder in children and adolescents is that up to 90% these individuals will often suffer from other psychiatric conditions at the same [ref].   Up to 75% of these children and adolescents will have an Anxiety Disorder, and just as many will be diagnosed with ADHD [ref].

Differentiating Between ADHD and Bipolar Disorder in Youth

It can often be difficult to differentiate between a diagnosis of ADHD and Bipolar Disorder in children and adolescents.  The following points may help in this regard [ref]:

  • True euphoria, decreased need for sleep and hypersexuality are uncommon in ADHD but common in Bipolar Disorder.
  • The onset of symptoms typically begins after age 7 in Bipolar Disorder (including inattention) but before age 7 in ADHD.
  • A family history of Bipolar Disorder is more common in those suffering from Bipolar Disorder whereas Disruptive Behavior Disorders such as Conduct Disorder are more common among family members of those with ADHD.
  • Periods of normal functioning and being symptom-free may be seen in children and adolescents with Bipolar Disorder but are rare in those with untreated ADHD.
  • According to some studies [ref, ref] there are six symptoms that occur in Bipolar Disorder much more commonly than in ADHD, and which can be helpful in making the proper diagnosis.  These include:
    • Irritablity:  The person seems easily angered, testy and moody in a way that is uncharacteristic of them and is not simply a reasonable reaction to a particular event. 
    • Elation:  This refers to an elevated mood state that is sustained and not simply a normal reaction to a positive event.
    • Hypersexuality:  The person becomes highly sexually aroused and may engage in sexual acts that seem excessive and to lack discretion.
    • Grandiosity:  The person's self-confidence and opinion of him or herself becomes grossly exaggerated and inflated.  Sometimes this can reach the point of psychosis. 
    • Flight of ideas/ racing thoughts: The person's thoughts seem to be racing to the point where it is hard to keep track of them, or they occurr at a rate faster than can be spoken. 
    • Decreased need for sleep

 

Associated Conditions (Comorbidity)

Bipolar Disorder in the Elderly