Mood changes, insomnia, lack of energy and more

Laughing one minute and crying the next isn’t that unusual for children. But you might not be too quick to dismiss dramatic changes in feelings.  

Wide or frequent swings in emotion can sometimes be a sign of the mental health condition called bipolar disorder. World Bipolar Day on March 31 represents the more than 40 million people around the world who have it, including 5.7 million American adults and about 4% of kids (or one student in a classroom of 25).  

History of bipolar

The name “bipolar” comes from two root words. Bi means two. Polar means opposite. Symptoms of the condition are cycles of extreme highs (mania) and lows (depression).  If you're older (Gen X or Boomer) you might have heard the condition called manic depression, even though the name officially changed in the early 1980s.  

This mental condition has been seen in various cultures for centuries — even noted by ancient writers thousands of years ago. In the past 50 years, medical professionals have learned more about bipolar and how it shows up in intensity and frequency.

Despite its long history and decades of research, the causes are still unclear, and there are no proven ways to prevent it. But there are a number of ways to help people of all ages who experience it.

“You might wonder how to tell if your child is experiencing signs of this disorder or if they’re just having a few bad days,” says Lindsay Olson, Psyd, a clinical psychologist at PeaceHealth in Bellingham, Washington. “Knowing what to look for is the first step to helping your child.”

Possible signs and symptoms of bipolar in children

Whether your child is in their teens or younger, there are symptoms typical of bipolar disorder, but some could be due to other possible causes — especially if the symptom occurs by itself. For bipolar disorder, multiple symptoms of mania usually happen at the same time in discreet periods of time.

Manic symptoms -- Hypomania and mania both show up as periods of high energy and extremely happy, irritable or motivated moods.  Hypomania is milder than mania and lasts at least four days. Mania is more intense and lasts at least a week. Your child or teen may:

• Have little need for sleep. This is more than just the universal sleep shift that most teens go through. This might look like staying up late and getting up early while not feeling tired after only three hours of sleep. Little need for sleep is usually accompanied by other unusual symptoms, like staying up all night to bake five cakes, for example. Sleep disruptions are least common in young children and occur in only about 40% of teens with bipolar.
• Show significant increase in activities and interests (e.g. wanting to start 10 new hobbies at once)
• Have high energy.
• Have extreme self-confidence.
• Talk very fast.
• Have many thoughts at once.
• Seem very distracted and unable to focus.
• Touch their privates and talk or act in sexual ways.
• Disrupt or act aggressive with friends or in groups.
• Act wild or seek thrills.

Depressive symptoms -- A depressive episode is a period of a sad, low or cranky mood. Your child or teen may:

• Not find pleasure in things that they normally enjoy.
• Have low energy or feel "slowed down."
• Experience sleep and appetite changes.
• Have low self-esteem.
• Feel guilty or worthless.
• Withdraw from friends or family.
• Have trouble focusing.
• Have thoughts about death or suicide.

If you’re seeing several of these behaviors or attitudes in your child at once and on a cyclic timeline, talk to your pediatrician or primary care provider about an evaluation.

Diagnosing bipolar

Doctors may use the following to help make a diagnosis:

• Your child’s current and past health conditions.
• Incidence of mood or substance use disorders in the family (especially close relatives).
• A physical examination, including possible blood tests or imaging studies.
• Tests or assessments in writing or by talking with your child to identify the type and intensity of their current feelings.
• Referrals to a psychologist or psychiatrist who specializes in pediatric evaluation and diagnosis.

It can be tricky to diagnose bipolar — especially in young people. Sometimes symptoms are caused by other physical or mental conditions. Your child’s provider will look to rule out those other causes.

And they might refer you to a pediatric specialist for diagnosis and treatment.  

Treating bipolar symptoms in children

After diagnosis, the health professional will go over your family’s options for managing the condition. Treatment often includes a combination of the following:

Self-care. Everyone benefits from sticking to the basics that boost physical and mental health. Work with your child on strategies to help them:

• Get daily exercise. Studies show that moderate exercise can lower the risk for depression and other conditions related to brain function.
• Eat nutritious food. Learn how diet can contribute to better mental health.  
• Follow a restful sleep routine. See the connection between sleep and bipolar.
• Avoid caffeine, energy drinks, alcohol or other substances that can trigger an episode.
• Keep a consistent daily schedule of social interaction and activities. Everyone has social rhythms that help to regulate mood, and this is even more important for people diagnosed with bipolar disorder.

Medicines. If your child is on medication, make sure they keep taking it, even if they feel better. Without medicine, symptoms often come back. Here are a few types that may help:

• Antidepressants
• Antipsychotic medicines
• Mood-stabilizing medicines

Counseling. This kind of treatment works best along with medication to manage other symptoms. Types of therapy to consider include:

• Cognitive behavioral therapy to encourage healthy behavior and thinking.
• Family therapy to educate and support the entire household.
• Dialectical-behavioral therapy to build skills that manage mood swings.
• Interpersonal and social rhythm therapy to help family and friends learn to recognize signs of a relapse.  

Hospital treatment. If your child acts aggressive or reckless, talks about or tries harming themselves, or if they hallucinate (see things that aren’t real), a hospital stay might be the best way to help them.

• Call your child’s healthcare provider right away if your child:
• Hears voices.
• Is thinking about suicide.
• Is worried that feelings of suicide or depression won’t go away.

If your child talks about suicide or self-harm, or they’re having a crisis or emotional distress, get help right away. You can save these numbers in your phone so you're prepared for urgent mental health needs:

• Suicide and Crisis Lifeline at 988
• 1-800-273-TALK (1-800-273-8255)
• Text HOME to 741741 to access the Crisis Text Line
• Go to 988lifeline.org for more information or to chat online

Managing bipolar for life

There is no cure for bipolar disorder. As with many other conditions, once someone has the diagnosis, their best approach is to find ways to manage it.

As a parent, grandparent or guardian, you can help a child with bipolar by learning as much as you can about the condition.  

• Did you know there are many celebrities who either have or had bipolar disorder?  While this condition can be challenging, you and your child may take comfort in knowing that others have found ways to live well and manage this condition.
• As you get to know your child’s patterns, watch for changes in their mood. You might be able to help them feel stable faster. Or you can work with them to reduce situations that tend to trigger a bipolar episode.
• Supporting a child with bipolar can be exhausting. Consider seeing a counselor or therapist to help you maintain your own well-being. You may also want to explore other self-care strategies.  
• Finally, you might appreciate the resources available through support organizations such as National Alliance on Mental Illness (NAMI) and the Child Mind Institute. Dr. Olson also recommends two books:  “The Bipolar Disorder Survival Guide” by David J. Miklowitz and “The Bipolar Teen” by Miklowitz & George. 

“Bipolar disorder is nobody’s fault,” says Dr. Olson. “Try to remember that you and your child are doing the best you can given the biological circumstances that contribute to bipolar disorder. Manage what you can in your own behavior and your immediate environment.”