How is bipolar disorder different in children than in adults?

Children with bipolar disease may experience different symptoms than adults. Many children swing more frequently between moods. Others have more mixed moods. Often they experience mania as irritability or anger. For this reason, doctors sometimes misdiagnose their disorder as attention deficit hyperactivity disorder (ADHD).
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This is a highly controversial area. Some authorities suggest that bipolar disorder in childhood may differ in its pattern from adult disorders, being less episodic and more persistent. Other authorities have concerns that this pattern may not represent true bipolar disorder but may overlap with other childhood disorders. At this point in time, the nature and patterns of childhood bipolar disorder remain uncertain and much work needs to be done in the area.
Research has shown that Childhood-Onset Bipolar Spectrum Disorder is different, and more severe, than that diagnosed in older adolescents and adults.
When the illness begins before, or soon after puberty, children and adolescents with the disorder often experience very fast mood swings between depression and mania, sometimes many times within a day, or over a period of several days. This is known as a mixed state.
They can feel agitated, restless, and have high energy, but also may feel worthless and self-destructive. While mixed states are not as common in adults (unless induced by antidepressant treatment), they are a true hallmark of Childhood-Onset Bipolar Spectrum Disorder.
Given this constant mixed state of emotions, the moods of children with the disorder are often irritable, and prone to destructive outbursts. At times they almost cannot stand to be in their own bodies. They are often inflexible and oppositional, and may have periods of explosive rage, with long-lasting tantrums.
Many parents and families may struggle for years before getting a proper diagnosis for their child or adolescent. For many parents and families, how do they know if their child or adolescent is simply moody, or whether it is something more?
Children and adolescents diagnosed with the disorder often exhibit frequent daily mood swings (for months or even years), mixed moods (short periods of intense mood changes and irritability), and chronic mood states (without periods of remission).
There is an alarming and growing trend in psychiatry to diagnose bipolar disorder in children. While the usual time of onset for a bipolar disorder is sometime in adolescence (see table under Bipolar Disorder), researchers are coming to the conclusion that the disorder can be present in children and cause disruption in the child’s life and the lives of those around them. They claim that rather than presenting with classic manic and depressive episodes, children are more likely to have rapidly cycling moods (with in the day) and mixed states, in which they are irritable and aggressive. They feel there is a strong overlap, if not diagnostic confusion, with attention deficit hyperactivity disorder (ADD/ADHD). They further support their position, by reasoning that since 50-60% of the risk of bipolar disorder comes from genetics (40—50% from environmental factors), it is likely that some manifestation of the disorder is present from childhood. Of course, the next step in the logical progression is that medication is the appropriate course of action.

However, before embarking on a course of medication, whose long term effects on the developing brain and body are completely unknown, we very thoroughly assess the various factors that can very easily impact and improve a child’s behavior and experience of him or herself. These factors include a thorough evaluation of eating habits and nutrition, nutritional deficiencies, unusual nutritional requirements (for example some children have a 5 fold increased need for zinc and other associate nutrients, as they have a condition called kryptopyrolluria), food sensitivities, inflammatory or infectious issues (e.g., asthma, eczema), digestive problems, toxic exposures (e.g., mercury) and even hormonal problems. In addition, a thorough evaluation for learning disabilities, or conversely unusually gifted abilities which are unused, and an assessment of the family dynamics and parental relationship are all in order. In the large majority of cases, this evaluation eliminates the need for medication.
Dr. Michael Roizen, MD
Internal Medicine
Children and teens with early-onset bipolar disorder tend to have more severe symptoms than adults who suffer from bipolar disorder. They have more mood swings, more severe highs and lows, and feel sick more often than adults with bipolar disorder. They also can experience more suicidal thoughts and attempt suicide more often.

As a parent, it’s important to remember that immediate action is very important. If you are concerned that your child is experiencing symptoms of bipolar disorder, talk to your child’s doctor as soon as possible.

When children develop the illness, it is called early-onset bipolar disorder. This type can be more severe than bipolar disorder in older teens and adults. Also, young people with bipolar disorder may have symptoms more often and switch moods more frequently than adults with the illness.

This answer is based on source information from National Institute of Mental Health.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.