Bipolar Disorder in Children

Most children have moods that come and go. Feelings of elation or sadness are typically normal reactions to daily events, stress, or hormones. The moods of children and adolescents with bipolar disorder, however, can strongly interfere with interactions and normal functioning. I've been working for a behavioral specialist for the past year, offering therapeutic support for children with bipolar disorder. It is important that this disorder is recognized and understood in children.

Bipolar disorder is characterized as a mood disorder. Individuals with mood disorders have mood problems that tend to last for extended periods of time. Bipolar disorder has been detected in children as young as age 6, though symptoms of bipolar disorder can emerge as early as infancy.

Symptoms of bipolar disorder involve changes in mood and energy, and a shifting between extreme moods. Individuals with this disorder experience both the lows of depression and the highs of mania.

Depression can be marked as a state of irritability or intense sadness accompanied by low energy. Symptoms of depression in adolescents can include persistent crying spells, extreme sadness, sleeping too much, agitation, withdrawal from favored activities, inability to concentrate, low energy, change in appetite or thoughts of death and suicide.

Mania is placed on the opposite end of the mood spectrum. It is characterized by persistent states of extreme elation or agitation accompanied by high energy. In adolescents symptoms of mania include, elevated mood, decreased need for sleep, racing speech, grandiose delusions, excessive involvement in risky activities, increased physical and mental activities, poor judgment, and hallucinations.

The symptoms of bipolar disorder in adolescents look much like the classical adult symptoms. In younger children, however, the illness may look different. Children usually have a continuous mood disturbance that is a mixture of mania and depression. For this reason, it is difficult to apply standard diagnostic criteria to very young children. Parents with children diagnosed with bipolar disorder report that symptoms may include, lack of interest in play, explosive and destructive rages, defiance of authority, hyperactivity, bed wetting, extreme dare-devil behaviors, frequent cravings for sweets, impaired judgment and delusions.

There is no cure for bipolar disorder, but with proper treatment it is possible to stabilize mood and allow for management of symptoms. There are several treatments shown to be effective for children and adolescents with bipolar disorder. A good treatment plan includes medication, monitoring of symptoms, education regarding the illness, counseling or psychotherapy, stress reduction, proper nutrition, and regular sleep.

The same medications used to treat adults with bipolar disorder are often effective in stabilizing mood in children and adolescents. Mood stabilizers include Lithium, Depakote, Tegretol, Neurontin, Lamictal, Topamax, and Gabitril. No one medication works in all children. Additionally two or more mood stabilizers plus other medications for symptoms that remain may be necessary to maintain stability. Psychotherapy- cognitive behavior therapy, interpersonal therapy, and multi-family support groups are essential in the treatment for children and adolescents with bipolar disorder. This therapy can work in conjunction with medication to stabilize the child's behavior.

Therapeutic parenting also plays a beneficial and often essential role in the treatment of bipolar disorder in children and adolescents. Various techniques are used to help calm children when they are symptomatic and, in addition, these techniques can help prevent relapses. Such techniques include, teaching children relaxation techniques, using firm restraints on children, prioritizing or "choosing" battles, reducing stress in the home, helping the child anticipate, avoid and prepare for stressful situations, engaging the child's creativity, providing routine structure, and developing a safe home environment by removing harmful objects.

This disease unfortunately appears more severe and with a much longer road to recovery than is seen with adults. Although bipolar disorder is a lifelong condition, it can be managed through medication, psychotherapy, and lifestyle change.