Children go through phases during which their behavior, interactions, mood and personality may change. Sometimes it’s tough to determine if your child is simply going through a normal developmental phase or if something more serious is occurring. In the past several years bipolar disorder in children and adolescents has gained more recognition and while not common, is far from rare.
Bipolar disorder is a condition of the brain that causes unusual extreme shifts in mood, activity level, and energy. These shifts can make it hard for kids to function in school, interact with friends, engage in regular activities or complete day-to-day tasks. However it’s not unusual for children and adolescents to seem up one minute and down the next. The mood swings of bipolar disorder are different from the normal ups and downs experienced by all youngsters. The characteristics of bipolar disorder in children can be severe, impacting relationships with friends, making it impossible to perform well in school, or result in such emotional turmoil that the child thinks about suicide.
Bipolar disorder can be effectively treated in all age groups. While the symptoms may be frightening for both the adolescent and the family, treatment options exist that allow the child to live a happy and productive life. While some programs treat children and adolescents with bipolar disorder the same as adults, at Abilene we recognize the significant differences between how the disorder effects different age groups. Our staff is trained to provide the most appropriate interventions for children and adolescents with bipolar disorder.
Statistics
While it’s unclear how frequently bipolar disorder develops in children and adolescents, rates of bipolar disorder are on the rise. This may be due to increased awareness of the disorder and how it differs in children and adolescents leading to more accurate diagnoses. Additionally, more appropriate diagnostic criteria have been developed that are applicable to the differences found in various developmental periods. Educational efforts have helped parents become aware of what constitutes normal childhood behavior and what problems may require further attention.
The most recent rates suggest that pediatric bipolar disorders have doubled in outpatient settings in the past ten years from 3% to 6%.
While these statistics don’t provide estimates of incidence and prevalence rates, they are considered decent approximations. Given the severe disability bipolar disorder causes, it is believed that parents and caretakers are more likely to seek help for their children when symptoms impair the child’s quality of life.
Co-Occurring Disorders
Other problems that co-exist with bipolar disorder in childhood and adolescence include:
- Alcohol abuse: The rates of co-occurrence of alcohol abuse in pediatric populations is almost the same as seen in adults with bipolar disorder.
- Attention deficit hyperactivity disorder (ADHD): Although the symptoms of mania or hypomania often resemble symptoms of ADHD, mania/hypomania is episodic while ADHD symptoms are continuous.
- Anxiety disorders: Seen in both youth and adults with bipolar disorder, the rates of co-occurrence vary according by specific disorders experienced. In youth, the most frequent anxiety disorders seen to co-occur with bipolar disorder are separation anxiety and generalized anxiety disorder.
- Depression/Dysthymia: similar to ADHD, while depressive periods are part of bipolar disorder they are episodic, while depression is more chronic, aiding in the discernibility when the two disorders co-occur.
Causes
There is little knowledge regarding the causes of bipolar disorder in children and adolescents as it was once assumed that the causes were the same across the lifespan. However, it’s now recognized that the pediatric version of the disorder is quite different from what is seen in adults, research has increased.
Genetic: similar to adults, if a child or adolescent has a first-degree relative with the disorder they are more likely to develop the disorder as well. Some research suggests that the influence of genetics is stronger when the relative also developed bipolar disorder in their youth.
Symptoms
Symptoms in pediatric bipolar disorder differ significantly from those seen in adulthood. In particular, children tend to be “rapid cyclers,” with moods changing quickly from one extreme to another, sometimes with a brief return to normal before transitioning into another mood state. Some children constantly cycle from mania to depression without returning to a normal mood state, often several times per day. Children and adolescents are also more likely than adults to experience symptoms of both depression and mania at the same time. Symptoms of mania and depression may be more difficult to recognize in youth since they don’t always resemble the classic adult presentation.
When children and adolescents experience manic or hypomanic symptoms they may:
- Feel and act irritable
- Anger outbursts or temper tantrums - triggered into uncontrollable rage by almost anything without warning
- Feel and act extremely happy, silly or have higher than normal energy and activity levels
- Act out sexually by touching their genitals, approaching others in a seductive manner or make sexual remarks to or about others
- Have a decreased need for sleep and become agitated at night, seeking out things to keep them busy
- Talk very fast and switch topics frequently
- Have trouble concentrating or paying attention
- Take on numerous activities and projects; jumping from one to the other without finishing any
- Become more impulsive and engage in risky activities
- An increase in pleasure-seeking activities to the exclusion of following through on responsibilities
When children and adolescents experience depression they may:
- Feel and express extreme sadness for a period of time
- Cry frequently
- Act out, become agitated and irritable
- Blame others for imaginary mistakes
- Have physical complaints including headaches, stomachaches, and muscle aches
- Complain they are too tired to do anything
- Lose interest in previously enjoyed activities
- Become overly clingy, seeking attention
- Become fearful of being alone and seek constant reassurance that a parent or caretaker hasn’t abandoned them
- Spend time alone due to imagined rejection or criticism by peers and family members
- Move very slowly, refuse to get dressed or engage in normal hygiene-related activities
- Express feeling or worthlessness or guilt over being a “bad” child despite reassurance
- Increased or decreased appetite along with weight gain or loss
- Sleeping more than usual and napping frequently throughout the day
- Lack energy and become less active
- Express thoughts about death or suicide – young children who don’t have a concrete understanding of death may state they just “don’t want to be around anymore”
Effects
The effects of bipolar disorder on children and adolescents is devastating compared to adults as bipolar disorder is more severe in youth.
- Family problems: family members often experience stress from their child’s mood swings resulting in physical illness, missed days from work, feeling of guilt and blame related to their child’s disorder and anxiety and depression due to their feelings of shame over the inability to help their child.
- Peer problems: children are quicker to judge peers than adults, so peer rejection as a result of the child’s unusual behavior, statements and rapid, unpredictable mood swings occurs more quickly than in adults. Depending on the age of the child, this may also prevent them from learning appropriate social skills due to lack of peer contact.
- Alcohol and substance abuse: children and adolescents frequently use substances in an effort to self-medicate their symptoms. Unlike adults, children do not typically find manic states pleasurable so they often alternate between taking energizing substances such as amphetamines and sedating substances such as alcohol or tranquilizers. While many children use whatever they can find in the house, even young children are able to obtain illegal substances.
- Lack of educational growth: children with untreated bipolar disorder often lack the ability to complete school work. Since childhood and adolescent education is built upon a series of skills, children with this disorder often lack the early building blocks to enable them to catch up to their peers once treated.
- Suicide: rapid cycling, especially when there are no periods of normal mood states between the extremes, can result in extreme distress, confusion and despair due to feeling out of control all the time and hopeless about this improving. This can result in both impulsive and non-impulsive suicide even in young children.
Even though bipolar disorder is more severe and debilitating in youth, it often takes longer to treat. However, the recognition of the differences in age groups has led to more effective treatments.
At Abilene our staff is trained to help individuals of all ages suffering from bipolar disorder. We understand the stress experienced by family members and provide support for everyone affected by the child’s difficulties.