Bipolar Disorder is a mood disorder that includes both depressive symptoms and manic or hypomanic symptoms. Often, these symptoms are not so clearly differentiated in children, meaning you do not see week(s) of depression and then week(s) of manic symptoms. The symptoms are often mixed, or the children’s moods cycle rapidly. Emotions can be extreme, and these changes can feel like a roller coaster. The diagnosis in children is often an “Other Specified Bipolar and Related Disorder.” Children with bipolar disorders are at a high risk for suicide and self-harm. They need support at home and school, and psychotherapy in both settings is important.
What are Bipolar Disorder?
Children who have significant problems in this area may have any of the following potential disability. *Note, this does not serve as a diagnosis in any way. See Where to Go for Help With Bipolar Disorder for professionals who can diagnose or provide a referral.
A depressive episode is defined by sad or irritable mood or loss of pleasure in things one used to find interesting, accompanied by a number of the following: inability to focus, thoughts of worthlessness, withdrawal, thoughts of death, poor sleep (too little or too much) and poor diet (over or under eating). These symptoms must be observable and cause clinically significant distress that impacts functioning.
In children, depression may often be marked by irritability. Children may be less able to define their own symptoms. They may have trouble talking about their feelings or may deny them entirely. In children, depression can be defined by irritable mood, loss of interest in activities and by considering parent and teacher reports of these and other depressive symptoms. Glaring symptoms include frequent thoughts of death and suicidal ideation. Large meltdowns that seem way more intense than you would expect may be related to depression.
A manic episode is a period in which elevated mood is remarkable and includes grandiosity, pressured speech, and engagement in dangerous activities. A hypomanic episode includes the same symptoms but fewer and to a lesser degree. Symptoms of mania and hypomania often seen in children include pressured speech and flight of ideas, which is talking rapidly and excitedly and changing topics quickly. Often, children use superlatives like best and greatest to describe everything. They may engage in risky behaviors, such as jumping from high places or participating in risky sports, such as ski jumping. They may stay up all night writing a play or plan to develop a robot to save the world. These children may move a lot in an assessment and may have poor attention and executive functioning. Hypomania includes at least three symptoms, and mania requires a greater number. Having one or two of these symptoms does not meet the criteria for significant mania.
What are the signs and symptoms of Bipolar Disorder?
Depression. Feelings of sadness. OR
Irritable Mood. May seem angry, frustrated, have a short temper, cry easily.
Loss of Pleasure. Less interest or participation in activities the child used to enjoy.
Inability to focus. Seeming unable to focus on anything. May seem lethargic or spacey.
Thoughts of worthlessness. Your child may make a lot of negative self-statements. “I’m not good enough.” “Everyone else can do that but I can’t.” “I never do anything right.”
Withdrawal. Your child may stop spending time with friends or family and may spend all his or her time quietly in a bedroom. Playdates and interest in others may decrease.
Thoughts of death/ suicidal. May report wishing he or she had not been born, may discuss life without him or her, and may try to give away treasured possessions. May express a desire to hurt him or herself and may share a plan. Be open to listening to your child, and hear his or her feelings instead of saying not to feel that way. Seek support immediately, and make sure not weapons or other dangerous opportunities are available. Keep close supervision of your child.
Poor eating. May not be interested in eating or may eat excessively with a focus on carbohydrates.
Poor sleep. May not be able to sleep or may sleep all the time, generally a disruption in typical sleep patterns.
Increased goal-directed activity. A child may spend 12 hours doing math homework packets, plan to write a play or swim in the Olympics. This activity could be very out of the blue and seem poorly planned.
Flight of Ideas. Talk may include a lot of superlatives and be hard to follow, tangential, and fast.
Rapid/Pressured Speech. Speech that is very fast could be a symptom of mania.
Little need for sleep. A child may stay up late into the night and/or wake very early, acting as if driven and energetic despite lack of sleep.
Inflated self-esteem or grandiosity. Statements of greatness, seeing self as more important, e.g., “I’m the next Albert Einstein.”
Poor attention. Distractible, in motion, inability to focus on any one thing.
Involvement in activities with potential for consequences. Risky sports, climbing dangerously, sneaking out at night, trying drugs and alcohol (adolescents).
Many of these mania symptoms could be confused with other psychological conditions, making it so important to have a comprehensive evaluation conducted by someone with expertise in assessment. This expertise can impact treatment significantly.
How is Bipolar Disorder treated?
Cognitive Behavioral Therapy (CBT). Cognitive Behavioral Therapy is a modality with considerable research to support its effectiveness. This therapy is often individual but may also be delivered in a group setting. Some goals of CBT include the following:
Increase Emotional Awareness. Activities to help your child recognize emotions may include drawing emotion faces, role playing and acting out different emotions, and recognizing them in the therapist. If CBT is offered in a group setting, emotions are recognized through engagement with group members. Practice recognizing emotions at home, starting with positive ones and moving to sadness, worry, and other negative emotions. Journaling and completing homework assignments related to the emotional awareness goals can help some children remember and practice their skills at home.
Improve Coping Skills. CBT often teaches and helps kids identify and practice coping skills, such as deep breathing, relaxation, reading, listening to music, taking a walk, jumping on the trampoline, or talking to a friend. Children learn to stop and identify their feelings and take a break instead of yelling or hitting. They work with a therapist to recognize the antecedents, behaviors and consequences associated with their thoughts and feelings.
Work to improve self-confidence. CBT focuses on identifying thoughts that lead to certain behaviors and determining whether those thoughts are valid or whether they are cognitive distortions. Children learn to combat negative thoughts and to see actions and experiences not as global and uncontrollable but as singular instances and under a child’s control.
Mindfulness. Mindfulness involves recognizing and accepting feelings and allowing them to just be. This practice involves scanning the body to notice any tension and working to let that tension go. Awareness of the present time and accepting thoughts and feelings are important in Mindfulness.
Relaxation and Meditation. Breathing and relaxation are encouraged in mindfulness and can make a big difference in reducing anxiety and the presence of negative, distorted thoughts.
Accepting Thoughts. Mindfulness focuses on acceptance and not the immediate push to change and criticize ourselves.
Play Therapy. For young children, play therapy utilizes toys and art to allow a child a safe setting to act out their feelings and experiences. Guided play therapy can introduce coping skills and emotional awareness into the play themes.
Bipolar is challenging, and symptoms can be lifelong. But, it can be treated. Taken together, it is valuable to obtain a diagnosis and to engage in the appropriate therapies as early as is feasible. With these supports in place, it is possible to see improvement in depressive and manic symptoms, better coping skills and emotional awareness, and the potential to live a happy life.
How can Clear Child Psychology help with Bipolar Disorder?
If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, it’s time to seek professional help.
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Helpful resources for Bipolar Disorder
 Papolos, Demitri & Papolos, Janice (2007). The Bipolar Child: The definitive and reassuring guide to childhood’s most understood disorder, 3rd Edition.
 Beck, Judith S. & Beck, Aaron T. (1995). Cognitive behavior therapy, 2nd edition: Basics and beyond.