Bipolar disorder typically begins during adolescence or young adulthood. But younger children can also develop bipolar disorder, including pre-school children under the age of seven.
At this age, some of the core symptoms of bipolar disorder are usually different from those that adults experience. There is also a lack of research and understanding about bipolar disorder in young children and a lack of awareness about the condition, even among clinicians. This means that bipolar disorder is often misdiagnosed with other disorders like ADHD.
However, receiving an accurate diagnosis is essential for young children. Accurate diagnoses pave the way for effective treatment that supports children in living full and active lives.
What Is Bipolar Disorder?
People with bipolar disorder experience extreme changes in mood. Mood episodes can last from a few days to several months. They may experience mania, hypomania, depression, or mixed episodes involving symptoms of both mania and depression.
Mood swings with bipolar disorder are much greater than people usually experience. Depressive episodes may include symptoms like suicidal thoughts and self-harm. Mania and hypomania involve intense excitement and happiness and elevated self-confidence.
Mood changes often accompany changes in sleep, energy levels, and cognitive function.
Some people experience more high episodes than low episodes, and others more lows than highs. There may be some times when their mood is stable. Among adolescents and adults, a small number of people experience ‘rapid cycling’ when they quickly switch between high and low moods.
How Is Bipolar Disorder Among Young Children Different?
Like adolescents and adults with the disorder, young children also experience extreme mood swings with high and low episodes. However, these episodes can manifest in slightly different ways.
One of the biggest differences is the way that young children experience high episodes, or ‘mania’. Adult bipolar disorder usually involves manic or hypomanic episodes that last at least four to seven days. These episodes are characterized by symptoms such as euphoria, increased self-confidence, creativity, and productivity. They may also involve irritability and impulsive decision-making.
Among young children, high episodes tend to be much shorter. Rather than experiencing a longer period of elevated mood, they may experience daily mood swings, sometimes described as ‘ultra-rapid cycling’.
High episodes are also less likely to involve feelings of elation or euphoria. Instead, young children might become very irritable or hostile, or aggressive. This irritability can be severe, sometimes involving violent behaviour.
What Misdiagnoses Are Common with Early-Onset Bipolar Disorder?
Sometimes, the symptoms of high bipolar episodes among young children can look very similar to attention-deficit hyperactivity disorder (ADHD) symptoms. ADHD is a neurodevelopmental disorder usually diagnosed around the age of seven. Its core symptoms include high energy levels, impulsiveness, and restlessness, all of which can be features of high episodes.
Because mood changes in young children with bipolar tend to be very fast, it can seem like these symptoms are more constant, rather than alternating with stable or low mood episodes. This may also contribute to misdiagnoses.
Other possible misdiagnoses include:
- Major Depressive Disorder (MDD)
- Anxiety
- Oppositional Defiant Disorder (ODD)
Co-Occurring ADHD and Bipolar Disorder in Young Children
Some research suggests that bipolar disorder in young children is often or almost always accompanied by ADHD. However, other research suggests that the co-occurrence of the two disorders may be significantly lower, at around 30%.
Some experts suggest that because of the overlap of symptoms, co-occurring ADHD may sometimes be diagnosed among young children who are actually only experiencing bipolar disorder. This might lead to children being wrongly prescribed ADHD stimulant medication, which may make bipolar symptoms worse.
What Causes Bipolar Disorder in Children?
Scientists still aren’t sure exactly what causes bipolar disorder. But they have identified several factors that may contribute to the illness developing.
Research suggests that some people may be more genetically vulnerable to developing the disorder than others. People are more likely to develop bipolar if they have a family member with the same illness, and this might be connected to genetics. But just because one person from a family lives with bipolar disorder doesn’t mean that other family members will have it too.
Experiencing trauma or stressful life events may also increase the risk of developing bipolar disorder.
Treatment for Young Children with Bipolar Disorder
Bipolar symptoms can make daily life difficult for young children. They may experience intense emotional distress and find it hard to get along with friends and family. It can also cause problems at the beginning of school and in other types of learning.
However, with effective treatment, children can learn to manage their symptoms and live fulfilling lives. Early diagnosis and treatment may lead to better outcomes. This means that receiving an accurate diagnosis as soon as possible is really important.
Treatment for bipolar disorder among children can involve both medication and psychotherapy. Several different kinds of medications may support children with bipolar disorder, but not all children respond to treatments in the same way. Usually, treatment providers prescribe the fewest medications with the lowest dose that’s possible to treat a child’s symptoms.
Treatment for bipolar disorder also involves psychosocial therapy for both children and their families. Treatment approaches, such as cognitive-behavioural therapy, can help children manage their symptoms by improving their emotional regulation and social interactions. When working with young children, therapists often use tools such as drawing or role-playing to help children express their experiences and learn in creative ways.
Family therapy also plays a key role in child and adolescent mental health treatment by providing key support and education to family members. Family therapy can teach family members how best to support a young person with bipolar disorder, such as by developing helpful responses to difficult behaviours or learning to create structure and routines at home.
The Wave Clinic: Transformative Recovery Programs for Young People
The Wave Clinic provides specialized mental health support for young people and their families. Our programs are designed and delivered by experts in child and adolescent psychiatry from around the world. We believe in inclusive mental health care that supports young people regardless of their presenting symptoms or concerns.
Our programs our family-centred and trauma-focused, adopting a whole-person, social approach to mental health support.
If you’re interested in finding out more about our programs, get in touch today.
