While Bipolar Disorder has long been established as a mental health condition, it is in the last few decades that it has become widely known by the public.
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Bipolar disorder in children
While Bipolar Disorder has long been established as a mental health condition, it is in the last few decades that it has become widely known by the public.
This is mainly due to public figures and celebrities being more willing to share their experiences and diagnosis. That being said, people are less well-versed in the different types of Bipolar that present in adults. Early diagnosis of the disorder usually leads to treatment being more effective and can prevent further periods of crisis. However, it is only in recent years that children have been diagnosed with Pediatric Bipolar Disorder.
It is much harder to recognize Bipolar symptoms in children as they present differently in adults. Mania in children is similar to symptoms of ADHD and DMDD and could easily be mistaken for either. Diagnosing Pediatric Bipolar is still controversial in the medical community, with some worrying that diagnosing at an early age will lead to more people being mistakenly given a Bipolar diagnosis and receiving ineffective treatment.
This article will examine the difference between the presentation of Bipolar in adults and children, how to differentiate the condition from similar disorders, and the potential treatment options available.
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Adult vs. Pediatric Bipolar Disorder
The following will review a few differences:
Adult Presentation
We have come to understand Bipolar by its 2 most extreme mood states. Mania is exceptionally high, and depression is extremely low. These states can last for weeks or months, and usually, a depressive episode is triggered in response to a manic episode. Usually, people can identify the onset of a manic episode best after a few days of hypomania, in which the less severe symptoms of mania begin to present themselves. When you live with Bipolar, you also experience periods of normal mood range, just like those without a mental health condition.
Less known is that adults with Bipolar also experience periods of mixed mood. During these, symptoms from both the manic spectrum and depressive can occur at the same time. Mood can also cycle quickly, known as rapid cycling, where instead of a manic or depressive episode lasting weeks or months, it can last days or hours. It can be particularly difficult to diagnose Bipolar if the adult is experiencing rapid cycling due to short bursts of extreme mood.
Here in the US, approximately 2.8% of the population have a diagnosis of Bipolar, with an average age of onset reported as 25 years old.
Pediatric Presentation
The most significant difference in the presentation of adult symptoms and children’s symptoms can be seen in a state of mania. Adults exhibit an elevated mood with high energy, rapid speech, and overconfidence. They often seem larger than life during a mania, leading to poor judgment, a sense of grandiosity, and heightened sexuality or promiscuity. During a mania, adults can become irritable and impatient if challenged about these behaviors and often feel like they are processing information quicker than the people around them. Manic episodes also lead to hallucinations and psychotic episodes, periods in which the adult disassociates from reality.
By contrast, children often exhibit mania through irritability, aggression, and extreme emotional outbursts. This is sometimes referred to as emotional dysregulation. Mania can be seen when a child has an unreasonable emotional reaction to a situation that is out of their typical character.
As children’s emotions are already less developed than adults, it can be hard to diagnose this as Bipolar Disorder. Mixed states and rapid cycling are also far more common in children than adults, adding further confusion for parents not well-versed in the nuance of adult Bipolar Disorder.
Diagnosing Pediatric Bipolar Disorder
It is challenging to diagnose Pediatric Bipolar Disorder as it is incredibly rare in pre-adolescents. It is thought that close to 0% of children suffer from the disorder. Its symptoms in children are similar to that of ADHD, which presents more frequently before the teenage years. This is perhaps why there is confusion around diagnosis, due to its rarity and similarity to other mental health conditions.
Here are a few disorders with similar symptoms to Pediatric Bipolar Disorder.
Attention Deficit Hyperactivity Disorder
Emotional dysregulation is commonly seen in ADHD as well as Pediatric Bipolar. This can come out in the form of tantrums, emotional outbursts, and aggressive behavior that is beyond the normal range of emotions for a child. Both Bipolar and ADHD can lead to difficulty with concentration and focus, difficulty getting to sleep, and children becoming frustrated quickly.
Mania in children will lead to higher levels of energy and activities, which can be commonly mistaken for hyperactivity in ADHD. Equally, the irritability exhibited during manic episodes can seem similar to the low frustration tolerance associated with ADHD. Where a child with ADHD can be impulsive, a manic episode will cause children to judge situations poorly and make what feel like random decisions.
The easiest way to tell the difference between ADHD and Bipolar when diagnosing a child is to look at whether this behavior is episodic or chronic. In other words, do these behaviors come and go or are they acting this way regularly? Only Bipolar is episodic, and you would expect to see other manic symptoms exhibited simultaneously during these episodes.
It is also possible, but much rarer, to have ADHD and Pediatric Bipolar Disorder within the same patient.
Disruptive Mood Dysregulation Disorder
DMDD is a relatively new diagnosis in the psychiatric field. It made its first appearance in the DSM-5, which was published in 2013. Unlike ADHD and Bipolar Disorder, it is only diagnosed in children between 6 and 18 years old.
It can be confused with mania in children because those with the condition also suffer from emotional dysregulation. It is harder for them to process emotions, leading to frustrated and aggressive behavior. A child with DMDD does not go on to develop Bipolar Disorder in adulthood, which is one of the main differences.
Unlike Pediatric Bipolar, DMDD does not alternate with periods of low mood and depression. If a child suffers depressive episodes, they are more likely to have Bipolar Disorder.
Depression
Often, Bipolar in adults can be first misdiagnosed as Depressive Disorder. This is partly because hypomanic symptoms can pass for a regular happy mood, and you are far more likely to go to the doctor when you present with negative emotions than positive ones. Most people diagnosed with Bipolar later in life will have been diagnosed with another mental illness in their teen and young adult years.
Interestingly, depression only develops into Bipolar in 10% of adults. In children, depression develops into Bipolar in 20-40% of cases. It is plausible that a fraction of these children could have experienced hypomanic episodes during their younger years without realizing it. Often it is only with the hindsight of a diagnosis that patients can understand previous behavior as mania.
Treatment options
Bipolar, in both adults and children, is usually treated with a combination of medication and psychotherapy. Often mood stabilizers and antipsychotics allow enough distance between the person and their emotions to allow psychotherapy to work effectively. Some parents will have an adverse reaction to the idea of such medication for their children, which presents challenges once Pediatric Bipolar Disorder has been diagnosed.
If you suspect the child may have ADHD, it is best to treat this first. It can help to rule out Pediatric Bipolar Disorder because ADHD symptoms usually begin to ease after days or weeks of treatment. In contrast, it will not ease the symptoms of Pediatric Bipolar Disorder. It is often safer to treat ADHD first because it is much more prevalent in children than Bipolar.
Stimulants are commonly prescribed to children with ADHD. You can use stimulants confident in the knowledge that they will not exacerbate the symptoms of Bipolar, unlike medications such as antidepressants. Antidepressants can trigger manic episodes in patients with Bipolar, whereas stimulants will not.
Suppose you suspect your child is exhibiting the symptoms of Pediatric Bipolar Disorder. In that case, it is always best to seek medical advice or reach out to organizations specializing in the condition.
