What Are the Differences Between Bipolar in Children and Bipolar in Adults?

In the past five to ten years, bipolar disorder has been identified in more and more children. Up to 5% of American children suffer from bipolar disorder.

Bipolar disorder is a mood disorder that affects 2.6% of American adults–about 5.7 million people–according to the National Institute of Mental Health. The disease is characterized by mood episodes: “highs” called mania and “lows” known as depression.

A picture of four white toddlers seated next to each other. Credit to flickr.com user rjp. Used with permission under a Creative Commons licen

In past posts, I’ve looked at how bipolar disorder specifically manifests in women, how men and women have different brain biomarkers, and how the illness shows up in children. But what are the differences between bipolar disorder in children and bipolar disorder in adults?

Let’s dig in.

Symptoms of Mania and Depression in Children and Adults: A Side-by-side Comparison

Check out the following chart to see a side-by-side comparison of symptoms of bipolar disorder in children and adults:

	Adults	Children
Depression	Sad, empty, or hopeless feelings Anhedonia – Loss of interest in pleasurable activities Insomnia or sleeping too much Fatigue, loss of energy Weight gain or loss Feelings of worthlessness Guilt Inability to concentrate Thinking about, planning, or attempting suicide	Sad, empty, or hopeless feelings Anhedonia – Loss of interest in pleasurable activities Insomnia or sleeping too much Irritability Failure to gain weight Change in grades, getting into trouble at school, or refusing to go to school Frequent crying Withdrawing from friends Acting out suicide in play
Mania	Excitement, or abnormal cheerfulness Decreased need for sleep Euphoria, exaggerated self-confidence Increased energy Pressured speech Racing thoughts Distractability Hypersexuality Spending sprees and other poor decisions	Irritability Decreased need for sleep Silliness or excessive goofiness Grandiosity, including statements about superpowers Distractability Hypersexuality Aggression

These symptoms are similar, but the way they manifest is different for children than adults. For example, during both manic and depressive phases, children are much more likely to be irritable and aggressive.

Let’s take a detailed look.

First Symptoms

Childhood-onset usually refers to children who develop bipolar disorder at age 12 or younger. The first signs of bipolar disorder in adults are usually manic or hypomanic episodes. But in children, depression is often the first indication that anything is wrong. Studies show that up to 30% of children who suffer from clinical depression will develop manic symptoms later in life, which can lead to a diagnosis of bipolar disorder. For a more detailed overview of what depression looks like in children, even toddlers, click here.

Pattern of the Disorder

The most striking difference between childhood-onset and adult-onset bipolar disorder is the patterns of the illness. Adults generally vacillate between defined episodes of mania and depression that last weeks or months. They can also have periods of wellness that last from months to years in between.

Kids are the opposite: they experience prolonged periods of rapid cycling, which means they bounce between mania and depression daily, if not multiple times per day. And there are no periods of respite in children with bipolar disorder; they are always suffering from a mood episode.

One study of pediatric bipolar patients examined children with bipolar disorder who suffered more than one hundred mood episodes over a short period of time. The manic periods were called “mini-manias.” According to the study, none of the patients under 9 years old endured a single mood episode lasting two weeks or more. Short, frequent episodes was the way the illness presented in the children.

Genetic Predisposition

Kids who end up with bipolar disorder were usually genetically predisposed to develop the disease. One of the many causes of bipolar disorder can be family history of the illness, though sometimes the disease can occur without any history present. But, in the case of children who develop the disorder, there are typically more family members with bipolar in their lives than those children without the disorder. The kids are also much more likely to have relatives–such as parents, aunts and uncles, and grandparents–on both sides with the disorder.

Adults who develop bipolar disorder may or may not be genetically predisposed. Genetic loading is less common in adults than children. If the adults are predisposed, the disease may or may not be more severe. It’s a lottery.

Difficult Time Adjusting

Pediatric bipolar disorder presents unique difficulties compared to the adult-onset form of the disease. Kids are still developing mentally and physically, so when they suffer from the rapid cycling moods of bipolar disorder, life can become very difficult. These children are establishing their identities, and enduring vacillating episodes of bipolar disorder makes that very hard.

Adults usually have their identities established, or at the very least, are set in their ways, so figuring themselves out is not as much of a struggle. Adults are also more emotionally mature than children, and can better handle shifts in mood.

Chronic Irritability and Mixed States

Instead of the euphoric highs of mania typically experienced by adults, kids are much more likely to suffer chronic irritability, a state where they are grouchy all of the time. This is because children tend to suffer from mixed states, where they endure extreme episodes of mania and depression at the same time. Treating mixed states can be very difficult. Even lithium, the gold standard medication that is used to treat bipolar disorder, is often ineffective at handling mixed states. Lithium is able to treat both depression and mania in bipolar patients, but it’s totally ineffective at handling mixed states.

Adults can also suffer from mixed states, but children are much more likely to experience them.

Difficulty Diagnosing

Often, childhood-onset bipolar disorder is missed or inaccurately diagnosed until the kid becomes an adult. Children are also more prone than adults to conditions that occur at the same time, such as attention deficit hyperactivity disorder (ADHD), learning disabilities, or anxiety disorders, which can make accurately diagnosing bipolar disorder difficult. If you weren’t diagnosed with bipolar disorder until adulthood, but suspect you have had it since you were a child, this information may help you sort out your own childhood.

The Bottom Line

If your child suffers from two or more of bipolar disorder symptoms, call your pediatrician to get a referral to a pediatric psychologist. Refer to the symptom chart to present daily examples of bipolar disorder symptoms to the doctors. Anhedonia is especially important to note, as it’s not typical of most healthy children. If you have a family history of bipolar disorder, make sure to bring that up.

When children with bipolar disorder grow up, their diseases are worse than people who suffer from an adult-onset version of the illness. The mood episodes are more intense in childhood. But early therapy and other interventions can help your child deal with their condition. The earlier a treatment team can intervene, the better.

Related:

• Children at high risk for bipolar disorder are genetically vulnerable to stress
• Bipolar patients more than twice as likely to have suffered childhood adversity
• What to do if your child has bipolar disorder

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