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.

children
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 with Bipolar Disorder May Be Diagnosed with Vitamin D Blood Test In the Future

blood test
Credit to flickr.com user CEHURD CEHURD. Used with permission under a Creative Commons license.

Researchers at Ohio State University are searching for a way to and quickly and accurately test for bipolar disorder in children. The scientists think they may have found it: a blood test which looks for a protein associated with vitamin D.

 

Finding a blood test could reduce the current average diagnosis time of ten years, said Ouliana Ziouzenkova, the study’s lead author and an associate professor of human nutrition at Ohio State.

In the study of 36 young people, levels of the vitamin D binding protein were 36 percent higher in those with bipolar disorder than in those without a mood disorder. The study appears online in the journal Translational Psychiatry.

Ziouzenkova said it made sense to look at vitamin D binding protein because it potentially plays a role in brain inflammation. The researchers also looked at inflammatory markers in the blood, but found no significant correlations. Looking for the nutrient vitamin D in the blood, as opposed to the binding protein, appears to have low diagnostic power, she said.

Confirming that the blood test works will take time, but Ziouzenkova and her colleagues are excited about the potential to help kids and their parents.

Materials provided by Ohio State University.

What to do if Your Child has Bipolar Disorder

So you’ve discussed your child’s symptoms with a pediatric mental health specialist, and have a diagnosis of bipolar disorder. What now? Thankfully, there are some suggestions you can take, and taking care of your child with bipolar disorder is similar to taking care of an adult with the disorder.

1. Pay attention to medications and therapy appointments

As a parent, you are responsible for making sure your child follows their treatment plan. Use whatever reminders you can to remember to give him or her the medication that he or she needs.  If your child must take their pills at school, then open a line of communication with his or her teachers and school nurse. Appointments with his or her therapist are also important. Make sure your child attends their appointments

children2
Credit to flickr.com user Cristyan González Alfonso. Used with permission under a Creative Commons license.

2. Monitor side effects

Some side effects of atypical antipsychotics, like weight gain and blood sugar changes, are awful in adults–and children do seem to be more prone to them. These drugs were originally formulated for adults, and few have been tested on kids. Ask your child’s psychiatrist what side effects you need to keep an eye on.

3. Work out agreements with your child’s teachers

Some children with bipolar disorder need more help at school, such as more breaks during manic episodes, or less homework. During especially bad episodes, your child may need to be removed from school until he or she stabilizes. Talk to your child’s teachers. Keeping an open line of communication is the best way to ensure your child has success at school.

4. Keep a schedule

Try to be consistent with mealtimes and bedtimes, as well as waking your child up at the same time every day. This will help keep stress in the home to a minimum. Try to be patient with your child as they adjust to new routines.

5. Go to family therapy, if needed

Taking care of a child with bipolar disorder may put a lot of stress on the family as a whole. Your marriage might suffer, and the child’s siblings might be jealous of all the attention he or she gets. Attending therapy as a family may help you handle these issues.

6. Don’t ignore threats of suicide

Suicide threats are extremely serious, even in young children who may not understand what it means. Talk to your children, and if they do have suicidal ideation, give them a safe environment. Remove all the weapons or pills from the house. And talk with their mental health specialists. Crisis lines are always open.

7. Communicate with your teenager

Teenagers may become irritated or resentful if they feel that you’re compelling them to be treated. Talk to them about why you’re giving them medication and taking them to therapy appointments. Educate your kids about their mental illness. Also, it’s important that your teenager avoid substance abuse, as the risks of developing a problem are much higher in teens with bipolar disorder. Alcohol and drugs can interact with medications poorly and worsen mood episodes, so it’s important that your teenager be made aware of the risks.

All in all, taking care of your child with bipolar disorder requires an extra level of parenting. But you can do it. There are steps you can take to help you.

How to Talk To Your Kids About Mental Illness

“Mom, are you crazy?” my eight-year-old son, Ryan, asked after reading over my shoulder while I worked on my book. My memoir, Committed, is about my stay in a mental hospital one week after Nolan’s birth, and the page he read demonstrated a particularly erratic behavior from me.

talking.jpg
Credit to flickr.com user Evan Long. Used with permission under a Creative Commons license.

“No, honey,” I said. My heart sank. I was not ready to have this conversation yet, but Ryan’s question made me think otherwise. “I do have bipolar disorder, which is a mental illness.”

“What’s bipolar disorder?” he said.

“Bipolar disorder is when I sometimes feel depressed–like nothing in the world matters anymore,” I said, patting him on the arm. “But it also means I feel super energetic sometimes, and can’t control myself very well.”

“Will I get it?” he said, his eyes widening.

“I don’t know,” I said. “You might. It comes when you’re a teenager or young adult. But there are medications available to help manage it, so don’t worry.”

“Oh,” he said, giving me a hug. “I’m sorry you have bipolar disorder, Mama.”

And that was that.  The dreaded conversation–the start of many–was over.

Arming your kids with age-appropriate information about your mental illness can help them feel secure. If you talk to them about your disorder, they will know what to expect when you have a down–or up–day. They’ll also learn to separate you from your illness, and from any negative feelings that might occur. If you don’t talk to then, they’ll invariably draw their own conclusions, which can make them feel unsure about you and their position in the world.

Here are some tips for talking about mental illness with your kids.

1. Keep it Simple

Children only need to know the basics of mental illness: it’s not contagious, they are not destined to have a disorder, there are treatments available, etc. Another important factor that goes into talking about mental disorders with your kids is stressing that it’s not their fault. They can’t make their parent better, nor should they try. They can only support their mother 0r father by checking in on them, watching movies with them, and generally being their awesome selves.

2. Reassure Them

Explain to your children if they ask that they might get your disorder, but reassure them that there are treatments available and that you’re getting help yourself, if you are. Tell your kids that you still love them, and no amount of mental illness will change that.

3. Know Your Child’s Maturity Level

All kids are different, and mature at different rates. Preschoolers will only want very basic information about why you’re sad. Preteens will want more information, so give them as much as you think they can handle. Teenagers will often turn to their friends when seeking information about things that bother them, so make sure they’re well-informed.

4. Address Their Fears

Ask your children if they have any worries now that you’ve brought up the topic. Reassure them that their needs will be met and that you’re not going anywhere. Repeat information if they appear confused. It may be helpful to bring their fears up with a mental health professional, so you can make a plan to address them.

5. Make Yourself Available

Make sure you don’t end the conversation there. Children will have questions as they grow, and it’s important that you be available to answer them. Explain to your kids that they are always welcome to ask questions of you about this topic.

Talking with your kids about mental illness can be tough. But if you’re open to it, they’ll appreciate your candor and feel more secure knowing what’s going on with their parent.