Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes people to experience noticeable, sometimes extreme, changes in mood and behavior. It is a common misperception that children cannot have bipolar disorder. Although most people are diagnosed with bipolar disorder in adolescence or adulthood, the symptoms can appear earlier in childhood.

Bipolar disorder is not the same as the typical ups and downs every child goes through. The mood changes in bipolar disorder are more extreme, often unprovoked, and accompanied by changes in sleep, energy level, and the ability to think clearly.

Children with bipolar disorder sometimes feel very happy or “up” and are much more energetic and active than usual. This is called a manic episode. Children with bipolar disorder sometimes feel very sad or “down” and are much less active than usual. This is called a depressive episode. Bipolar disorder is often episodic, but it usually lasts a lifetime.

Bipolar disorder symptoms can make it hard to perform well in school or get along with friends and family members. Some children and teens with bipolar disorder may try to hurt themselves or attempt suicide. Early diagnosis and treatment can lead to better functioning and well-being over the long term.

Signs and symptoms of bipolar disorder may overlap with symptoms of other disorders that are common in young people, such as attention-deficit/hyperactivity disorder (ADHD), conduct problems, major depression, and anxiety disorders.

Diagnosing bipolar disorder can be complicated and requires a careful and thorough evaluation by a trained, experienced mental health professional.

With treatment, children and teens with bipolar disorder can manage their symptoms and lead full, active lives.

The exact causes of bipolar disorder are unknown, but several factors may contribute to the illness.

For example, researchers are beginning to uncover genetic mechanisms that are linked to bipolar disorder and other mental disorders. Research shows that people’s chance of having bipolar disorder is higher if they have a close family member with the illness, which may be because they have the same genetic variations. However, just because one family member has bipolar disorder, it does not mean that other members of the family will have it. Many genes are involved in the disorder, and no single gene causes it.

Research also suggests that adversity, trauma, and stressful life events may increase the chances of developing bipolar disorder in people with a genetic risk of having the illness.

Some research studies have found differences in brain structure and function between people who have bipolar disorder and those who do not. Researchers are studying the disorder to learn more about its causes and effective treatments.

Mood episodes in bipolar disorder include intense emotions and significant changes in sleep habits, activity levels, thoughts, or behaviors. Children and teens with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, symptoms occur every day and last for most of the day.

These mood and activity changes are very different from the child’s usual behavior and the behavior of healthy children and teens.

Children and teens having a manic episode may:

• Show intense happiness or silliness for long periods of time.
• Have a very short temper or seem extremely irritable.
• Talk fast about a lot of different things.
• Have trouble sleeping but do not feel tired.
• Have trouble staying focused and experience racing thoughts.
• Seem overly interested or involved in pleasurable but risky activities.
• Do risky or reckless things that show poor judgment.
• Have an inflated sense of ability, knowledge, and power.

Children and teens having a depressive episode may:

• Feel frequent and unprovoked sadness.
• Show increased irritability, anger, or hostility.
• Complain a lot about physical pain, such as stomachaches and headaches.
• Start sleeping a lot more.
• Have difficulty concentrating.
• Feel hopeless and worthless.
• Have difficulty communicating or maintaining relationships.
• Eat too much or too little.
• Have low energy and no interest in activities they usually enjoy.
• Think about death or have thoughts of suicide.

Young people with bipolar disorder can have several problems at the same time. For example, they may also be at risk of misusing alcohol or drugs. Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldn’t usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously and call your child’s health care provider.

If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline (Lifeline) at 1‑800‑273‑TALK (8255), or text the Crisis Text Line (text HELLO to 741741).  These services are confidential, free, and available 24/7.

A health care provider will ask questions about your child’s mood, sleeping patterns, energy levels, and behavior. There are no blood tests or brain scans that can diagnose bipolar disorder. However, the health care provider may use tests to determine if something other than bipolar disorder is causing your child’s symptoms. Health care providers may need to know about medical conditions in the family, such as depression or substance use.

Other disorders—such as ADHD, disruptive mood dysregulation disorder, oppositional defiant disorder, conduct disorder, and anxiety disorders—have symptoms like those of bipolar disorder. It can be challenging to distinguish bipolar disorder from depression that occurs without mania, referred to as “major depression.” A health care provider who specializes in working with children and teens can carefully evaluate your child’s symptoms to provide an accurate diagnosis.

Children and teens can work with their health care provider to develop a treatment plan to help them manage their symptoms and improve their quality of life. It is important to follow the treatment plan, even when your child is not currently experiencing a mood episode. Steady, dependable treatment works better than treatment that starts and stops.

Several types of medication can help treat symptoms of bipolar disorder. Children respond to medications in different ways. They may need to try different types of medication to find the one that works best for them. Some children may need more than one type of medication because their symptoms are complex. Health care providers usually try to prescribe the fewest number of medications and the smallest doses possible to help treat a child’s symptoms. Always tell your child’s health care provider about any medication side effects. Do not stop giving your child a prescribed medication without speaking to a health care provider. Stopping medication suddenly can be dangerous and can make symptoms worse.

Different kinds of psychosocial therapy can also help children and their families manage the symptoms of bipolar disorder. Therapies based on scientific research—including cognitive behavioral approaches and family-focused therapy—can provide support, education, and guidance to youth and their families. These therapies teach skills that can help people manage bipolar disorder, including skills for maintaining routines, enhancing emotion regulation, and improving social interactions.

With treatment, children and teens with bipolar disorder can get better over time. Treatment is more effective when health care providers, parents, and young people work together.

Sometimes a child’s symptoms may change, or disappear and then come back. When this happens, your child’s health care provider may recommend changes to the treatment plan. Treatment can take time, but sticking with the treatment plan can help young people manage their symptoms and reduce the likelihood of future episodes.

Your child’s health care provider may recommend keeping a daily life chart or mood chart to track your child’s moods, behaviors, and sleep patterns. This may make it easier to track the illness and see whether treatment is working.

Help begins with an accurate diagnosis and treatment. Talk to your child’s health care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

• Be patient.
• Encourage your child to talk, and listen to your child carefully.
• Pay attention to your child’s moods, and be alert to any major changes.
• Understand triggers and learn strategies for managing intense emotions and irritability.
• Help your child have fun.
• Remember that treatment takes time: Sticking with the treatment plan can help your child get better and stay better.
• Help your child understand that treatment can make life better.

Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a child’s mood episodes and other symptoms—such as short tempers and risky behaviors—can challenge any caregiver.

It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.