Bipolarin Children and Teens

National Institute
of Mental Health
Does your child go through extreme changes in mood and
behavior? Does your child get much more excited or much
more irritable than other kids? Do you notice that your child
goes through cycles of extreme highs and lows more often
than other children? Do these mood changes affect how your
child acts at school or at home?
Some children and teens with these symptoms may have
bipolar disorder, a brain disorder that causes unusual shifts in
mood, energy, activity levels, and day-to-day functioning. With
treatment, children and teens with bipolar disorder can get
better over time.
What is bipolar disorder?
Bipolar disorder is a mental disorder that causes people to experience
noticeable, sometimes extreme, changes in mood and behavior. Sometimes
children with bipolar disorder feel very happy or “up” and are much more
energetic and active than usual. This is called a manic episode. Sometimes
children with bipolar disorder feel very sad or “down” and are much less active
than usual. This is called a depressive episode.
Bipolar disorder, which used to be called manic-depressive illness or manic
depression, is not the same as the normal 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. Bipolar symptoms can make it hard for young people to perform
well in school or to get along with friends and family members. Some children
and teens with bipolar disorder may try to hurt themselves or attempt suicide.
Most people are diagnosed with bipolar disorder in adolescence or adulthood,
but the symptoms can appear earlier in childhood. Bipolar disorder is often
episodic, but it usually lasts a lifetime.
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 successful lives.
What causes bipolar disorder?
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.
What are the symptoms of bipolar disorder?
Mood episodes in bipolar disorder include intense emotions along with significant
changes in sleep habits, activity levels, thoughts, or behaviors. A person 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, the symptoms last every day for most of the day.
These mood and activity changes are very different from the child’s usual
behavior and from 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 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.
Children and teens having a depressive episode may:
• Feel frequent and unprovoked sadness.
• Show increased irritability, anger, or hostility.
• Complain a lot about pain, such as stomachaches and headaches.
• Have a noticeable increase in amount of sleep.
• Have difficulty concentrating.
• Feel hopeless and worthless.
• Have difficulty communicating or maintaining relationships.
• Eat too much or too little.
• Have little energy and no interest in activities they usually enjoy.
• Think about death, or have thoughts of suicide.
Can children and teens with bipolar disorder
have other problems?
Young people with bipolar disorder can have several problems at the same
time. These include:
• Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of
misusing alcohol or drugs.
• Attention-deficit/hyperactivity disorder (ADHD). Children and teens who
have both bipolar disorder and ADHD may have trouble staying focused.
• Anxiety disorders. Children and teens with bipolar disorder also may have an
anxiety disorder.
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).
The deaf and hard of hearing can contact the Lifeline via TTY at
1-800-799-4889. These services are confidential, free, and available 24/7.
How is bipolar disorder diagnosed?
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 see if something other than bipolar disorder is causing your child’s
symptoms. Sometimes health care providers need to know about medical
conditions in the family, such as depression or substance use.
Other disorders have symptoms like those of bipolar disorder, including ADHD,
disruptive mood regulation disorder, oppositional defiant disorder, conduct
disorder, and anxiety disorders. It also can be challenging to distinguish bipolar
disorder from depression that occurs without mania, which is referred to as
“major depression.” A health care provider who specializes in working with
children and teens can make a careful and complete evaluation of your child’s
symptoms to provide the right diagnosis.
How is bipolar disorder treated?
Children and teens can work with their health care provider to develop a treatment
plan that will 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.
Treatment options include:
• Medication. Several types of medication can help treat symptoms of bipolar
disorder. Children respond to medications in different ways, so the right type of
medication depends on the child. This means children may need to try different
types of medication to see which one works best for them. Some children may
need more than one type of medication because their symptoms are complex.
Children should take the fewest number of medications and the smallest doses
possible to help their symptoms. A good way to remember this is “start low,
go slow.” Medications can cause side effects. Always tell your child’s health
care provider about any problems with side effects. Do not stop giving your
child medication without speaking to a health care provider. Stopping medication
suddenly can be dangerous and can make bipolar symptoms worse.
• Psychosocial Therapy. Different kinds of psychosocial therapy can help children
and their families manage the symptoms of bipolar disorder. Therapies that
are 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.
What can children and teens expect from treatment?
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.
How can I help my child or teen?
Help begins with the right diagnosis and treatment. Talk to your family 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.
How does bipolar disorder affect caregivers and families?
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 problems—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.
Where do I go for help?
If you’re not sure where to get help, your doctor, pediatrician, or other family health
care provider is a good place to start. A health care provider can refer you to a
qualified mental health professional, such as a psychiatrist or psychologist, who
has experience treating bipolar disorder and can evaluate your child’s symptoms.
You can learn more about getting help and finding a health care provider on
the National Institute of Mental Health website at www.nimh.nih.gov/findhelp.
Hospital health care providers can help in an emergency. The Substance Abuse
and Mental Health Services Administration (SAMHSA) has an online tool at
https://findtreatment.samhsa.gov to help you find mental health services in
your area.
I know someone who is in crisis. What do I do?
If you know someone who might be thinking about hurting themselves or
someone else, get help quickly.
• Do not leave the person alone.
• Call 911 or go to the nearest hospital emergency room.
• Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255)
or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the
Crisis Text Line (text HELLO to 741741) or go to the National Suicide Prevention
Lifeline website at https://suicidepreventionlifeline.org.
What should I know about clinical trials?
Clinical trials are research studies that look at new ways to prevent, detect, or
treat diseases and conditions. Although individuals may benefit from being part
of a clinical trial, participants should be aware that the primary purpose of a
clinical trial is to gain new scientific knowledge so that others may be better
helped in the future.
Researchers at NIMH and around the country conduct clinical trials with patients
and healthy volunteers. Talk to your health care provider about clinical trials,
their benefits and risks, and whether one is right for you. For more information,
visit www.nimh.nih.gov/clinicaltrials.

NIH Publication No. 20-MH-8081
Revised 2020
National Institute
of Mental Health