How is bipolar disorder detected in children and adolescents?

No blood tests or brain scans can diagnose bipolar disorder. However, a doctor or health care provider may use tests like these to help rule out other possible causes for your child's symptoms. In addition, they may recommend testing for problems in learning, thinking, or speech and language.¹⁸ A careful medical exam may also detect problems that commonly co-occur with bipolar disorder and need to be treated, such as substance abuse.

Health care professionals who have experience with diagnosing early-onset bipolar disorder will ask questions about changes in your child's mood. They will also ask about sleep patterns, activity or energy levels, and if your child has had any other mood or behavioral disorders. They may also ask whether there is a family history of bipolar disorder or other psychiatric illnesses, such as depression or alcoholism.

Doctors diagnose bipolar disorder using guidelines from the Diagnostic and Statistic Manual of Mental Disorders (DSM). To be diagnosed, the symptoms must be a major change from your child's normal mood or behavior. There are four basic types of bipolar disorder:

• Bipolar I Disorder—defined by manic or mixed episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks.
• Bipolar II Disorder—defined by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
• Bipolar Disorder Not Otherwise Specified (BP-NOS)—diagnosed when symptoms of the illness exist but do not meet diagnostic criteria for either bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior.
• Cyclothymic Disorder, or Cyclothymia—a mild form of bipolar disorder. People with cyclothymia have episodes of hypomania as well as mild depression for at least 2 years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

When children have manic symptoms that last for less than 4 days, experts may diagnose BP-NOS. Some evidence indicates that many of these young people will develop longer episodes within a few years and then meet the criteria for bipolar I or II.¹⁹

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