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What are the signs and symptoms of bipolar disorder in children and adolescents?

Youth with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." The extreme highs and lows of mood are accompanied by extreme changes in energy, activity, sleep, and behavior. Each mood episode represents a drastic change from a person's usual mood and behavior.

An overly joyful or overexcited state is called a manic episode. An extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Symptoms of bipolar disorder are described below.

Symptoms of mania include:Symptoms of depression include:
Mood Changes
  • Being in an overly silly or joyful mood that is unusual for your child. It is different from times when he or she is just being silly and having fun.
  • Having an extremely short temper and unusual irritability.

Behavioral Changes
  • Sleeping little but not feeling tired
  • Talking a lot and having racing thoughts
  • Having trouble concentrating or paying attention, jumping from one thing to the next in an unusual way
  • Talking and thinking about sex more often than usual
  • Behaving in risky ways more often, seeking pleasure a lot, and doing more activities than usual.
Mood Changes
  • Being in a sad mood that lasts a long time
  • Losing interest in activities once enjoyed
  • Feeling worthless or guilty.

Behavioral Changes
  • Complaining about pain more often, such as headaches, stomach aches, and muscle pains
  • Eating a lot more or less than usual and gaining or losing a lot of weight
  • Sleeping or oversleeping when these were not problems before
  • Losing energy
  • Recurring thoughts of death or suicide.

It's normal for almost every child or teen to show some of these behaviors sometimes. These passing changes should not be confused with bipolar disorder.

Symptoms of bipolar disorder are not like the normal changes in mood and energy that everyone has. Bipolar symptoms are more extreme and tend to last for most of the day, nearly every day, for at least 1 week. Also, depressive or manic episodes include moods very different from a child's normal mood, and the behaviors described in the chart generally all come on at the same time. Sometimes the symptoms of bipolar disorder are so severe that the child needs to be treated in a hospital.

Bipolar disorder can be present even when mood swings are less extreme. For example, sometimes a child may have more energy and be more active than normal, but not show the severe signs of a full-blown manic episode. This is called hypomania. It generally lasts for at least 4 days in a row. Hypomania causes noticeable changes in behavior, but does not harm a child's ability to function in the same way that mania does.

Note on Misdiagnosis: Rapidly Shifting Moods and High Energy

Findings from the NIMH-funded Longitudinal Assessment of Manic Symptoms (LAMS) study suggest that most young children with rapid mood swings and extremely high energy levels do not actually have bipolar disorder. However, these symptoms do cause significant problems at home, school, or with peers. The LAMS researchers re-assessed the children periodically to determine which children with rapid mood swings and high energy develop bipolar disorder later in life.4

Rapid mood changes and high energy are common among youth, but some researchers suggest these symptoms are hallmarks of mania in children. Other experts believe that over-diagnosis and misdiagnosis may play a role in the sharply rising numbers of children being diagnosed with and treated for this disorder.5

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