How common is bipolar disorder in children?

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Bipolar disorder (also known as manic-depression) is a serious but treatable medical illness. It is a disorder of the brain marked by extreme changes in mood, energy, thinking and behavior. Symptoms may be present since infancy or early childhood, or may suddenly emerge in adolescence or adulthood. Until recently, a diagnosis of the disorder was rarely made in childhood. Doctors can now recognize and treat bipolar disorder in young children.

Early intervention and treatment offer the best chance for children with emerging bipolar disorder to achieve stability, gain the best possible level of wellness, and grow up to enjoy their gifts and build upon their strengths. Proper treatment can minimize the adverse effects of the illness on their lives and the lives of those who love them. 

Families of affected children and adolescents are almost always baffled by early-onset bipolar disorder and are desperate for information and support. In this section of the CABF web site, you will find answers to some of the most common questions asked about the disorder.

It is not known, because epidemiological studies are lacking. However, bipolar disorder affects an estimated 1-2 percent of adults worldwide. The more we learn about this disorder, the more prevalent it appears to be among children.

* It is suspected that a significant number of children diagnosed in the United States with attention-deficit disorder with hyperactivity (ADHD) have early-onset bipolar disorder instead of, or along with, ADHD.
* Depression in children and teens is usually chronic and relapsing. According to several studies, a significant proportion of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder, but have not yet experienced the manic phase of the illness.

What are the symptoms of bipolar disorder in children?

Bipolar disorder involves marked changes in mood and energy. Persistent states of extreme elation or agitation accompanied by high energy are called mania. Persistent states of extreme sadness or irritability accompanied by low energy are called depression.

However, the illness may look different in children than it does in adults. Children usually have an ongoing, continuous mood disturbance that is a mix of mania and depression. This rapid and severe cycling between moods produces chronic irritability and few clear periods of wellness between episodes.

Diagnosis is made using the DSM-IV criteria, for which there is no lower age limit. See section below for DSM-IV criteria. However, it becomes more difficult to apply the DSM-IV criteria to very young children.

Behaviors reported by parents in children diagnosed with bipolar disorder may include:

* an expansive or irritable mood
* extreme sadness or lack of interest in play
* rapidly changing moods lasting a few hours to a few days
* explosive, lengthy, and often destructive rages
* separation anxiety
* defiance of authority
* hyperactivity, agitation, and distractibility
* sleeping little or, alternatively, sleeping too much
* bed wetting and night terrors
* strong and frequent cravings, often for carbohydrates and sweets
* excessive involvement in multiple projects and activities
* impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
* dare-devil behaviors (such as jumping out of moving cars or off roofs)
* inappropriate or precocious sexual behavior
* delusions and hallucinations
* grandiose belief in own abilities that defy the laws of logic (ability to fly, for example)

Symptoms of bipolar disorder can emerge as early as infancy. Mothers often report that children later diagnosed with the disorder were extremely difficult to settle and slept erratically. They seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages out of proportion to any event. The word “no” often triggered these rages.

Several ongoing studies are further exploring characteristics of affected children. Researchers are studying, with promising results, the effectiveness and safety of adult treatments in children.

This article reviewed by CABF Professional Advisory Council members and Martha Hellander, Executive Director.
Child and Adolescent Bipolar Foundation

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