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Bipolar disorder in children often involves periods of mania and depression and can be mistaken for mood swings that can arise during childhood.

Bipolar Disorder in Children

Displays of rapid mood changes are a common occurrence for all children and teens. When quick changes in behavior and mood interfere with a child’s daily life and normal development, bipolar disorder might be the culprit. Differentiating between normal childhood behavior and bipolar disorder is challenging, so clinicians are often cautious about accurately diagnosing bipolar disorder in children.

What is Bipolar Disorder?

Bipolar disorder, formerly known as manic depressive disorder, is a mental health condition that affects people of all ages. The disorder causes observable – and sometimes significant – shifts in behavior and mood.

Children with bipolar disorder experience extreme changes in energy, thinking, behavior and mood, often with severe fluctuations in episodes of mania and depression.

Episodes of Mania in Children: Signs and Symptoms

One hallmark sign of bipolar disorder includes episodes of mania. When children experience mania, they appear hyperactive and full of energy. As they undergo a manic episode, the child might be difficult to redirect or have uncontrollable outbursts, which can pose as a safety issue.

1. Increased Energy

An increase in energy occurs during a manic episode. During this time, the child might be unable to remain still or keep quiet. Their speech is often rapid and pressured, sometimes interrupting others, being unable to wait their turn. They might talk about loosely-connected topics and jump from subject to subject, perhaps talking so rapidly that they are difficult to understand. During this time, the child might involve themselves in multiple activities but cannot finish their tasks.

2. Heightened Self-Esteem

During a manic episode, a child might exhibit heightened self-esteem. A child with bipolar disorder might see themselves as all-powerful or indestructible, showing signs of grandiose thinking. Because of this unrealistic belief in their strength and capabilities, they might engage in dangerous behaviors, thinking they are impervious to adverse events.

3. Reduced Need for Rest

Children who experience a manic episode also need little to no sleep. They resist sleep and may stay awake throughout the night. They may engage in risk-taking behaviors and are impulsive and quick to react.

Episodes of Depression in Children: Signs and Symptoms

Another hallmark sign of bipolar disorder is depression. During periods of depression, a child may show the following symptoms.

1. Extreme Fatigue and Sadness

During a depressive episode, a child with bipolar disorder may experience low self-esteem and poor self-worth. These children may have bouts of crying and sadness, along with extreme sensitivity to failure or rejection. Children may have difficulty focusing and following directions.

2. Changes in Sleeping and Eating Habits

The signs and symptoms of a depressive episode can vary from child to child, especially when it comes to sleeping and eating. During a depressive episode, some children may have insomnia or restless sleep, while others may sleep excessively. The child may also exhibit signs of overeating or not eating enough.

3. Low Self-Esteem

Feelings of worthlessness and self-loathing may occur during a depressive episode. The child may feel worthless or unwanted and pull away from friends and family. Depressive episodes can result in poor schoolwork and engagement in activities, partly due to low self-esteem.

4. Self-Injurious and Suicidal Behavior

One of the most distressing signs of a depressive episode for both parents and their child is self-harm and suicide attempt. A child may plan and seek ways to hurt themselves physically. A few examples of self-injurious behavior include cutting, swallowing known poisons, or hitting themselves. Children may also contemplate suicide, make plans and attempt to carry out the act.

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Risk Factors for Bipolar Disorder in Children

According to the National Institute of Mental Health (NIMH), the exact cause of the bipolar disorder is not known. However, several factors are thought to play a role in the development of the condition.

1. Family History

Research into bipolar disorder shows a strong family link, indicating that genetics may play a significant part in the development of the illness. Having close relatives or immediate family members raises the risk. However, genetics or a family history does not guarantee that a child will develop bipolar disorder.

2. Adversity and Trauma

The environment a child lives in, or traumatic experiences, can result in the development of bipolar disorder. Stressful events, like abuse or a car accident, can trigger bipolar disorder, especially if there is a family history of the illness. Ongoing stress, like long-term childhood neglect, also fosters the development of bipolar disorder in some children.

3. Brain Structure

Studies into bipolar disorder and brain structure show a connection between the condition and parts of the brain. For example, children with bipolar disorder show disturbances in the structural and functional connections of the prefrontal and limbic brain areas. Furthermore, concussions and traumatic brain injuries can also trigger the development of bipolar disorder.


According to information from Mental Health America and American Academy of Child and Adolescent Psychiatry, about one-third of the 3.4 million children and adolescents diagnosed with depression may actually be struggling with bipolar disorder.

Because children and adolescents show mood changes as a regular part of their development, correctly diagnosing bipolar disorder in children is challenging. As a result, many experts believe bipolar disorder is underdiagnosed in children.

On the other hand, some experts believe that bipolar disorder in children is rare and is currently over-diagnosed. These experts believe that manic episodes are symptoms of attention-deficit hyperactivity disorder (ADHD) instead.

As researchers continue to study the presence of bipolar disorder in children, it is essential for parents and healthcare professionals to appropriately identify the signs and symptoms of bipolar disorder in children.