Childhood Bipolar Disorder


Childhood bipolar disorder is a complex difficult disorder to diagnose.  I know because I have been working with these children for many years.  In fact, it is so complex that it is very frequently misdiagnosed.  Learn more about it here in my radio interview.

I hope these pages and the pages they are linked to will give help and guidance to parents, professionals and others concerned about children with bipolar disorder.

If you are a parent of a teenager with a mood disorder click here.

Has you child been diagnosed with DMDD? Learn about this diagnosis here.

Please browse through these topics on bipolar disorder in children before reading on. Each topic can be clicked on to access more information about that area! If you are looking for information on medications, anxiety, or teens or toddlers click on the navigation bar on the left hand side of this page

School is frequently a difficult are to navigate. Below are pages about school.

Links about Differences between ADHD and Bipolar

Pages about Differences between Autism and Bipolar

Looking for support from others who have experienced what you have?

click here to find out about support groups and join the online group. If you are in Charlotte, consider attending our free monthly support meeting!

Links about Parenting Tips

Click here for more information about bipolar disorder parenting techniques

What's all the controversy about?

The first serious studies on childhood bipolar disorder in children began about fifteen years ago This is despite the fact that case studies in psychiatric literature dating as far back as the 1920’s, document cases of mania in children.

You might ask yourself, why did it take so long? The psychiatric profession is notoriously slow to recognize mental health issues in children. Beliefs get established in the profession and Doctors are slow to change their minds- even when there is overwhelming evidence to the contrary. Usually, mental health diagnoses are studied in adults, and then whatever is learned is applied to children. This is unfortunate because many of the symptoms used to identify disorders in adults are not observed in children.

If you suspect your child might have childhood bipolar disorder  you have probably experienced some of the division that still continues in the profession over the diagnosis. Many parents come to me for help insisting that they recognize the symptoms in their child and baffled by the refusal of professionals to make the diagnosis.

Childhood Bipolar Disorder: Difficulty with Making he Diagnosis

Clinicians and psychiatrists are hesitant to make a diagnosis of bipolar disorder in children because with that diagnosis comes the need for a lifelong cocktail of medications. The first line of treatment for childhood bipolar disorder is medication. Once your child carries that diagnosis the implication is that they will need medication for the rest of their life. That’s pretty serious! Also, the medications are pretty serious, they are not all well researched and we don’t know much about the long term effects of them.

Childhood bipolar disorder  hasn’t been accepted into the Diagnostic and Statistical Manual as a new category.  The DSM is the manual mental health professionals use to diagnose all mental health conditions.   Making a bipolar diagnosis for a child is difficult when it must be done according to adult criteria, and therefore, insurance companies can sometimes argue that it is not an accurate diagnosis.  There is also a lot of overlap of symptoms between disorders such as autism and adhd (and many others) and bipolar disorder. In children, there are not necessarily easily distinguishable periods of time when they are manic versus when they are depressed. They do have periods of mania and depression, but the cycling is much shorter and the symptoms of mania and depression appear very  different.

All of these factors conspire to make it difficult to diagnose childhood bipolar disorder. Every day, more research is being done in this area and we are learning a lot about how to recognize bipolar disorder in children. Not only is it difficult for professionals to keep up with all the research, but  bipolar disorder has symptomatic overlap with ADHD, anxiety disorders, psychotic disorders, oppositional defiant disorder and autism . It takes a lot of work to tease out all these other factors and get to the root of the problem.

I think my child may have bipolar disorder. Is it important for me to get a diagnosis?

  • It’s  generally the consensus in the field that the earlier a child is identified as having bipolar disorder, the better their long term chance of success.  Children who have bipolar disorder need medication to be appropriately treated.   If your child is misdiagnosed or not diagnosed their condition could worsen.
  •  A formal diagnosis is very important when choosing a qualified therapist or psychiatrist.
  • When a child is not stable, their academics, social life, self esteem and family life suffer. When diagnosed and treated the prognosis can be very good. Bipolar disorder in children is treatable!

Some other reasons why a formal diagnosis is important:

  • You likely will need a formal diagnosis to get accommodations for your child in school.  A bipolar diagnosis qualifies as a disability.
  • The diagnosis of bipolar disorder can help you to choose parenting techniques that are appropriate.
  • If mistreated this illness has a high correlation with academic difficulties, substance abuse and suicide.

What can I do as a parent to help get my child an appropriate diagnosis?

Seek out therapists and psychiatrists who have training in identifying childhood bipolar disorder. Ask the therapist or Doctor what their credentials are.  Arrive at your first appointment with a typed family history in hand.  This family history should include both sides of your family and document substance abuse, mental health issues, legal issues and anything else of relevance.

  • Be prepared to give a clear account of your child’s developmental history, behavior as an infant, school behavior, and interactions with peers.
  • Keep a diary or chart of fluctuations in your child’s mood, sleep patterns, energy levels and appetite.
  • Keep a history of medications trialed and treatment providers your child has seen.

Childhood Bipolar Disorder.  What are the symptoms?

Extreme mood swings characterize bipolar disorder in children

Bipolar disorder, whether in an adult or child, is characterized by fluctuation between the mood states of depression and mania. Adults with bipolar disorder have distinct periods of mania (high energy moods) and depression (low energy moods). In children these states exist, but they are not easily distinguished and they shift rapidly many times a day. This rapid cycling and varying symptoms in children complicates our understanding of bipolar disorder in children. Are you looking for more help with diagnostic issues? Are professionals giving you contradictory information? Read on to learn about symptoms of depression and mania.

Childhood Bipolar Disorder: Signs of Depression


Adults who are depressed experience an inability to feel joy. Young children experience this as boredom. When they feel this way they may bother the adults around them. This can be infuriating and exhausting for the adults. However, these children are only trying to feel better. The boredom is scary and uncomfortable.


Depressed children can be irritable and angry. They may make negative self statements such as “I hate myself” or “No one likes me”. They may become violent or aggressive when they are depressed and lash out, or they may isolate themselves. When kids are experiencing irritability they often get in trouble for being disrespectful to adults.

Changes in Sleep and Appetite

Depressed kids may lose their appetite or sleep more than usual.


Sadness is another sign of child depression is sadness. Children may cry withdraw or otherwise indicate they are feeling sad. They may have trouble expressing these emotions depending on their age. Bipolar toddler symptoms are much more difficult to identify because their verbal skills are not as sophisticated. Toddlers may cry and whine and may seem less playful.

Morbid Thoughts

Children who are depressed may be preoccupied with morbid thoughts and their play and artwork usually reflects this. For example, one occasion I had a parent who brought in a child who was “just not himself”. During the first session he drew a picture of a headstone with his name on it. He was clearly experiencing suicidal thoughts.

Learn more about depression in children:

Childhood Bipolar Disorder: Mania

Childhood bipolar disorder symptoms  includes the mood state of mania. Mania is defined by some of the features below.


Young children experiencing mania may laugh hysterically for no reason. They act goofy and out of control, but rarely do other people with them understand why.


Manic children make statements about how wonderful they are, or all of the things they can do. In therapy children who are experiencing mania have told me they can fly like superman, beat up their father or that they are stronger than any superhero. They may also become excited without a reason, talk quickly without much breath between words, or jump from topic to topic.

Decreased Need for Sleep

Children experiencing mania need less sleep or may stay up all night. Childhood bipolar disorder symptoms usually include some kind of sleep disruption. Parents will often come in and say kids were up moving around the furniture, taking things apart or going through their clothes, closets and cabinets looking for something to do.


Children with mania may become interested in sexuality without any evidence of sexual abuse. These children act flirtatious beyond their years, may try to touch the private areas of adults (including teachers), or use explicit sexual language.

There is a great deal of overlap between mania symptoms and depression symptoms. For example irritability and aggression are symptoms of both mood states. Childhood bipolar disorder includes rapid and dramatic mood shifts often many times during one day. Even if you are able to distinguish between the two states, they can disappear just as quickly as you identify them.

Childhood Bipolar Disorder Checklist

I have created this bipolar disorder checklist merely as a possible list of symptoms that may alert you that your child may have a mood disorder. In no way is this diagnostic, and a mental health professional must complete a thorough assessment prior to giving you a diagnosis of Bipolar disorder.

Signs of Depression in Children

  •  Your child has oppositional behavior
  • Your child has trouble with school
  • Your child has irritability
  • Your child complains constantly of boredom
  • Your child verbalizes feeling of worthlessness or is guilty sad or hopeless
  • Your child has recurrent thoughts of death or thinks of suicide
  • Your child has low energy

Signs of Mania in Children

  •  Your child experiences a decreased need for sleep
  •  Your child has obsessions and compulsions
  •  Your child is preoccupied with weapons or fire
  •  Your child tries to build weapons
  •  Your child is overly sexual for their age
  •  Your child experiences periods of time where they exhibit inflated self-esteem or grandiosity. They may believe they are able to do things they are not, and brag that they are smarter than adults or better than other kids.
  •  At times your child is more talkative than usual
  •  Your child has periods of time where their thoughts seem to race and their ideas fly
  •  Your child is easily distracted or has difficulty paying attention
  •  Your child has periods of time when they become fixated on a certain idea and they become aggressive when an obstacle gets in their way
  • Other Symptoms
  •  There is a history of bipolar disorder or alcoholism in the family
  •  Your child has night terrors
  •  Your child has sleep and appetite disturbance
  •  Your child is afraid of sleeping alone
  •  Your child is self mutilating
  •  Your child has long protracted rages
  •  Your child has sensory integration problems
  •  Your child has poor social skills
  •  Your child hears voices or sees things that are not there

Bipolar in Children is a Spectrum Disorder

Childhood Bipolar Disorder  symptoms are different from child to child. This means that some kids have it worse than others. For example, one child may have a great amount of difficulty with hyper-sexuality while another child with the diagnosis has no hyper-sexuality. Other symptoms noted to occur in children with bipolar disorder are listed below. These traits may also be associated with many other mental health conditions in children. Just because a child has tantrums does not necessarily mean they have bipolar disorder! Remember it is extremely difficult to diagnosis bipolar  in children variety of reasons, if you feel your child has bipolar make sure to get your child evaluated by a professional who has experience.

  • Tantrums which last an extraordinary length of time
  • Aggression, property destruction or bad language that is normally uncharacteristic of a child
  • Obsession with gore or violence
  • Suicide threats or threats to kill and murder
  • Vivid night terrors
  • Reverse sleep wake cycle or other sleep disturbances. Often these children have great difficulty getting up in the morning and increased energy in the evening
  • Sensory integration issues
  • Severe anxiety, panic attacks, obsessive compulsive patterns, separation anxiety
  • Hoarding
  • Poor ability to regulate appetite
  • Poor self esteem
  • Difficulty writing and shaping letters
  • A discrepancy between verbal and performance IQ

Click here to learn about FEAR OF HARM. This is a new phenotype of bipolar disorder the JBRF is doing great research on diagnosing and treating. If your child is suffering from this they will help you learn about treatment and diagnosis. Many professionals do not know about this. 

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Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.