Bipolar Disorder

If your child or adolescent experiences extreme shifts in their mood or behavior, they may have bipolar disorder. Bipolar disorder is a condition that causes dramatic changes in mood. These changes can swing from upbeat,happy, and or irritable with a decreased need for sleep - known as a manic episode - to being very down and lacking in energy, which is known as a depressive episode.

Although bipolar disorder is more common in adolescents and adults, it can occur at any age. However, diagnosing childhood bipolar disorder can be challenging, as it shares many symptoms with other conditions, such as ADHD, Post-traumatic Stress Disorder, and other mood disorders, as well as general childhood behaviors not associated with any condition.

​​​​​​​What are the Signs of Childhood Bipolar Disorder?

Your child may have bipolar disorder if they show symptoms from two strongly contrasting phases: mania and depression. For a diagnosis, these symptoms must impair the child or adolescent’s ability to function.

Mania

According to the DSM-V, a manic episode is characterized by several of the following symptoms that last seven days or require hospitalization (one of which must be irritability or elation):

• Decreased need for sleep (hallmark feature of this disorder, feeling rested after only 3-4 hours of sleep)
• Elevated/expansive or irritable mood
• Increased goal-directed activity or agitation
• Inflated Self-Esteem or grandiosity (unrealistic beliefs in ability/powers)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing (hard to interrupt the person, they jump from topic to topic)
• Distractibility
• Excessive involvement in activities that have a high potential for painful consequences (unrestrained buying sprees, sexual indiscretion, or poor business investments)

Depression (Similar to Depression without Mania)

In order to diagnose a depressive episode, the following symptoms need to be present for most of the day, nearly every day, for two weeks or longer; one of these symptoms must be depressed mood or loss of interest or pleasure (anhedonia):

• Sadness
• Hopelessness or pessimism
• Loss of interest in activities
• Irritability and restlessness
• Aches and pains that aren’t explainable by any physical injury
• Recurrent Thoughts of Death, Suicidal ideation
• Impaired executive function: diminished ability to think, concentrate, or make decisions
• Lack of energy, feelings of fatigue
• Sleeping less than usual or more than usual
• Increase or decrease in appetite
• Feelings of worthlessness or excessive, inappropriate guilt

How is Childhood Bipolar Disorder Diagnosed?

Diagnosing childhood bipolar disorder requires a professional evaluation and observation over a prolonged period of time. This entails a review of the child or adolescent’s family history, as well as any information from those who know the child, such as caregivers, family members and teachers.

Evaluation also involves speaking with the child/adolescent directly, in order to understand what they are experiencing. It can take several sessions to determine whether a child/adolescent has bipolar disorder, or whether another condition might explain their symptoms.

How Common is Treatment-Resistant Childhood Bipolar Disorder?

Although there are a number of medications that have been shown to be effective in treating bipolar in children and adolescents, a substantial number of individuals do not fully respond to these treatment approaches.

Sometimes this may be due to misdiagnosis; other times it could be because of poor medication compliance (where the child/adolescent doesn’t commit to taking their medication regularly). Often it is not the case that an individual is treatment resistant, they just haven’t found the treatment approach that works best for them yet.

Integrative Approaches to Childhood Bipolar Disorder

If your child/adolescent has not fully responded to bipolar disorder treatment, you may wish to consider an integrative approach to treatment. This can include therapy and dietary interventions along with medication..

Therapy for Childhood Bipolar Disorder

Therapy for childhood bipolar disorder can be approached from a number of angles.

Social Rhythms Therapy This form of therapy grew from the idea that individuals with Bipolar disorder have a genetic predisposition to problems with their sleep-cycle.Administered in concert with medications, interpersonal and social rhythm therapy combines the basic principles of interpersonal psychotherapy with behavioral techniques to help patients regularize their daily routines, diminish interpersonal problems, and adhere to medication regimens.

Psychoeducational Treatment is designed to give children/adolescents a set of skills they can use to help them cope with their negative emotional states. This includes improving knowledge of bipolar disorder, improving the management of symptoms, improving communication and problem-solving skills, controlling impulses, and increasing the child/adolescent and family’s feeling of support in managing bipolar disorder.

Family-focused therapy (FFT) aims to ease the symptoms of bipolar disorder through sessions of psychoeducation about bipolar disorder, communication enhancement training, and problem-solving skills training.

Child- and Family-Focused Cognitive-Behavioral Therapy (CFF-CBT) helps primary caregiver(s) to develop an effective parenting style that meets the needs of their child/adolescent. CFF-CBT incorporates psychoeducation, CBT, interpersonal therapy, mindfulness and positive psychology to address the needs of the child across four main psychosocial areas - individual, family, peer and school.

Diet & Supplements for Childhood Bipolar Disorder

As with depression, poor diet can play a role in childhood bipolar disorder. Bipolar disorder is associated with inflammation in the brain, which can be impacted by the food that individuals eat.

Reduced levels of omega-3 are very closely associated with bipolar disorder, and this supplement has been found to contribute to alleviating the symptoms of bipolar disorder. Omega-3 is most effective in treating the depressive phase of the condition.

Low levels of the neurochemical acetylcholine (ACh) are believed to play a role in mania. The B vitamin choline is required for the production of ACh, and choline deficiency is believed to be one of the causes of bipolar disorder that can be remedied with lifestyle changes. Choline can be found in foods such as salmon, cod, chicken breast, and legumes.