Diagnosing Bipolar Disorder in Children

Bipolar disorder, also known as manic–depressive illness, is a chronic mental health condition that causes a child or teen to experience intense mood swings, in alternating episodes of depression and mania. These mood swings can last for hours, days, or even weeks, and can seriously disrupt usual patterns of activity, including schoolwork, sleeping, and eating.

Mental health specialists at NYU Langone’s Child Study Center can help determine if your child has bipolar disorder and, if so, how best to manage his or her symptoms.

Symptoms of Bipolar Disorder in Children

A child or adolescent with bipolar disorder experiences cyclical mood swings, in which periods of the child’s usual mood alternate with depression and mania.

A manic episode produces feelings of grandiosity, excessive exuberance or silliness, and, at times, severe irritability. During a manic episode, a child may show a dramatic change in mood and seem unusually happy or excited. He or she may exhibit an increase in activity and energy levels and may talk excessively, rapidly, or loudly, and change the topic of conversation frequently or abruptly. Other symptoms of a manic episode may include irritability, agitation, and unrealistically high self-esteem.

Other signs of mania include needing less sleep, losing touch with reality, and engaging in risky behavior such as drug or alcohol use, reckless driving, or sexual promiscuity.

During a depressive episode, a child may experience persistent or frequent irritability, sadness, or crying. He or she may have thoughts of death or suicide and lose interest in favorite activities. Other signs of depression include low energy levels, fatigue, physical complaints, poor concentration, and a change in eating or sleeping habits.

Despite the similarities between depression and the depressive episodes associated with bipolar disorder, they require different treatments.

Types of Bipolar Disorder

There are two types of bipolar disorder. Bipolar disorder I produces severe manic episodes, and bipolar disorder II produces milder manic episodes. In both, the depressive episodes can be severe.

Although bipolar disorder usually appears in the late teenage or young adult years, either type can affect people of any age, and first symptoms can sometimes develop later in life. Children and young teens with bipolar disorder may have more frequent mood swings than older teens and young adults with the condition.

Bipolar disorder tends to occur among family members. Research suggests certain genes may increase the likelihood of someone developing this condition.

Diagnostic Evaluation

NYU Langone specialists diagnose bipolar disorder in children and adolescents based on a comprehensive evaluation, including in-person interviews with you and your child, both individually and together.

Our specialists assess your child’s symptoms and current functioning and discuss family history. They may also speak with your child’s teachers, other caregivers, and previous healthcare providers and ask you and them to fill out questionnaires.

To be diagnosed with bipolar disorder, a child must have experienced at least one manic episode. Most but not all children and adolescents with bipolar disorder also have intermittent depressive episodes. Occasionally, children have “mixed” symptoms, in which mania and depression occur together. “Rapid-cycling” refers to at least four episodes of mania and depression occurring within one year.

Our clinicians also evaluate for coexisting mental health conditions. Anxiety disorders and attention deficit hyperactivity disorder are frequently seen in children with bipolar disorder.

There have been misperceptions and controversy about the diagnosis of bipolar disorder, especially in younger children. Two questions have caused confusion. The first is whether the diagnosis requires that a child’s behavior and mood be different from his or her baseline. The second is whether chronic irritability alone, without mania, is sufficient for the diagnosis. These confusions resulted in a tendency for doctors to overdiagnose bipolar disorder.

Recently, children with chronic, non-episodic irritability have been diagnosed with disruptive mood dysregulation disorder, related to depression and not bipolar disorder. Our clinicians are especially skilled in clarifying the confusion and making an accurate diagnosis.

Feedback Session

After your child’s doctor has gathered the necessary information, he or she sets up a feedback session with you to discuss any diagnoses, review treatment options, and develop a comprehensive plan. Our specialists aim to help you understand how this condition affects your child and provide you with the most appropriate treatment plan to best meet your child’s—and your family's—needs.