Here’s how bipolar in young children contrasts with adult-onset bipolar disorder:
No longer rare
One study that looked at bipolar symptoms in children under 18 is shedding light on why psychiatrists used to think pediatric bipolar disorder was a rare diagnosis, says Francis Mark Mondimore MD. “Although adolescents with bipolar have symptoms similar to those of adults, bipolar disorder in young children can appear rather different.” Doctors now recognize and treat the disorder in young people, but it is still an under-recognized illness.
First signs
The first sign of bipolar disorder in children is frequently major depression, instead of mania or hypomania as is the case with adults. Also, several studies indicate that 20 to 30 percent of young children with major depressions develop manic symptoms later in life.
Course of the disorder
The most striking difference between childhood-onset and later-onset bipolar is the course of the condition, notes Mondimore. “Pediatric bipolar is a much more continuous illness than adult bipolar. In most adults, the illness appears in discrete episodes of depression or mania, and the symptoms go into remission for months or years at a time. Children, in contrast, often have long periods of continuous rapid cycling. These children sometimes cycle between depression and mania several times a day…”
Complex pattern
One study of bipolar in the pediatric age range described children who had more than one hundred mini-manias in a year, mood episodes that lasted only a day or two. In this study, none of the research subjects under the age of nine had a single mood episode lasting two weeks or more as his only episode. For these children, a complex pattern of frequent, short episodes was the rule, not the exception.
The genetic factor
It appears that when bipolar disorder occurs in young children (before puberty), it is a more severe form of the illness, Mondimore writes. “Perhaps this is because children who develop symptoms of bipolar disorder at so young an age have a heavier genetic ‘loading’ for mood disorders than do people whose symptoms begin later.” There are typically more individuals with mood disorders in the families of children with bipolar disorder than adult-diagnosis patients and for many of these children, mood disorders exist on both sides of a family.
Unique difficulties
The onset of bipolar disorder can come at any age, but when it occurs during childhood, it presents some unusual difficulties that differ from its adult counterpart, explains Sheryl M. Hakala MD. “Children are still growing and reaching developmental milestones. They are establishing their identity and discovering their place in the world. When bipolar disorder strikes during this time period, it interrupts this normal developmental process. They face difficulties unique to the pediatric population as they attend school and try to make social connections and to handle the already difficult transition to puberty.”
More volatile
Generally, with pediatric bipolar, mood swings are more volatile than in adult-onset, Hakala explains in her book Childhood Bipolar Disorder Answerbook. Adults with bipolar disorder may spend weeks or months in one mood phase before switching to another; they also experience periods of wellness in between. However, children with bipolar disorder experience very few periods of wellness, and their moods swing rapidly between the extremes.
Mixed state
The pediatric population is much more likely to experience chronic irritability than the “high” feelings of euphoria that accompany mania, Hakala writes. “Children spend more time in a mixed state, meaning that they are experiencing symptoms of both mania and depression at the same time.” They are also more prone to experiencing a co-occurring condition, such as ADHD, anxiety disorders, or learning disabilities.
More chronic
Not unlike other illnesses that onset during youth, childhood bipolar disorder is considered more chronic and more ever-present than its adult counterpart, says Hakala. “Some believe these differences constitute a completely different illness altogether. Hopefully, current ongoing research will clarify the degree of difference in the expression of the illness between adults and children.”
Late-teen onset
The late-teen onset is more likely to resemble the adult-onset characteristics of the disorder rather than the younger childhood onset. This includes longer periods of time spent in one mood state before switching to another. The development of older teens may be less affected by the symptoms of the illness simply because they have already reached certain developmental milestones before the onset of symptoms.
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