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Evidence indicates that early onset bipolar disorder tends to be different and more severe than later onset. Bipolar disorder in children and young teens is often characterized by rapid-cycling, chronic irritability, and a mix of symptoms between the two states as opposed to distinct cycles of mania vs. depression. This can make it harder to recognize and diagnose.

Younger children with bipolar disorder are more likely to suffer from night terrors and bed wetting beyond the normal age. They tend to complain frequently and/or have bouts of unexplained crying. As they get older, they are more likely to have physical complaints such as stomachaches or headaches. Often they experience strong cravings, usually for carbohydrates or sweets.

Especially in adolescents, there is a notable lack of judgment as well as increased impulsivity. They are more likely to experience social isolation, particularly due to poor communication, and extreme sensitivity to failure or rejection. Adolescents often show precocious or inappropriate sexual behaviors including explicit language or even sexual acts. They are also much more likely to engage in dangerous activities or take extreme risks.

Children and adolescents with bipolar disorder are much more likely to be irritable and prone to disruptive outbursts than becoming elated or euphoric. Many experience explosive, lengthy and often destructive rages in response to minor or imagined issues. It is common for adolescents to have frequent absences from school and give a poor performance when they do attend. They also will talk about running away from home as well as be more likely to make the attempt. In general, they exhibit a marked defiance of authority that is not limited to their parents. This often leads to school suspensions and getting in trouble with the law.

Adolescents are often misdiagnosed as having borderline personality disorder, post-traumatic stress disorder (PTSD), or even schizophrenia. There are also common diagnoses that often co-occur with bipolar disorder. Many times these disorders are diagnosed and treated while hiding the underlying bipolar condition. The most frequent of these are ADHD, oppositional-defiance disorder (ODD), and conduct disorder (CD). Stimulant medications typically given for these disorders can have an adverse reaction for bipolar disorder and actually worsen symptoms of mania.

Because of the difference in symptoms compared to adult bipolar disorder, children and young adolescents are at the most risk of being left untreated. The consequences of not recognizing and treating early onset bipolar disorder can include poor performance and failure at school, scrapes with the law, higher risks of substance abuse issues, and an increased suicide rate.

Learn more about this author, Tina Golden.
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