Some children are troubled by both depressed and elevated moods. The child’s mood may shift suddenly from one extreme to the other; in other children, there is a rapid cycle between high and low moods. Although the disorder is not common in children, youngsters with sever mood changes may have a bipolar mood disorder.

 

In bipolar disorder, manic episodes usually alternate with episodes of depression and with normal moods. The manic element of bipolar or manic-depressive disorder is signaled by an elevated, expansive angry, suspicious, or irritable mood lasting at least one week.

 

During a manic episode, a child irrationally distorts her view of herself and has inflated self-esteem. She may talk constantly and rapidly, and have difficulty sticking to one idea or subject at a time. She is easily distracted, appears agitated and restless, and sleeps very little. Most alarming, she may engage in reckless and dangerous activities. Bipolar disturbance usually interferes with school functioning and/or peer and family relations.

 

Children with bipolar illness are often extremely hard to tolerate. Hyperactive, silly, giggly, and aggressive in their verbal communications, they may use profanities and sexual comments loosely during a manic episode. Delusions of grandeur (believing, for example, not just pretending, to be Superman) can lead to dangerous behaviors, like running in front of cars or jumping off roofs. A manic child is often unable to eat and sleep and she may be insensitive, mocking, or cruel to others.

 

Bipolar disorder occurs more commonly in families with mood disorders. As a result of their own intense moods and feelings, some parents with mood disorders have difficulty being consistent and effective in their parenting.

 

Children with mania may resemble those with severe attention-deficit/hyperactivity disorder. However, manic children have greater mood swings, often appearing euphoric, irritable, or suspicious.

 

Treatment of bipolar disorders (manic-depressive illness) in children should begin with a full evaluation by a child and adolescent psychiatrist or other mental health professional.

 

Individual Psychotherapy Since bipolar disorder is a lifelong condition, it is crucial that the child learn about the disorder and how to live with it. When identified, symptoms can be successfully treated and controlled. In addition, stressors that may precipitate symptoms can be avoided or reduced and coped with. When coping skills are learned, these children and their families can lead emotionally rich and productive lives.

 

Cognitive-Behavioral Therapy Often effective in treating the ups and downs of bipolar disorder in older children, cognitive therapy focuses on the irrational beliefs and distorted thoughts which are part of the mania or depression. In dealing with periods of depressions, the therapy may address the youngster’s negative view of self, the world, and the future. Such negative though patterns may have been formed or reinforced by the child’s family environment. Cognitive therapy focuses on identifying and correcting negative distortions and on helping the child change her thinking.

 

Group Therapy Group therapy for children helps them develop social skills that can lead to a greater sense of mastery and self-esteem. Children may find it easier to express feelings in a supportive group environment. Support groups for parents can help them manage specific problem behaviors, use appropriate positive reinforcement, communicate with children in an age-appropriate manner, and become better listeners for their child.

 

Family Therapy Family therapy addresses family problems that may worsen bipolar disorder in children, like a lack of generational boundaries (in which parents or caregivers treat their children as peers), severe marital conflict, rigid or chaotic rules, or neglectful or overly involved parent-child relationships. In addition, family sessions may help identify other depressed family members and assist them in getting their own treatment.

 

Medication Once other possible causes for the symptoms such as substance abuse, a medication reaction, another medical condition, or other behavioral disorders have been ruled out, a mood-stabilizing medication like lithium may be prescribed. Other mood stabilizers that have been prescribed are carbamazepine (Tegretol) and valproic acid (Depakene). Before a child begins taking a medication, specific target symptoms should be identified in a discussion between the child, the parent, and the physician. Possible side effects and other aspects of the medication should also be fully discussed. In some children, antidepressants may be needed in addition to the mood stabilizer during the depressed phase, and an antipsychotic medication may be used in combination with the mood stabilizer during the manic phase.

 

Hospitalization If recognized early, manic-depressive episodes can be treated on an outpatient basis or in partial hospital programs. When there is self-destructive or aggressive behavior toward others, hospitalization may be necessary. Some children with mania may require hospitalization to ensure their safety.