Bipolar disorder is a serious mental illness characterized by recurrent episodes of depression, mania, and/or mixed symptom states. These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning. Children with bipolar disorder are at risk for school failure, substance abuse, and suicide.

This disorder is difficult to recognize and diagnose in young children, mainly because it does not fit precisely the symptom criteria established for adults. Besides, its symptoms can resemble or co-occur with those of other common childhood-onset mental disorders. In addition, symptoms of bipolar disorder may be initially mistaken for normal emotions and behaviors of children and adolescents.

Manic symptoms include:

• Severe mood swings- either extremely irritable or overly silly and elated
• Grandiose behavior
• Hyper-activity
• Less requirement of sleep- can go on without sleep for days together.
• Highly talkativeness- talks too fast, on too many topics at the same time and changes topics too quickly.
• Lack of attention span
• Hyper-sexuality - increased sexual thoughts, feelings, or behaviors; use of explicit sexual language
• Aggressive and violent behavior
• Undertaking risky activities without thinking about the consequences.
  

Depressive symptoms include:

• Often sad or irritable
• Lack of interest in activities once enjoyed
• Change in eating pattern and body weight
• Irregular sleeping habits - difficulty in sleeping, oversleeping, lack of sleep
• Physical agitation or slowing
• Inactive behavior - loss of energy
• Feeling of worthlessness or in appropriate guilt
• Recurrent thoughts of death or suicide

Early intervention by a skilled clinician is essential, because early onset bipolar disorder can sometimes be difficult to diagnose. There is no specific test for the illness, the disorder is often accompanied by other psychiatric disorders, and many symptoms overlap. Bipolar disorder in children often begins with major depression marked by chronic irritability. Treatment with the wrong medications-stimulants and antidepressants in particular-can result in significant worsening of the illness. Prompt diagnosis and appropriate treatment, however, can lead to much more stable lives for these children and their families.

It is essential to treat bipolar disorder with medication, typically consisting of mood stabilizers in combination with other drugs, in order to stabilize the child's mood and to prevent worsening of symptoms. In addition, some kind of behavior or interpersonal therapy may be helpful to help children learn ways to control behavior and learn new behaviors, as well as come to accept the realities of their life-long disorder.

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