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Bipolar disorder in children and adolescents is being addressed more intensively and studies are being conducted to investigate safe and effective treatment. The prevalence of bipolar disorder in adolescents is estimated at 1%. However, the prevalence in children is much more difficult to determine partly because symptoms in children may differ subtly from those of adolescents and adults making diagnosis harder to identify. Bipolar disorder in children and adolescents impacts normal child/teenage development, academic performance, relationships, and social/family functioning. As a general rule, symptoms of bipolar disorder in adolescents are more similar to symptoms of bipolar disorder in adults, whereas symptoms of childhood bipolar disorder can be quite different.

Onset of bipolar disorder during childhood and adolescence appears to be a more severe form of bipolar than adult onset and there tends to be more psychosis involved. When the young patients reach their late 20's or early 30's, the manifestations and characteristics of bipolar usually become more typical of adult-onset bipolar disorder. Children and adolescents also tend to experience very rapid mood swings many times a day. Bipolar disorder in youth is usually chronic and is also accompanied by a significant risk for suicide. As with adults, any mention of thoughts about suicide voiced by a child or adolescent with bipolar should be taken very seriously and appropriate help should be sought.

While the criteria for diagnosis in children and adolescents are similar as for adults, (i.e., episodes of mania and depression) children may experience these episodes differently, exhibiting characteristic such as:

• Mixed symptoms
• Rapid-cycling many times a day
• Emotional lability
• Explosive outbursts

Children with bipolar disorder tend to have longer states of irritability, agitation, belligerence and mood lability, rather than discreet episodes. They may exhibit significant aggression during these states. They also have additional problems with attention in general, but especially in school during this time since, the restriction of movement during the day at school exacerbates the agitation.

For many children, the first episode may be major depression and the transition to bipolar states may later develop. It is common to see children experience depressive states in the morning that is followed by increasing energy and mania later in the afternoon or evening. Studies indicate that 33-45% of the children whose first episode is depression develop subsequent episodes of mania or hypomania. Children with mania tend to be more irritable and prone to destructive tantrums versus adults who tend to be elated and happy. Mixed symptoms are also very common in children.

Treatments used for children and adolescents with bipolar disorder are similar to those used for adults, (e.g., medication and counseling). Although there are few studies which have evaluated long term safety and efficacy of medications used by adults, for children those medications are used as the basis of treatment. Treatments used for this population include mood stabilizers, antipsychotics, and electroconvulsive therapy (ECT).

Family history of affective or mood disorders is a significant predictor of bipolar disorder in prepubertal children who experience at least one episode of major depression. In a study of 37 families in which at least one parent had bipolar disorder, 51% of their offspring had psychiatric disorders; 28% were diagnosed with ADHD, approximately 15% were diagnosed with bipolar disorder and another 15% with major depression.