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Bipolar disorder is a mental illness characterized by one or more episodes of mania (emotional highs) or mixed episodes (in which manic episodes coincide with episodes of major depression on a daily basis for at least a week). The condition was formerly called manic-depressive illness. The onset of bipolar disorder usually occurs in late adolescence or early adulthood, and the average age of onset is 20 years. However, the disorder can occur at any age, including during childhood. Many people who are diagnosed with bipolar disorder in their 20s report experiencing symptoms during childhood.

Most healthy people experience swings in mood. This is true of children as well. However, people with bipolar disorder experience severe shifts in mood that alternate between periods of extreme energy and impulsive behavior (mania) and periods of sadness, hopelessness and loss of interest in activities (depression). These severe mood swings typically impair a patient’s functioning at work or school and affect relationships with family and peers.

Children with bipolar disorder also experience these mood swings, although in many cases they are more likely than adults to experience these moods at the same time, a condition known as a mixed state. Among adults, the mood swings take place over a period of weeks or months. Children with bipolar disorder may cycle rapidly between moods within the same day.

Approximately one-third of the 3.4 million children and adolescents diagnosed with depression in the United States may be experiencing the early stages of bipolar disorder, according to the American Academy of Child and Adolescent Psychiatry.

Children with bipolar disorder may display behavior that changes rapidly and unpredictably. They may be aggressive at one point, then suddenly appear withdrawn later on. These mood changes significantly interfere with a child’s ability to function and to enjoy life. Academic performance, friendships and especially family relationships can all be affected.  

Bipolar disorder typically does not affect a person until late adolescence or early adulthood. Although physicians and other mental health professionals are now more aware of the role of this disorder in childhood, many experts believe it is still underdiagnosed in children and adolescents. The symptoms associated with bipolar disorder are also associated with other mental health disorders in children, including attention deficit hyperactivity disorder (ADHD) and anxiety disorders.

In addition, parents and others often view unpredictable behavior as a normal part of childhood and adolescence, and as a result may be less likely to identify problem behavior. However, bipolar behavior may have serious consequences if not addressed with treatment. People with bipolar disorder, including children, have an increased risk of suicide. Children with the condition may also engage in risk-taking behaviors, such as attempting to fly. Their behavior may also be extremely disruptive in school and at home.

A recent study conducted by the U.S. National Institute of Mental Health (NIMH) found that bipolar children and adolescents tended to misread neutral facial expressions as hostile, which may account for the poor social skills, aggression and irritability often seen in children with the disorder.