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Many of the symptoms of bipolar disorder in children are similar to those of adults with the condition. However, children may experience some symptoms slightly differently than adults. Symptoms of bipolar disorder are typically divided into two categories – mania and depression.

Symptoms of manic episodes include:

• Euphoria and elevated, “high” feelings or irritability. The patient may be in a good mood that remains even when things happen that would normally dampen the mood. For example, a child may appear extremely elated, even when waiting in a principal’s office for a reprimand. During mania, children and teenagers are more likely than adults to become irritable and to engage in destructive behavior rather than to be euphoric.
  
  
• Uncharacteristically elevated self-esteem, feelings of grandiosity or unrealistic confidence. Patients often feel very good about themselves, or feel like they can take on the world. Children may feel that they can defy logic, by being able to fly or not being subject to rules or laws.
  
  
• Decreased need for sleep. The patient may wake up feeling rested after only a few hours of sleep. Children may stay up late at night, but be extremely difficult to awaken in the morning.
  
  
• Rapid talking, talking more than usual or feeling a need to keep talking. Patients may be excessively talkative. They may be loud or talk too fast.
  
  
• “Flight” of ideas, feeling as though thoughts are racing, distraction or agitation. Patients may be easily distracted or restless. They may have rapidly shifting thoughts that may be revealed in conversation as the patient constantly changes the subject.
  
  
• Increased goal-directed activity. Productivity may be increased.
  
  
• Intrusive or aggressive behavior. The patient may seem nosy or aggressive, sometimes with destructive outbursts. Children with bipolar disorder may physically attack peers or family members during manic outbursts. This may prevent them from establishing solid peer relationships. Children may also become enraged when they are disciplined or told “no.”
  
  
• Unaware that anything is wrong. Because patients feel good and are often more productive, they may be unaware or in denial of their condition.
  
  
• Seeking pleasure without regard to consequences, reckless behavior or poor judgment. Patients may engage in sexually precocious behavior, substance abuse or other behavior when they would normally exercise better judgment. Adolescents may be sexually promiscuous, whereas younger children may use sexually explicit language or touch themselves or other people inappropriately. Bipolar children may also engage in daredevil type behavior, such as reckless driving among adolescents.

Major depressive episodes are the most common of the depressive disorders occurring in bipolar disorder. Nearly all patients will have one at some point during their lifetimes.

The symptoms of major depressive episodes include:

• Altered mood. The patient may experience sadness, anxiety, anger, irritability or apathy (lack of emotion). They may be pessimistic (feel that everything in life will turn out badly) or discouraged and may experience crying spells or excessive emotional sensitivity. Crying and irritability are common among children with bipolar disorder.
  
  
• Anhedonia. Reduction or loss of interest in activities the patient formerly found pleasurable, such as food, school, friends, hobbies and entertainment.
  
  
• Significant change in appetite or weight. Reduced or increased appetite or significant weight loss or gain.
  
  
• Changes in sleep patterns. The patient may sleep too much (hypersomnia) or not enough (insomnia). Often, the patient wakes up early in the morning and cannot get back to sleep.
  
  
• Physical or verbal activity. The patient may be agitated and anxious. They may wring their hands, pace or not be able to sit still. Conversely, the patient may have sluggish movements or speech. There may be a pause before answering questions or starting actions. The patient may speak quietly or not be able to be heard. They may not speak except in response to a direct question or may become completely mute (not talking at all).
  
  
• Fatigue and loss of energy.
  
  
• Diminished self-worth. The patient may have feelings of worthlessness, self-reproach or excessive or inappropriate guilt.
  
  
• Impaired concentration. There may be a diminished ability to concentrate.
  
  
• Death thoughts. The patient may have recurrent thoughts of death and death wishes. They may think about committing suicide (suicidal ideation) or exhibit suicidal actions. The patient may even attempt or complete suicide.

Symptoms of depression that are especially characteristic of children include physical ailments such as various body aches and fatigue. Children are also likely to encounter academic difficulties when depressed, including regular absences from school and poor academic performance. They may threaten to run away from home and may follow through on such threats. Other characteristic symptoms of depression in children with bipolar disorder include:

• Constant complaints
• Difficulty with relationships
• Extreme difficulty handling rejection or failure
• Poor communication
• Social isolation

Children with bipolar disorder sometimes display symptoms of hallucinations and delusions, which are more commonly associated with disorders such as schizophrenia.

Studies suggest that children and teens with bipolar disorder may have a more severe form of the condition than that experienced by older patients. This may include more continuous and rapid cycling between moods and greater tendency for symptoms to be “mixed” – partially depressed and partially manic. Though adults are likely to have clearly defined and separated periods of depression and mania, children may cycle between the two states several times daily.

Children with bipolar disorder are also more likely than adults to experience other mental health disorders, including attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD) and anxiety disorders.

Teens and children who have bipolar disorder are at higher risk than other youths for developing substance abuse disorders. The use of recreational drugs and alcohol may help these youths to numb themselves from the emotional imbalance and unsettled behavior associated with bipolar disorder.