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Parents who observe behaviors associated with bipolar disorder in their children for at least two weeks are urged to schedule an examination with their child’s primary physician. The onset of bipolar disorder may begin with either a depressive or a manic episode.

Diagnosing bipolar disorder in children can be difficult. In addition, some symptoms that appear to be related to bipolar disorder may actually be the result of another disorder such as anxiety disorders and attention deficit hyperactivity disorder. Children exposed to physical abuse, sexual abuse or domestic violence may display severe shifts in mood. In such cases, a diagnosis of post-traumatic stress disorder may be more appropriate than a diagnosis of bipolar disorder. Many drugs, both legal and illegal, can produce the symptoms of bipolar disorder.

Children with bipolar disorder often do not fully meet the diagnostic criteria established for adults. However, the condition in children may be more severe than in adults. It may be characterized by a continuous state of rapid cycling, mixed symptoms of mania and depression.

Bipolar disorder is often underdiagnosed and misdiagnosed in patients of all ages. According to the National Mental Health Association (NMHA), up to 80 percent of patients with the condition go undiagnosed or misdiagnosed for up to 10 years. However, there may be an overrepresentation of bipolar disorder in higher social-economic and education groups. This may be because these groups may be more aware of the disorder and are more likely to acknowledge and accept mental health disorders.

Before bipolar disorder can be diagnosed, a physician must perform a physical examination of the child to rule out other potential causes of the symptoms. Many medications or medical conditions (e.g., viral infections) can cause symptoms similar to those of bipolar disorder. Lab tests may also be ordered, particularly to check for thyroid dysfunction, which can produce the symptoms of bipolar disorder or make the symptoms of bipolar disorder worse in people with the disorder. Urine toxicology may be ordered to detect mood-altering drugs that can cause similar changes in mood.

The actual diagnosis of bipolar disorder begins with a mental health evaluation performed either by a primary care physician or by referral to a mental health professional, typically a child and adolescent psychiatrist. This evaluation includes a complete history of symptoms, including when they started, how long they have lasted and how severe they are. It is also noted whether the child has had these symptoms before and, if so, whether and how they were treated. The Mood Disorder Questionnaire (MDQ) may be used, as well. This is a set of questions for the patient to answer that helps to determine if the child has had any previous manic symptoms.

The physician or mental health professional will also ask about whether the child has thought about death or suicide and whether other family members have had a mood disorder or history of alcohol and drug use.  The family’s medical history is especially important in identifying bipolar disorder in children. Many children with the condition have a bipolar parent or other family member, although the parent’s condition may remain undiagnosed.

Bipolar disorder is generally characterized by many separate episodes of mania. For an episode to be considered a new episode, the following criteria must exist:

• There must be a shift in mood or lapse of time. The patient must display a drastic shift in mood, such as from major depression to mania. A new episode may also be diagnosed if it is separated from the previous episode by at least two months of normal mood. However, most children with bipolar disorder do not meet this standard because their mood swings occur more rapidly.
  
  
• Episodes must occur spontaneously. They cannot be directly caused by a general medical condition or the use of prescription or illegal substances.
  
  
• Psychotic disorders (e.g., schizophrenia) must be ruled out.

Diagnosis of bipolar disorder in children is largely dependent on symptoms. It is especially difficult because the symptoms change rapidly and may only occur at home and be observed only by family members or caregivers.