Children and adolescents will have symptoms that are somewhat different from the adult forms of bipolar disorder. Mood swings, such as mania and depression, will typically not meet the DSM-IV duration criteria (days to weeks). More typically, mood symptoms are intense and rapid, often lasting minutes to hours, with several occurring over the course of the day.
Other symptoms of mania, mixed, depressed, and hypomanic states seen in the adult forms of bipolar disorder will be present, but need to be evaluated in terms of the child or adolescent’s developmental stage, that is, some symptoms look different in the childhood forms of bipolar disorder.
• Irritability, This can manifest as intense rages and tantrums, often triggered by seemingly trivial frustrations.
• Grandiosity, This might take the form of out-of-proportion role play: the difference between throwing on a cape and saying “I’m Superman” and running around the back yard vs. throwing on a cape, saying “I’m Superman,” and jumping off a two-story roof with the belief that you can actually fly.
• Euphoria, an over-the-top feeling of well being
• Diminished sleep, but not feeling tired
• Rapid, or pressured, speech
• Racing thoughts
• Increase in goal-directed activities, Staying up all night and writing a book, or deciding to put on a play and then running around the neighborhood to collect money for tickets, while simultaneously bullying playmates into long rehearsals.
• Excessive involvement in pleasurable or risky activities, This can even include sexually provocative behavior in very young children. A prepubertal boy asking women, often strangers, for kisses, or wanting to feel their breasts. Older children and teens may become sexually promiscuous.
• Psychotic symptoms, These must be differentiated from the normal make-believe of childhood. It’s more than having an imaginary friend, and can assume bizarre proportions, including hearing voices and seeing visions.
• Suicidal thinking and behaviors
One insightful literary description of bipolar disorder in children can be found in the early chapters of Danielle Steele’s excellent biography of her son who had bipolar disorder, His Bright Light: The Story of Nick Traina.