National Institute

of Mental Health

Disorder Bipolar

in Children and Teens
Does your child go through extreme changes in mood and 

behavior? Does your child get much more excited or much 

more irritable than other kids? Do you notice that your child 

goes through cycles of extreme highs and lows more often 

than other children? Do these mood changes affect how your 

child acts at school or at home?

Some children and teens with these symptoms may have 

bipolar disorder, a brain disorder that causes unusual shifts in 

mood, energy, activity levels, and day-to-day functioning. With 

treatment, children and teens with bipolar disorder can get 

better over time. 

What is bipolar disorder?

Bipolar disorder is a mental disorder that causes people to experience 

noticeable, sometimes extreme, changes in mood and behavior. Sometimes 

children with bipolar disorder feel very happy or “up” and are much more 

energetic and active than usual. This is called a manic episode. Sometimes 

children with bipolar disorder feel very sad or “down” and are much less active 

than usual. This is called a depressive episode.

Bipolar disorder, which used to be called manic-depressive illness or manic 

depression, is not the same as the normal ups and downs every child goes 

through. The mood changes in bipolar disorder are more extreme, often 

unprovoked, and accompanied by changes in sleep, energy level, and the ability 

to think clearly. Bipolar symptoms can make it hard for young people to perform 

well in school or to get along with friends and family members. Some children 

and teens with bipolar disorder may try to hurt themselves or attempt suicide.

Most people are diagnosed with bipolar disorder in adolescence or adulthood, 

but the symptoms can appear earlier in childhood. Bipolar disorder is often 

episodic, but it usually lasts a lifetime.

Signs and symptoms of bipolar disorder may overlap with symptoms of other 

disorders that are common in young people, such as attention-deficit/

hyperactivity disorder (ADHD), conduct problems, major depression, and 

anxiety disorders. Diagnosing bipolar disorder can be complicated and 

requires a careful and thorough evaluation by a trained, experienced mental 

health professional. 

With treatment, children and teens with bipolar disorder can manage their 

symptoms and lead successful lives.
What causes bipolar disorder?

The exact causes of bipolar disorder are unknown, but several factors may 

contribute to the illness. 

For example, researchers are beginning to uncover genetic mechanisms that 

are linked to bipolar disorder and other mental disorders. Research shows that 

people’s chance of having bipolar disorder is higher if they have a close family 

member with the illness, which may be because they have the same genetic 

variations. However, just because one family member has bipolar disorder, it 

does not mean that other members of the family will have it. Many genes are 

involved in the disorder, and no single gene causes it.

Research also suggests that adversity, trauma, and stressful life events may 

increase the chances of developing bipolar disorder in people with a genetic 

risk of having the illness.

Some research studies have found differences in brain structure and function 

between people who have bipolar disorder and those who do not. Researchers 

are studying the disorder to learn more about its causes and effective treatments. 

What are the symptoms of bipolar disorder?

Mood episodes in bipolar disorder include intense emotions along with significant 

changes in sleep habits, activity levels, thoughts, or behaviors. A person with 

bipolar disorder may have manic episodes, depressive episodes, or “mixed” 

episodes. A mixed episode has both manic and depressive symptoms. These 

mood episodes cause symptoms that often last for several days or weeks. During 

an episode, the symptoms last every day for most of the day.

These mood and activity changes are very different from the child’s usual 

behavior and from the behavior of healthy children and teens. 

Children and teens having a manic episode may:

• Show intense happiness or silliness for long periods of time.

• Have a very short temper or seem extremely irritable. 

• Talk fast about a lot of different things.

• Have trouble sleeping but not feel tired.

• Have trouble staying focused, and experience racing thoughts.

• Seem overly interested or involved in pleasurable but risky activities.

• Do risky or reckless things that show poor judgment.
Children and teens having a depressive episode may:

• Feel frequent and unprovoked sadness.

• Show increased irritability, anger, or hostility.

• Complain a lot about pain, such as stomachaches and headaches.

• Have a noticeable increase in amount of sleep.

• Have difficulty concentrating.

• Feel hopeless and worthless.

• Have difficulty communicating or maintaining relationships.

• Eat too much or too little.

• Have little energy and no interest in activities they usually enjoy.

• Think about death, or have thoughts of suicide.

Can children and teens with bipolar disorder 

have other problems?

Young people with bipolar disorder can have several problems at the same 

time. These include:

• Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of 

misusing alcohol or drugs.

• Attention-deficit/hyperactivity disorder (ADHD). Children and teens who 

have both bipolar disorder and ADHD may have trouble staying focused.

• Anxiety disorders. Children and teens with bipolar disorder also may have an 

anxiety disorder.

Sometimes extreme behaviors go along with mood episodes. During manic 

episodes, young people with bipolar disorder may take extreme risks that they 

wouldn’t usually take or that could cause them harm or injury. During depressive 

episodes, some young people with bipolar disorder may think about running 

away from home or have thoughts of suicide.

If your child shows signs of suicidal thinking, take these signs seriously 

and call your child’s health care provider. 

If you think your child is in crisis and needs immediate help, call 911. 

You also can call the National Suicide Prevention Lifeline (Lifeline) at 

1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). 

The deaf and hard of hearing can contact the Lifeline via TTY at 

1-800-799-4889. These services are confidential, free, and available 24/7. 
How is bipolar disorder diagnosed?

A health care provider will ask questions about your child’s mood, sleeping 

patterns, energy levels, and behavior. There are no blood tests or brain scans 

that can diagnose bipolar disorder. However, the health care provider may use 

tests to see if something other than bipolar disorder is causing your child’s 

symptoms. Sometimes health care providers need to know about medical 

conditions in the family, such as depression or substance use. 

Other disorders have symptoms like those of bipolar disorder, including ADHD, 

disruptive mood regulation disorder, oppositional defiant disorder, conduct 

disorder, and anxiety disorders. It also can be challenging to distinguish bipolar 

disorder from depression that occurs without mania, which is referred to as 

“major depression.” A health care provider who specializes in working with 

children and teens can make a careful and complete evaluation of your child’s 

symptoms to provide the right diagnosis. 

How is bipolar disorder treated?

Children and teens can work with their health care provider to develop a treatment 

plan that will help them manage their symptoms and improve their quality of life. 

It is important to follow the treatment plan, even when your child is not currently 

experiencing a mood episode. Steady, dependable treatment works better than 

treatment that starts and stops. 

Treatment options include:

• Medication. Several types of medication can help treat symptoms of bipolar 

disorder. Children respond to medications in different ways, so the right type of 

medication depends on the child. This means children may need to try different 

types of medication to see which one works best for them. Some children may 

need more than one type of medication because their symptoms are complex. 

Children should take the fewest number of medications and the smallest doses 

possible to help their symptoms. A good way to remember this is “start low, 

go slow.” Medications can cause side effects. Always tell your child’s health 

care provider about any problems with side effects. Do not stop giving your 

child medication without speaking to a health care provider. Stopping medication 

suddenly can be dangerous and can make bipolar symptoms worse.

• Psychosocial Therapy. Different kinds of psychosocial therapy can help children 

and their families manage the symptoms of bipolar disorder. Therapies that 

are based on scientific research—including cognitive behavioral approaches 

and family-focused therapy—can provide support, education, and guidance to 

youth and their families. These therapies teach skills that can help people 

manage bipolar disorder, including skills for maintaining routines, enhancing 

emotion regulation, and improving social interactions. 
What can children and teens expect from treatment?

With treatment, children and teens with bipolar disorder can get better over time. 

Treatment is more effective when health care providers, parents, and young 

people work together.

Sometimes a child’s symptoms may change, or disappear and then come back. 

When this happens, your child’s health care provider may recommend changes 

to the treatment plan. Treatment can take time, but sticking with the treatment 

plan can help young people manage their symptoms and reduce the likelihood 

of future episodes.

Your child’s health care provider may recommend keeping a daily life chart or 

mood chart to track your child’s moods, behaviors, and sleep patterns. This may 

make it easier to track the illness and see whether treatment is working.

How can I help my child or teen?

Help begins with the right diagnosis and treatment. Talk to your family health 

care provider about any symptoms you notice.

If your child has bipolar disorder, here are some basic things you can do:

• Be patient.

• Encourage your child to talk, and listen to your child carefully.

• Pay attention to your child’s moods, and be alert to any major changes.

• Understand triggers, and learn strategies for managing intense emotions 

and irritability.

• Help your child have fun.

• Remember that treatment takes time: sticking with the treatment plan can help 

your child get better and stay better. 

• Help your child understand that treatment can make life better.

How does bipolar disorder affect caregivers and families?

Caring for a child or teenager with bipolar disorder can be stressful for parents 

and families. Coping with a child’s mood episodes and other problems—such as 

short tempers and risky behaviors—can challenge any caregiver. 

It is important that caregivers take care of themselves, too. Find someone you 

can talk to or consult your health care provider about support groups. Finding 

support and strategies for managing stress can help you and your child.
Where do I go for help?

If you’re not sure where to get help, your doctor, pediatrician, or other family health 

care provider is a good place to start. A health care provider can refer you to a 

qualified mental health professional, such as a psychiatrist or psychologist, who 

has experience treating bipolar disorder and can evaluate your child’s symptoms. 

You can learn more about getting help and finding a health care provider on 

the National Institute of Mental Health website at www.nimh.nih.gov/findhelp. 

Hospital health care providers can help in an emergency. The Substance Abuse 

and Mental Health Services Administration (SAMHSA) has an online tool at 

https://findtreatment.samhsa.gov to help you find mental health services in 

your area. 

I know someone who is in crisis. What do I do?

If you know someone who might be thinking about hurting themselves or 

someone else, get help quickly.

• Do not leave the person alone.

• Call 911 or go to the nearest hospital emergency room.

• Call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255) 

or the toll-free TTY number at 1-800-799-4TTY (4889). You also can text the 

Crisis Text Line (text HELLO to 741741) or go to the National Suicide Prevention 

Lifeline website at https://suicidepreventionlifeline.org. 

What should I know about clinical trials?

Clinical trials are research studies that look at new ways to prevent, detect, or 

treat diseases and conditions. Although individuals may benefit from being part 

of a clinical trial, participants should be aware that the primary purpose of a 

clinical trial is to gain new scientific knowledge so that others may be better 

helped in the future. 

Researchers at NIMH and around the country conduct clinical trials with patients 

and healthy volunteers. Talk to your health care provider about clinical trials, 

their benefits and risks, and whether one is right for you. For more information, 

visit www.nimh.nih.gov/clinicaltrials.
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For More Information

NIMH website

www.nimh.nih.gov

MedlinePlus (National Library of Medicine)

https://medlineplus.gov

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ClinicalTrials.gov

www.clinicaltrials.gov

(En español: https://salud.nih.gov/investigacion-clinica)

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 20-MH-8081 

Revised 2020

National Institute

of Mental Health