A youngster can experience either phase of the disorder, the depression or the mania, anywhere from several days to several months. She can be passive, lethargic, have difficulty sleeping or eating, be uncaring about her physical state, or even be agitated. At least once, the youngster easily and unpredictably switched to being manic, as evidenced by elevated mood, grandiosity, seemingly unlimited energy despite a lack of sleep, risky behavior, lack of awareness of usual human limits, possible delusions and hallucinations, and losing touch with reality. A rapid sequencing of thoughts that at first may seem illogical, but are actually related to one another. For some youngsters, periods of time when they are functioning quite well and have 'normal moods' are interspersed with periods of time when they are manic or depressed.
Mixed presentations are most common for pre-pubertal children.
Teens show discrete manic and depressive episodes. Less common are youngsters who cycle rapidly, four times a year, or day to day, alternating between depression and mania. Many of the signs of ADHD and Bipolar mixed presentation overlap. Forty percent of Bipolar preteens also have ADHD, which usually starts first. The youngster with Bipolar Disorder also has the defining feature of moodiness.