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THE ROAD AHEAD I BIPOLAR AND MANIA
Bipolar disorder happens when kids have intense mood swings: they may feel very sad or down for several days or weeks at a time, and then very energetic, irritable, or motivated. Mania or hypomania are the terms scientists use to talk about times when kids feel energetic, irritable, or more motivated, and depression is the term used to describe times when they feel sad or down. Explore the questions below to learn how to recognize the signs, understand what causes it, and discover effective treatment options.
What caregivers might notice in their child
Bipolar disorders are diagnoses where people experience depression and also times when their mood is better and they have a lot more energy than other kids their age. Mania, or hypomania, is what we call the times when people do not feel depressed. There are a few different diagnoses in this category and to understand the diagnoses, caregivers have to know the differences between mania or hypomania.
What causes bipolar disorder?
Bipolar disorder isn’t caused by just one thing – there are a few factors that can make it more likely that a child will develop this kind of disorder.
Kids are more energetic and their mood seems better or they can be irritable. When they are more energetic and their mood changes, they can also think more positively about themselves, need less sleep, talk more quickly, have racing thoughts, and be more impulsive. Mania is severe and causes problems in a child’s ability to function. This can include things like throwing severe tantrums, not being able to concentrate on anything, or doing risky things like using drugs, spending a lot of money very quickly, or being sexually active in ways that aren’t safe. Sometimes people need to go to the hospital when they experience mania, and sometimes they see or hear things that other people can’t see or hear.
Like what happens in mania, kids are more energetic and their mood can seem better or irritable. They might think more positively about themselves, need less sleep, talk more quickly, have racing thoughts, and be more impulsive. Unlike mania, hypomania is less severe and might not cause any problems. People might feel like they are “back to normal” or that they are more productive and happier than usual.
In a bipolar disorder, kids’ moods shift from depression to mania or hypomania. Different diagnoses are given based on these mood shifts.
Is what is diagnosed when someone has experienced at least one manic episode (their mood was elevated and their behaviors were very severe and caused problems).
Is what is diagnosed when someone has only had hypomanic and depressive episodes.
Is what is diagnosed when kids have moods that cycle back and forth but they don’t have all the symptoms that come along with mania, hypomania, or depression.
These symptoms can cause a lot of problems for kids and can make parenting really challenging. Kids with bipolar disorders also have a higher risk of suicide, which makes it really important to get help. Medications for bipolar disorder are different than medications for depression, so it’s important to make sure your child has the correct diagnosis. All kids have moods that can change quickly and all kids are irritable sometimes. If you notice your child seems to have consistent periods of time when their moods go up and down, or periods of time when they do things without thinking or can’t seem to slow down and it gets them into trouble, you may want to ask a provider about mania and hypomania.
Who is affected by bipolar & mania?
Most people who are diagnosed with bipolar disorder first have problems when they are teenagers or young adults, but we know that kids can have it too. Bipolar disorder is harder to diagnose in kids because kids experience emotions differently than adults, and they can have lots of ups and downs in their emotions as their brains and bodies grow and change. Your child’s provider will also have to make sure that mood and energy changes aren’t happening because of something else, like ADHD or disruptive behaviors.
About 1-3% of kids and teenagers have bipolar disorder. Bipolar disorder can really impact the brain, especially in kids and teenagers because their brain is still growing and changing, so it’s important to get professional help right away if you think your child may have bipolar disorder.
Treatments that work for bipolar disorder
There are a lot of things that you can do to help your child who has bipolar disorder – and you’re already taking a big step by learning more! Many kids & parents see a lot of improvement with the right support. Here are some treatments that scientists have found to help with bipolar disorder in kids:
Kids with a parent, grandparent, or sibling who struggles with bipolar disorder are usually more likely to have these symptoms too. Some scientists have found differences in brains of kids who have bipolar disorder compared with kids that don’t. But just because someone in your family has bipolar disorder, that doesn’t mean your child will automatically have it too.
Kids who experience a lot of stress or trauma might be more likely to develop bipolar disorder, especially if they already have a family history of it. Certain medications or drugs can also cause kids to experience an episode of mania or hypomania.
Cognitive behavioral therapy (CBT) is used to treat a lot of different disorders, and it can be helpful for bipolar disorder because it teaches kids to recognize how their thoughts, feelings, and actions all work together. CBT can help kids figure out when their mood is changing and why, and can teach them skills to manage their thoughts and emotions when things feel out of control.
Family focused therapy (FFT) is a type of therapy that involves the whole family in supporting a child with bipolar disorder. This is helpful because caregivers spend a lot of time with their children, and you can provide support for your child outside of therapy sessions once you learn the right skills. It’s also important because kids can’t always recognize when their moods are changing, so caregivers can learn early signs of manic and depressive episodes to help provide extra support when these things are happening.
Medication is often an important part of treatment for people with bipolar disorder, and even though people with bipolar disorder have periods of time when they are depressed, the kind of medication kids need for bipolar disorder works differently than medications people need when they have a depression disorder. This is because medication for bipolar needs to stabilize their mood and help with both the depression and the mania or hypomania. If kids take depression medication and they really have bipolar, it could actually make their moods worse. This is why it’s really important to make sure your child’s diagnosis is correct – so if your child is being treated for something and treatment doesn’t seem to be helping, you can always ask your provider if there is another diagnosis you should be considering.
There are two kinds of medications that doctors will often prescribe for kids with bipolar disorder. One type is called an atypical antipsychotic, which are medications that were originally made to help people with psychosis but can actually help with a lot of different mental health problems. These are usually recommended first for kids with bipolar disorder. The other type is called a mood stabilizer. These medications usually work well for adults with bipolar disorder, but there isn’t as much information about how well they work in children. You can ask your child’s provider about both types of medication and what they recommend for your child specifically.
It is really important for caregivers to make sure their child takes their medication consistently if that is part of their treatment plan. Sometimes, people with bipolar disorder stop taking their medication once they start to feel better, because they think they don’t need it anymore. But it’s actually the opposite – the medication is probably what is helping them feel better, and it’s really important to keep taking it as often as it is prescribed. If you think your child should stop taking their medication for any reason, consult their provider first. Sometimes another medication might be prescribed, and even if they are ready to stop taking a medication, it’s important to do this gradually with the help of a doctor, otherwise your child could have a lot of bad side effects.
It may be helpful to make a visual chart to put somewhere in your home, and add a check mark each day when your child takes their medication. Or if it’s easier for your family, apps like Medisafe and MyTherapy can give reminders to take medication and track when you miss a dose.
ADVOCATING FOR HELP I BIPOLAR AND MANIA
Getting support for bipolar disorder starts with knowing what to ask for. Use the questions below to find out how to get help, talk with providers, and access the tools your child may need.
How to get help
There are a few ways to get diagnosed with Bipolar I, Bipolar II, or Cyclothymic Disorder. Here is how you can get started:
Therapists, psychologists, and psychiatrists can help assess your child. They might do an interview with you to learn more about what’s going on, and sometimes they might have you fill out some questionnaires that ask specific things about your child’s feelings and actions. Psychiatrists can also prescribe medication, like an atypical antipsychotic or a mood stabilizer, if that is needed to manage your child’s symptoms.
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They can do a basic screening, tell you whether your child’s behaviors are typical for their age, and refer you to someone else if needed. Because bipolar disorder is less common in kids than in adults, most pediatricians don’t diagnose this very much – it’s always okay to ask your provider if they have expertise in treating bipolar disorder in kids, and if they don’t, it’s always okay to get a second opinion from another provider who has more experience in that area!
Teachers and school staff may struggle to know how to handle your child’s changing mood in the classroom and to understand why they act the way they do. In particular, the way kids behave when they are having a manic or hypomanic episode can be difficult in school. Sometimes, kids with a bipolar disorder benefit from accommodations at school (these are usually called IEP’s or 504 plans).
Click here to learn more on how to talk to your child’s school.
If my child has bipolar disorder, what treatment components should I ask my provider about?
The first step in treating bipolar disorder is usually helping kids and caregivers understand it better. Psychoeducation is just a big word to describe learning about the psychology facts related to bipolar disorder. It’s important for kids and caregivers to understand how bipolar disorder impacts the brain, and that big mood swings are a real result of things happening to the chemicals in their brains. Kids and caregivers also look at common symptoms and experiences that other kids with bipolar disorder have, and learn to track their mood so they can start to understand when they are more likely to feel sad and down (depressive episode) and when they might feel more energetic, irritable, or motivated (manic or hypomanic episode).
It can be hard to communicate well with a child who has bipolar disorder, and the way they communicate with you might change depending on how they are feeling. Kids need certain support when they feel depressed and down, and other types of support when they feel energetic or irritable. It’s super important for kids and caregivers to learn to talk to each other about what is going on and figure out how they can work together to address these symptoms.
Emotion regulation skills are things kids can use to regulate their mood. There are certain skills that might work well when they feel depressed, and other skills that might work well when they have mania or hypomania symptoms. Learning new skills won’t stop the mood episodes, but it can help kids and caregivers feel like they have more control over their episodes, and it might make them less intense.
Learning problem-solving skills can help kids feel more in control of what’s going on in their lives. Kids who have bipolar might struggle with this because their emotions often feel out of control, and it’s hard for them to predict how they might think and feel when their mood changes are so intense. When kids learn problem-solving skills, it can help them think through things more clearly, no matter how they’re feeling, and to find ways to do things differently and deal with challenges effectively.
PROGRESS OVER TIME I BIPOLAR AND MANIA
This section offers a few extra tools to help you along the way. Whether things are going smoothly or getting more challenging, these resources can support you as your child grows and their needs change.
My child has a diagnosis, now what?
Once your child has been diagnosed and is getting treatment, there are still more ways you can support them – and yourself. Here are some next steps to consider:
Know that you don’t have to figure this out alone. Parenting a child with bipolar disorder can be a challenge. Joining a parent support group (such as Parent to Parent at Children’s Village, or a Parenting Skills Class through Catholic Charities) can help you learn new strategies and get encouragement and support from other parents who are on a similar journey.
There are some excellent, practical reads written for parents like you.
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“The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder” by Demitri Papolos, M.D. and Janice Papolos
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“What Works for Bipolar Kids: Help & Hope for Parents” by Mani Pavuluri, M.D., Ph.D.
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“Positive Parenting for Bipolar Kids: How to Identify, Treat, Manage, and Rise to the Challenge” by Mary Ann McDonnell, APRN, BC, and Janet Wozniak, M.D.
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You can ask your child’s therapist or doctor to use things like behavior checklists and emotion rating scales to track what’s improving – and what still needs support. Some apps can help you track mood, behaviors, and daily routines, too (such as eMoods) which can give you helpful information to share with your child’s provider at their next visit.
Even if your child already has support at school, it’s worth checking in regularly. Ask for updated reports, suggest team meetings, and make sure accommodations are still working. You can also request changes to your child’s IEP or 504 plan if needed. See the Talking with My Child’s School section below.
My child is getting worse, what can I do?
It’s hard to see your child struggling, especially when it feels like things are getting more intense, not better. You’re not alone—and there are steps you can take to get support and stabilize things.
Every family should have a plan for what to do if things get worse or if you or your child feel unsafe. This is especially important for kids with mood disorders like bipolar because the risk of suicide and self-harm is high – but there are many ways to keep your child safe and offer support in a crisis! This might include knowing who to call during a crisis (like a mobile crisis team or behavioral health urgent care), when to head to the ER, or how to calm things down safely at home. Your provider can help you build a plan that fits your family.
Let them know what’s changed. Sometimes therapy needs to be more frequent or focused differently, or something needs to be changed in your child’s routines or environment. Be specific about what you’re seeing: more depressive episodes, bigger meltdowns, school issues, more frequent outbursts, etc. This will help your provider to identify areas of change that might help your child.
Medication support is often a key part of treatment for people with bipolar disorder, but it can take time to find the right medication, schedule, and dosage for your child. Ask your child’s provider if it might be an appropriate time to try a new medication, or if it’s best to wait and see if their current treatment will help with time.
Some communities offer “wraparound” programs that bring together a team to support your child across home, school, and community settings. This can be helpful for kids with bipolar disorder because it makes it easier to track where symptoms are showing up and get their whole care team on the same page with how to provide support. Ask your provider if there are different types of services that could be a good fit for your child.
When your child is struggling it can take a toll on your whole family. Connecting with other parents, talking to a therapist, or simply having a support system in place can help you stay grounded while you’re supporting your child.
Talking with my child’s school
Your child spends a big part of their day at school—so it’s important that their learning environment supports their needs. You don’t have to be an expert in education law to advocate for your child. Here’s how to get started:
If your child already has a 504 Plan or IEP, you can call a meeting anytime – not just during annual reviews. Share your concerns, ask for updates, and discuss if changes need to be made. If your child doesn’t have a plan yet, you can formally request an evaluation to see what supports they qualify for.
Schools respond best to clear examples. Keep track of patterns—like missed assignments, behavior changes, or stress around certain subjects. You can also ask your provider to write a summary of concerns or diagnoses to share.
Resources like Wrightslaw explain special education laws in parent-friendly language. Knowing your rights helps you feel more confident in meetings and ensures your child gets what they’re entitled to.
Understood.org and wapave.org is a great website full of free tools, templates, and stories from families navigating similar school challenges. It can help you figure out what to ask for and how to phrase it.
A behavioral health consultant or educational advocate can go to meetings with you, help interpret school evaluations, and suggest goals that actually match your child’s needs. This kind of support can make a big difference—especially if meetings feel overwhelming or you’re not sure what to ask for.
CAREGIVER TOOLKIT I BIPOLAR AND MANIA
This section offers simple, practical tools to help you support your child—from building routines and healthy habits to improving communication and recognizing their strengths. It’s also a reminder that taking care of yourself is part of the plan—you’re not alone on this journey.
Daily habits that help
Most kids thrive on routine and consistent structure, and this is especially true for your child with bipolar disorder. Having structure and routine lets kids know what to expect, even when their mood and feelings are constantly changing, and helps them feel safe. If you haven’t had a lot of routine, structure, or consistency before, it’s likely that your child will push back on this at first and you might see their behaviors and moods get worse for a period of time. This is normal, but it can be helpful to work with a professional to do this right and stay on track with routines that you know will help your child in the long run.
Sleep is important for any child as their brains and bodies grow, but it is even more important for your child with bipolar disorder. When kids don’t get enough sleep, this can start a hypomanic or manic episode, or it can make a depressive episode worse. Kids with severe mania might not want to or be able to sleep during their manic episodes, so if this is your child, talk to your provider about this at the beginning of treatment so you can make sure your child is physically safe when this happens. Many medications for bipolar disorder will help with sleep issues over time. As this stabilizes, focus on going to bed and getting up at the same time each day, and talk to your pediatrician about how much sleep your child should be getting.
Kids with bipolar disorder often don’t know exactly when or why their mood changes. Sometimes there isn’t a reason why – that’s part of the nature of bipolar disorder. It can feel like these mood changes come out of nowhere and are completely unpredictable. However, many times there are some patterns that can help you figure out when your child may start a manic, hypomanic, or depressive episode. And even if patterns are hard to find, there are likely early symptoms that a mood episode is about to start, before it gets really challenging.
You can find these patterns and early symptoms by spending a few weeks tracking your child’s mood. The longer you are able to do this, the more likely you will identify patterns. You’ll look for any factors that may have been involved. Did your child get less sleep than usual for a few nights in a row? Has it been several weeks since their last mood episode? Did they have more or less energy than usual in the morning? Did they have a hard time concentrating at school? If you can find a pattern or some early symptoms, that’s the first step to making meaningful change!
You can find a sample mood tracker here
Your child will be learning a lot of new coping skills and ways to regulate their emotions as they go through treatment for bipolar disorder. The best time to practice these skills is before you need them – don’t wait until your child is in the middle of a mood episode to start using these skills! Just like you practice playing a sport before a game, or practice playing music on your instrument before a concert, you want your child to learn how to use these skills before the high-stress situation when you really need them. Make time as a family to work on some deep breathing, relaxation exercises, or other activities that may help your child when they’re struggling. That way, when it’s time to use them, your child knows exactly what to do!
Caregiver self-care
Parenting a child with bipolar disorder is a big job. It’s okay to ask for help, and it’s good for your child to learn that they can also ask others for help when they need it!
Take breaks when you can. It makes a big difference when you can be consistent, patient, and supportive in the way you respond to your child – even when they have big feelings and changing moods. In order to do this, you need other people in your corner to support you. Take care of yourself first so you can show up for your child when they need you.
Your child has a lot of big emotions and changing moods, and you might have a lot of big feelings too since you’re on this journey with them! It’s important to acknowledge what you’re feeling and work on being able to name it. You might say things like “I woke up feeling frustrated today” or “This happened to me today and it made me feel excited!” Showing your child it’s okay to talk about positive emotions (like happiness and excitement) as well as negative emotions (like anger, sadness, and anxiety) makes it possible for them to do the same thing.
Find a way to check in with both yourself and your child on how things are going that day. This doesn’t have to be a big conversation every day, but find a way to briefly identify their mood and energy level. Maybe your teenager chooses some emojis (one for sad and down, one for neutral, and one for excited and energetic) and texts one to you at the same time every day to let you know how they’re feeling. Maybe your younger child has an emotion poster or color chart that they can point to in the morning to let you know how they’re feeling that day. Get creative and find something that works for your family.
It can be hard when their moods and attitudes towards you change often, and it’s easy for a lot of your interactions with your child to focus on what’s not going well and what needs to change. Look for sweet pictures of them, write down funny stories, and think about positive characteristics they have that stay the same no matter how they are feeling (does your child always look out for others? Do they care for animals? Do they always greet you with a joke or a smile?). When you feel frustrated or hopeless about how things are going with your child, looking back on positive memories can help remind you how much you love them and why you’re working so hard on this journey to support them. And while you’re at it – share some of these positive things with them so they can focus on what’s going well, too!
Find ways that work for you and your child to spend time together doing something you love (bonus points if it is a creative activity or something that allows you to think about and express your emotions). Things like art, journaling, or listening to music can help older kids and teenagers focus on their feelings, while doing something they enjoy. Participate in these things with them if you can, because they’re good for adults too!
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