Bipolar Disorder – Child/Adolescent Onset

Bipolar Disorder: Definition

Bipolar disorder is a biological condition that has both physical and psychological features that affects one’s functioning.   It was once believed that bipolar disorder commenced in early adulthood, however growing research suggests that identified of individuals with early features of mood instability can lead to early treatment and that establishment of early in life of a lifestyle that reduces the effects of this significant condition.

In childhood/adolescence abrupt swings of mood and energy that occur multiple times within a day, intense outbursts of temper, poor frustration tolerance, and oppositional defiant behaviors are commonplace in juvenile-onset bipolar disorder. These children veer from irritable, easily annoyed, angry mood states to silly, goofy, giddy elation, and then just as easily descend into low energy periods of intense boredom, depression and social withdrawal, fraught with self-recriminations and suicidal thoughts. At SWA we engage in a comprehensive evaluation model that involves information gathering on impacts on neurological functioning, genetic mental health risks, genetic medical risks, environmental impacts, cultural and religious information, the developmental period, the developmental progression of features, the developmental progression of diagnostic impressions, and response to environmental, clinical and psychopharmacological interventions.  Recent studies have found that from the time of initial manifestation of symptoms, it takes an average of ten years before a diagnosis is made for this disorder.

The assessment of manic features in childhood/adolescence a hallmark features of this disorder is complicated.  In our screening we ensure that medical issues are not complicating the clinical picture of mania (e.g., temporal lobe epilepsy, hyperthyroidism, head injuries, multiple sclerosis, lupus, alcohol related neurodevelopmental disorder, Wilson’s disease) and mood cycling (e.g., stimulant side effects, anti-depressant side effects, effects from Corticosteroids, effects from sympathomimetic amines, and antibiotics).  When elevating manic features we encourage screening methods that gather information based on FIND guidelines.  The FIND guidelines lead clinicians to gather information on the Frequency, Intensity, Number and Duration of features.

The Juvenile Bipolar Research Foundation is studying a group of features identified as the Fear of Harm phenotype.  These six dimensions when taken together are able to predict 96% of the children with this phenotype that they believe identify individuals with childhood onset bipolar disorder:

Territorial Aggression

  • Is wilful and refuses to be subordinated by others
  • Argues with adults
  • Defies or refuses to comply with rules
  • Is easily angered in response to limit setting
  • Is bossy towards others
  • Relentlessly pursues own needs and is demanding of others
  • Blames others for mistakes
  • Has protracted, explosive temper tantrums
  • Displays aggressive behaviour towards others
  • Has irritable mood states
  • Lies to avoid consequences of actions
  • Is intolerant of delays
  • Has difficulties maintaining friendships

Harm of Self/Others

  • Makes clear threats of violence to others or self
  • Makes moderate threats to others or self
  • Has made clear threats of suicide
  • Curses viciously, uses foul language in anger has destroyed property intentionally
  • Is fascinated with gore, blood, or violent imagery


  • Feels easily criticized and/or rejected
  • Feels easily humiliated or shames
  • Experience periods of self-doubt and poor self-esteem
  • Complains of being bored
  • Has periods of low energy and/or withdraws or isolates self
  • Has decreased initiative


  • Wets bed
  • Has night terrors and/or nightmares
  • Hoards or avidly seeks to collect objects or food
  • Has acknowledged experiencing auditory and/or visual hallucinations
  • Craves sweet tasting food
  • Has concerns with dirt, germs or contamination


  • Displays excessive distress when separated from family
  • Exhibits excessive anxiety or worry


  • Has difficulties getting to sleep
  • Has difficulties settling at night
  • Sleeps fitfully and/or awakenings in the middle of the night
  • Has difficulty arising in the AM

Bipolar Disorder: Treatment

Proper treatment of children/adolescence with bipolar affective disorder helps them to gain better control of their mood swings and the associated secondary impacts on their thoughts, feelings and decision making.  The cognitive-behavioural model of bipolar disorder is based on mood instability producing changes in thinking and feeling, which produces changes in behaviour, which leads to decreased functioning, which leads to psychosocial problems, which leads to sleep disruption, stress and other symptoms, and if unsuccessfully treated leads right back to further episodes of general mood instability.  Together we interrupt the cycle through a combination of individual therapy, education, life style changes, and as required medication.

At Stevenson, Waplak & Associates we assist children/adolescents develop an understanding of their unique features of the disorder (e.g., their symptoms, how to monitor their mood, how to recognize their triggers), learn to how to develop a mood stabilizing approach to life (e.g., what makes features worst, how to add structure and routine, add positives to life, decrease negative in life) and assist with specific symptom reduction (e.g., changing activity levels, challenging disruptive thinking, learning affective regulation skills).

We are actively with the child/adolescent every step of the way.