Bipolar disorder is a biological brain disorder causing severe fluctuations in mood, energy, thinking and behavior. It was previously known as manic depression, as it causes moods to shift between mania and depression. Children—whose symptoms present differently than those of adults—can experience severe and sudden mood changes many times a day.
Symptoms of mania and depression can also occur simultaneously. Young people with this disorder are frequently anxious and have very low frustration tolerance.

At least three quarters of a million American children and teenagers struggle with bipolar disorder, most of them undiagnosed and untreated. Children with bipolar disorder are at risk for school failure, substance abuse, and suicide. The lifetime mortality rate for bipolar disorder (from suicide) is higher than some childhood cancers. Yet children who are stable and have the right support can thrive in school and develop satisfying peer relationships.

Commonly Seen Behaviors:
Crying for no apparent reason
An expansive or irritable mood
Depression
Rapidly changing moods lasting a few minutes to a few days
Explosive, lengthy, and often destructive rages
Separation anxiety
Defiance of authority
Hyperactivity, agitation, and distractibility
Sleeping too little or too much
Night terrors
Strong and frequent cravings, often for carbohydrates and sweets
Excessive involvement in multiple projects and activities
Impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
Dare devil behaviors
Inappropriate or precocious sexual behavior
Delusions and hallucinations
Grandiose belief in personal abilities that defy the laws of logic (ability to fly, knows more than the teacher or principal)
Extreme irritability

Depressed children may not appear to be sad. Instead they may withdraw, not want to play, need more sleep than usual, display chronic irritability, or cry for no obvious reason. Children may also talk of wishing to die and may need to be hospitalized for harm to themselves or others.

Symptoms of mania may include elation, grandiose thinking, racing thoughts, pressured speech, hypersexuality, and decreased need for sleep. Since hyperactivity can be seen in both bipolar disorder and ADHD, a growing number of researchers believe that many children who are diagnosed with "severe ADHD" may actually have undiagnosed bipolar disorder.

Bipolar disorder is a chronic, lifetime condition that can be managed, but not cured, with medication and lifestyle changes. Because the symptoms wax and wane on their own, and children’s bodies change as they grow, managing medication to ensure continued stability is a complex and ongoing challenge.