The adolescent brain is still developing. Neurons are still firing, making new connections, and their emotional landscape is still maturing. It’s no different than the infant who needs to babble before talking in full sentences. Teens need to have immature emotional experiences – like having angry outbursts, tantrums, or lonely wandering – before growing into mature ones.
Despite this recognition, many teens in recent years are being diagnosed with teen bipolar disorder. Some clinicians say that there is an excessive amount of diagnosing bipolar among adolescents, while others believe that it is appropriate because the age of onset for this psychological disorder is late adolescence.
If a child is angry, he or she might have behavioral explosions, mood swings, and perhaps an inability to meet the demands of life. However, this may or may not be the reason to diagnose a teen with bipolar disorder. There are other possible diagnoses such as depression, anxiety, learning difficulties, sleep disturbances, stress, or medical issues. A depressed teens, for example, might not have the skills for managing unbearable sadness. As a result, they might appear angry instead. Their anger might also be a symptom of an unrecognized medical concern or a teen’s inability to manage stress.
Attention Deficit/Hyperactivity Disorder, also known as ADHD, is easy to confuse with Bipolar Disorder, particularly a manic episode. However, ADHD symptoms are distinctly different than those of Bipolar. One of the biggest differences in that the hyperactivity and high levels of energy are due to a manic episode in Bipolar Disorder, whereas in ADHD, symptoms of hyperactivity are consistent. Other differences are below.
ADHD: Hyperactivity, impulsivity, but not usually accompanied by elation or grandiosity
Bipolar: Manic episodes are distinct periods of an elated mood, grandiosity, along with a decreased need for sleep
ADHD: Problems with distractibility, attention, organization, and memory are consistent.
Bipolar: Problems with attention, distractibility, and impulsivity are usually signs of a manic episode.
ADHD: Moods do not fluctuate widely.
Bipolar: There is a rapid cycling of moods, ranging from two extremes.
ADHD: The age of onset is usually under 10 years old.
Bipolar: The age of onset is typically during mid to late adolescence.
ADHD: Irritability, accelerated speech, and increased levels of energy are symptoms that are stable.
Bipolar: Irritability, accelerated speech, and increased levels of energy are the result of mood swings.
The symptoms of depressed teens include persistent changes in their functioning at school or home, possible self harm behavior, withdrawal, or shifts in energy or sleep. If a teen is experiencing these symptoms, it’s possible to begin to wonder whether he or she will eventually have a manic episode, which will eventually lead to a diagnosis of bipolar disorder. Research indicates that those who develop depression earlier in life have a higher risk of developing bipolar disorder. Some of the risk factors that would turn a diagnosis of depression into bipolar include: repeated episodes of depression, family history of bipolar disorder, how a teen responds to anti-depressants (such as medication being ineffective or effective at the start and later stop working), and among those who have a very high energy personality, sometimes referred to as hyperthymic.
Regardless of the above distinctions, what is clear among clinicians is that an episode of mania or hypomania must be present in order to diagnose a teen with bipolar disorder. The above list points out that just because a teen throws a fit or is hyperactive in some way, doesn’t mean that he or she has bipolar disorder. Instead, a thorough psychological examination is required in order to make an accurate diagnosis. Of course, with an accurate diagnosis the appropriate treatment – therapy and/or medication – can follow.
Fink, C. & Kraynak J. (2013). Bipolar disorder for dummies. Hoboken, NJ: John Wiley & Sons, Inc.