Bipolar disorder in children: Helping your child prevent manic episodes

Your child with bipolar disorder may have unique manic behaviors that are identifiable. Family and friends can help to identify manic behaviors, especially if they know ahead of time what to watch for. General behaviors associated with a manic episode include:

• Abnormal happiness (euphoria).
• Extreme irritability or silliness.
• Long-lasting or intense outbursts or tantrums.
• Unrealistic feelings of self-importance (delusions of grandeur).
• Intense energy levels maintained for a long period of time.
• A decreased need for sleep.
• Increased talkativeness that is difficult to interrupt.
• Racing thoughts and distractibility-attention constantly moving from one thing to the next.
• An intense focus on sexual thoughts, feelings, or behaviors (hypersexuality); use of explicit sexual language.
• An intense focus on reaching a goal.
• Dangerous or reckless behavior. For example, a young child may think he or she can fly and jump off a roof. A teen may drive too fast, spend money unwisely, or have unprotected sex.
• Extreme behavior that causes problems on the job, at school, in social situations, or at home.
• Symptoms of psychosis (detachment from reality), such as hearing voices or being paranoid.

Test Your Knowledge

1. Some signs of going into a manic episode include having a great deal of energy, having racing thoughts, and talking a lot.

   1. True

      This answer is correct.

      Manic episodes often begin with a feeling of high energy, racing thoughts, and talkativeness. Your child may even like the way it feels when the episode begins. However, this energy can quickly develop into behaviors that are uncomfortable, difficult to manage, and potentially dangerous.

   2. False

      This answer is incorrect.

      Manic episodes often begin with a feeling of high energy, racing thoughts, and talkativeness. Your child may even like the way it feels when the episode begins. However, this energy can quickly develop into behaviors that are uncomfortable, difficult to manage, and potentially dangerous.

Controlling a manic episode from its beginning stages can help your child avoid going into an episode of full-blown mania. Your child may be able to avoid destructive behaviors associated with mania if the manic episode is recognized and treated right away.

Test Your Knowledge

1. Identifying early warning signs of a manic episode will help my child seek treatment quickly and avoid unpleasant or dangerous consequences.

   1. True

      This answer is correct.

      Learning to identify the manic behaviors early in a new episode and seeking treatment will help your child avoid unpleasant or dangerous behaviors associated with mania.

   2. False

      This answer is incorrect.

      Learning to identify the manic behaviors early in a new episode and seeking treatment will help your child avoid unpleasant or dangerous behaviors associated with mania.

The best way to manage a manic episode is to help your child avoid triggers that can cause mood swings and conditions that might make manic feelings more intense. Some simple lifestyle adjustments can help. Work with your child to:

• Maintain a stable sleep pattern. Your child should go to bed around the same time each night and awaken around the same time each morning. Changing sleep patterns can cause chemical changes in the body that trigger mood episodes.
• Maintain a regular daily routine. Your child should follow a routine of trying to do the same things every day at about the same time.
• Set realistic goals. Setting high goals and focusing too hard on achieving them can trigger a manic episode.
• Avoid alcohol and illegal drugs. It may be tempting for your child to use alcohol or drugs to help get through a manic episode. However, this will make the mood changes worse. Even small amounts can interfere with sleep, mood, or medications used to treat bipolar disorder. Nonprescription medications for a cold, allergies, or pain can also trigger a change in mood.
• Get help from family and friends. Your child will sometimes need help getting through a manic episode, especially if he or she loses touch with reality. Having a plan in place before any mood changes occur will assist family members and friends in getting the needed help. However, remember that these mood changes can sometimes be upsetting to loved ones and that these people may also need to seek support.
• Reduce stress at home and at school or work. Your child should try to keep regular hours at school and at work. Doing a good job is important, but avoiding a depressive or manic mood episode is more important. Communicate with your child's teachers and guidance counselor about your child's needs. Academic adjustments or a plan such as an individualized education program (IEP) may be helpful.
• Learn to recognize the early warning signs of a new manic episode. This is one of the most important ways to avoid a full-blown manic episode. If you catch the episode in its early stages, your child may be able to avoid an intense manic episode by avoiding triggers that are causing the new mood change. You may want to keep a chart to record your child's mood changes and the activities that may trigger those changes.
• Continue treatment. It may be tempting for your child to discontinue treatment because he or she feels better or enjoys the euphoric feeling of a manic episode. However, it is very important to continue treatment as prescribed to avoid the unpleasant consequences associated with mania. If you have concerns about treatment or the side effects of your child's medications, talk with your doctor; do not adjust the medication on your own.

Test Your Knowledge

1. Learning the early warning signs of particular manic behaviors, seeking treatment early, and getting help from loved ones can help you and your child avoid a full-blown manic episode.

   1. True

      This answer is correct.

      Recognizing the early warning signs of particular mood episodes is one of the most important things you can do to treat bipolar disorder. Keeping a mood chart may be helpful for identifying triggers and recognizing when your child is moving into a manic episode. Recognizing a change in mood and getting early treatment can help avoid the roller-coaster effects of bipolar disorder mood changes and the consequences of harmful manic behaviors.

   2. False

      This answer is incorrect.

      Recognizing the early warning signs of particular mood episodes is one of the most important things you can do to treat bipolar disorder. Keeping a mood chart may be helpful for identifying triggers and recognizing when your child is moving into a manic episode. Recognizing a change in mood and getting early treatment can help avoid the roller-coaster effects of bipolar disorder mood changes and the consequences of harmful manic behaviors.

2. My child with bipolar disorder can try to manage a manic episode by avoiding the behaviors that trigger mania or that make an episode worse, not using alcohol or drugs, avoiding stress, getting enough sleep and exercise, and keeping a regular daily routine.

   1. True

      This answer is correct.

      These simple lifestyle changes can help avoid triggering a manic episode or making one worse. Keeping the daily routine fairly consistent; avoiding stress at home, at school, and at work; getting regular exercise and sleep; and avoiding alcohol and drug use can keep your child's mood even.

   2. False

      This answer is incorrect.

      These simple lifestyle changes can help avoid triggering a manic episode or making one worse. Keeping the daily routine fairly consistent; avoiding stress at home, at school, and at work; getting regular exercise and sleep; and avoiding alcohol or drug use can keep your child's mood even.

3. There is no need to ask family and friends for help with a manic episode until one occurs.

   1. True

      This answer is incorrect.

      Relying on friends or family alone to help once your child is already in the middle of a manic episode is not a reasonable expectation. Let your family and friends know ahead of time that your child has a plan for treatment (such as taking another medication or seeking a counselor's or doctor's advice) that they can help your child follow if an episode occurs. Seeking help when the first signs of a manic episode appear is best. Friends and family should be educated about bipolar disorder, learn the early warning signs of mood episodes, and help your child seek treatment at the first signs of a change in mood.

   2. False

      This answer is correct.

      Relying on friends or family alone to help once your child is already in the middle of a manic episode is not a reasonable expectation. Let your family and friends know ahead of time that your child has a plan for treatment (such as taking another medication or seeking a counselor's or doctor's advice) that they can help your child follow if an episode occurs. Seeking help when the first signs of a manic episode appear is best. Friends and family should be educated about bipolar disorder, learn the early warning signs of mood episodes, and help your child seek treatment at the first signs of a change in mood.

Now that you understand the importance of having a solid plan in place to prevent and manage your child's manic episodes, you are ready to take the following steps:

• Establish daily routines and healthy lifestyle choices that help prevent manic episodes.
• Learn how to identify a developing manic episode and how to eliminate or reduce the factors that may be triggering it or making it worse. Recording mood changes and possible triggers in a calendar or notebook can be helpful in identifying patterns.
• Develop a support network of adults who understand how to help your child during a manic episode.
• Make sure your child continues to follow his or her treatment program, such as taking medications exactly as prescribed and attending counseling sessions.
• Communicate with your doctor about how to prevent manic episodes and cope with them when they occur.