Key Takeaways
- Children and teens can have bipolar disorder, but most people are diagnosed in late adolescence or adulthood, and it is less common in younger children.
- What matters is episodes: days to weeks of changed mood, energy and sleep that break from your child’s usual self. Constant irritability usually points somewhere else.
- DSM-5 created DMDD in 2013 partly because bipolar disorder was being overdiagnosed in chronically irritable children.
- Several medications are FDA-approved for bipolar disorder in young people, each for specific ages; lamotrigine, valproate and carbamazepine are not.
- If your child talks about suicide, call or text 988 or call 911. Antidepressants need screening for bipolar risk before they are started.
Yes, children and teenagers can have bipolar disorder, though it is less common than many worried parents fear and harder to pin down than in adults. Most people with the condition are diagnosed in late adolescence or adulthood. In a young person, the question is not how big the moods are on a bad day, but whether there are distinct episodes, lasting days or longer, that are a clear break from how your child usually is. This guide walks through how bipolar disorder shows up in youth, what else it could be, how a careful evaluation works, and what treatment and safety at home look like.
If you are worried about safety right now
Get emergency help now if your child…
- talks about wanting to die, has a plan, or has hurt themselves
- is seeing or hearing things that are not there, or believes things that put them in danger
- has hardly slept for several nights and is getting more agitated, reckless or out of control
- has taken too much of a medication, including lithium
Call 911 or go to the nearest emergency room. For urgent support at any hour, call or text 988 or chat at 988lifeline.org, or text HOME to 741741. Willow & Stone provides outpatient, scheduled care and is not an emergency service.
If none of that is happening today, take a breath. Bipolar disorder in young people is serious but treatable, and the rest of this guide is about getting a clear answer without rushing to a label.
Can a child or teen really have bipolar disorder?
Yes. NIMH calls it “a common misperception that children cannot have bipolar disorder.” Symptoms most often begin in late adolescence or early adulthood, but they can appear earlier, and NIMH notes that children occasionally have symptoms.
The best U.S. estimate is old but useful. In NIMH’s national adolescent survey, using data collected in 2001–2004 under the earlier DSM-IV criteria, the lifetime prevalence of bipolar disorder among 13- to 18-year-olds was 2.9%, and it climbed with age: 1.9% at ages 13–14, 3.1% at 15–16 and 4.3% at 17–18. Treat those as a rough picture, not a current count.
In younger children the diagnosis is rarer and much harder to make, because tantrums, irritability, poor sleep and hyperactivity have many more common causes. Our page on bipolar disorder in children covers the younger age group, and signs of bipolar disorder in teens goes through what to watch for in adolescents. For the adult picture, including types and long-term treatment, see the complete guide to bipolar disorder.
How bipolar disorder shows up in young people
The pattern to look for is an episode: a stretch of days or weeks when your child’s mood, energy and sleep shift together and they seem like a different version of themselves, followed by a return toward baseline. NIMH lists these signs of mania in children and teens:
- Long periods of intense happiness or silliness that do not fit the situation
- A very short temper or extreme irritability
- Talking fast about many different things
- Trouble sleeping but not feeling tired
- Racing thoughts and trouble staying focused
- Risky behavior they would not normally take on
- An inflated sense of their own abilities
On the depressive side, NIMH lists frequent sadness without a clear reason, irritability or hostility, frequent stomachaches or headaches, sleeping much more than usual, hopelessness, eating too much or too little, and thoughts of death or suicide. Physical complaints and irritability are often how depression shows up in young people. Our page on signs of depression in teens covers that side.
Irritability deserves a note. Under the U.S. DSM-5-TR criteria, an irritable mood can count toward a manic episode when it comes with the other symptoms, increased energy and a clear time course. The UK’s NICE guideline is stricter for young people: it requires euphoria on most days for at least seven days and says irritability is not a core criterion. Either way, irritability alone, without an episode, is not enough.
Teenagers are moody, and that is normal. A few questions help sort ordinary moodiness from something more: Is this a change from how they usually are? Does it last days rather than hours? Has their need for sleep dropped, not just their bedtime? Do teachers or other adults see it too? Our pages on teen mood swings vs bipolar disorder and whether your teen is moody or something biological is going on go further.
Why bipolar disorder was overdiagnosed in children, and where DMDD came from
For a period, many children with severe, constant irritability and explosive outbursts were diagnosed with bipolar disorder in community practice. The American Academy of Child and Adolescent Psychiatry (AACAP) noted the problem in its 2007 practice parameter: community-diagnosed youth often had rapid mood swings along with ADHD or disruptive behavior, and it was “not clear” whether these atypical presentations were the same illness as classic bipolar disorder. (AACAP now lists its practice parameters as historical documents, and no newer AACAP guideline on pediatric bipolar disorder has replaced it.)
Research backed up the concern. In a study summarized in a 2016 review, only 1 of 84 young people with severe mood dysregulation, the research forerunner of DMDD, developed mania over about two years, compared with 58 of 93 young people who had bipolar disorder. Chronic irritability and bipolar disorder looked like different paths.
So when DSM-5 was published in 2013, the APA added disruptive mood dysregulation disorder (DMDD), in its words “to address concerns about potential overdiagnosis and overtreatment of bipolar disorder in children.” As reproduced in that 2016 review, the DSM-5 criteria include:
- Severe temper outbursts about three or more times a week
- An irritable or angry mood most of the day, nearly every day, between outbursts
- Symptoms for at least 12 months, in at least two settings such as home and school
- Onset before age 10, with a first diagnosis made between ages 6 and 18
DMDD and bipolar disorder cannot be diagnosed together. NIMH notes that youth with DMDD are at higher risk of anxiety and depression later, and that no medication is FDA-approved specifically for DMDD. Read what DMDD is and the side-by-side DMDD vs bipolar disorder comparison.
What else it could be: the common look-alikes
NIMH lists ADHD, DMDD, oppositional defiant disorder (ODD), conduct disorder and anxiety disorders as conditions whose symptoms overlap with bipolar disorder in youth, and notes that bipolar depression can be hard to tell apart from ordinary depression. Several of these can also occur alongside bipolar disorder, which is why a careful clinician considers more than one at a time.
| Condition | How it can resemble bipolar disorder | What usually differs |
|---|---|---|
| ADHD | Restlessness, fast talking, distractibility, impulsive choices | Present steadily since early childhood rather than in episodes; sleep need does not drop |
| DMDD | Severe irritability and frequent outbursts | Chronic and constant, starting before age 10; no distinct manic episodes |
| ODD or conduct problems | Anger, defiance, rule-breaking | Aimed at authority or rules; no shift in energy and sleep |
| Anxiety | Agitation, poor sleep, irritability | Driven by worry or fear; calms when the worry is resolved |
| Trauma reactions | Mood swings, poor sleep, irritability, risk-taking | Tied to what happened and to reminders of it |
| Substance use | Highs, crashes, sleeplessness, paranoia | Follows use of cannabis, stimulants, alcohol or other drugs |
| Autism | Intense reactions, sleep differences, absorbing focus | Lifelong traits, not a new change from baseline |
ADHD is the overlap parents ask about most. In adults, research suggests about 1 in 6 people with bipolar disorder also has ADHD, and bipolar disorder tends to start about four years earlier when ADHD is present. When mood symptoms are part of the picture, stimulant decisions are made carefully. For Texas patients, Schedule II stimulant prescriptions are written by the collaborating physician who works with Dr. Forbes. See ADHD vs bipolar disorder in children and teens and ADHD signs parents miss in teenagers.
Substances matter in teens: a 2026 meta-analysis found cannabis use associated with later bipolar disorder (relative risk 2.46), an association rather than proof that one causes the other. Autistic young people can have mood disorders too, and telling a mood episode from autistic traits takes someone who knows both; see bipolar disorder and autism.
How an evaluation for a young person works
A bipolar diagnosis in a young person should rarely be made in one visit. AACAP’s family guide says diagnosis in youth “is complex and involves careful observation over an extended period of time.” NICE goes further, advising that bipolar disorder be diagnosed in children and young people only after intensive monitoring over time by a trained team working with parents or carers, and not on the strength of depression plus a family history alone.
A careful evaluation usually includes:
- Time with your teen alone and time with you, because each sees things the other misses
- A developmental history and a family history of mood disorders, suicide and substance use across generations
- Input from school, such as teacher observations or report cards
- A daily mood and sleep chart over several weeks, which NIMH recommends
- A medical review, with labs ordered as needed to rule out thyroid problems, substance effects and other causes; NIMH notes no blood test or brain scan can diagnose bipolar disorder
- Sometimes a parent-report rating scale, which supports the clinician’s judgment but cannot make the diagnosis
Expect the clinician to talk with you about consent and confidentiality; in Texas, see teen mental health consent in Texas. Our page on what a teen psychiatric evaluation involves describes the visit itself.
Willow & Stone sees patients 10 and older. For children under 10, we refer to a child psychiatry specialist. Our general teen service is described on teen and adolescent psychiatry in Arlington and online.
Treatment: therapy, family work and steady care
AACAP’s family guide describes treatment for young people as usually combining education for the child and family, medication such as a mood stabilizer or an atypical antipsychotic, and psychotherapy. NIMH adds three practical points: steady treatment works better than treatment that starts and stops, stopping medication suddenly can be dangerous, and prescribers try to use the fewest medications at the smallest doses that work. Our page on bipolar treatment for teens and children 10 and older explains how this looks in practice.
Family-focused therapy and what the evidence shows
Family-focused therapy (FFT) teaches the whole family about the illness and practices communication and problem-solving skills. It is one of the best-studied therapies for young people with bipolar disorder, and the evidence is worth knowing honestly. In a 2014 trial of 145 adolescents with bipolar I or II, adding 21 sessions of FFT to medication did not speed recovery or delay recurrence compared with medication plus brief education, though manic symptoms were less severe in the second year. In a 2020 trial of higher-risk youth aged 9–17 (with depression or milder bipolar symptoms plus a family history), FFT lengthened the time to the next mood episode, mostly depressive episodes, without changing the time to mania or the chance of developing bipolar disorder.
CBT-based approaches are also used. For young people with bipolar depression, NICE advises offering structured individual CBT or interpersonal therapy for at least three months. See therapy for bipolar disorder and parenting a teen with bipolar disorder for how families take part.
Medication for young people: FDA-approved options by age
FDA approval for children and teens is specific to the drug, the type of episode and the age. The table reflects the current U.S. labels. It is not a ranking, and the right choice for your child is a conversation with the prescriber.
| Medication | FDA-approved pediatric use for bipolar disorder |
|---|---|
| Lithium | Some lithium products: bipolar I (manic and mixed episodes, and maintenance) from age 7. The extended-release Lithobid label still says safety is not established under 12. |
| Aripiprazole, risperidone, asenapine | Manic or mixed episodes of bipolar I, ages 10–17 |
| Quetiapine | Manic episodes of bipolar I, ages 10–17 (its depression and maintenance uses are adult-only) |
| Cariprazine (Vraylar) | Manic or mixed episodes of bipolar I, age 10 and older (added December 2025); depression use is adult-only |
| Olanzapine | Manic or mixed episodes of bipolar I, ages 13–17; the label notes greater weight gain and lipid changes in teens |
| Lurasidone (Latuda) | Bipolar I depression, ages 10–17 |
| Olanzapine/fluoxetine combination | Bipolar I depression, ages 10–17 |
| Lamotrigine, divalproex (valproate), carbamazepine | No FDA-approved pediatric bipolar indication |
A medicine without a pediatric approval is not automatically ruled out, but the evidence in young people is thinner and the prescriber should explain why it is being considered. NICE advises against valproate in young people unless no other effective, tolerated option exists, and lamotrigine’s label reports a higher rate of serious rash in patients aged 2–17 (about 0.3%–0.8%) than in adults. According to a 2023 summary of the CANMAT/ISBD 2018 pediatric section, lithium, risperidone, aripiprazole, asenapine and quetiapine are first-line options for acute mania in youth, and lurasidone for acute depression.
Monitoring is part of the deal: weight, blood sugar and lipids for antipsychotics, and blood levels plus kidney and thyroid checks for lithium. NICE also advises a multidisciplinary review before continuing an antipsychotic in a young person beyond 12 weeks. Read bipolar medications for teens and lab monitoring for psychiatric medication.
Antidepressants and mania risk
Many teens first see a clinician for depression, so this matters. FDA labeling requires a boxed warning on antidepressants because, in short-term studies, they increased suicidal thoughts and behaviors in children, teens and young adults; the increase was not seen in people over 24. The same labels tell prescribers to ask about any personal or family history of bipolar disorder, mania or hypomania before an antidepressant is started.
NIMH explains why: if a first depressive episode in someone with bipolar disorder is treated with an antidepressant alone, it can trigger mania or rapid cycling. In bipolar disorder, antidepressants are not used on their own, though a prescriber may add one to a mood stabilizer or antipsychotic.
If your teen is taking an antidepressant and suddenly needs much less sleep, talks fast, takes unusual risks or seems agitated and “wired,” call the prescriber that day, and do not stop the medication abruptly on your own. Read antidepressants and mania risk in teens and our page on the antidepressant boxed warning for teens.
School and daily routine
Episodes affect school in predictable ways: missed days, trouble concentrating, conflict with teachers during irritable stretches, and morning grogginess while a medication is being adjusted. A plan made in calm times works better than one made in a crisis.
- Decide with your teen what the school needs to know and who will be told
- Ask the counselor or nurse how medication at school, missed work and a gradual return after an episode are handled
- Families often ask about a formal support plan such as a 504 plan or an IEP; our school page explains how those conversations usually go
- Protect a steady wake time, even on weekends, and guard against all-nighters before exams
- Keep a simple log of mood, sleep and school stress that you can share at appointments
NIMH recommends a regular routine and a daily mood chart for young people with bipolar disorder, and both help at school as much as at home. See school support for teens with bipolar disorder.
Keeping your teen safe at home
Suicide risk is higher in bipolar disorder than in almost any other condition, and an earlier age at onset is one of the factors research links to suicide attempts. Most of what keeps a teen safe is unglamorous and practical.
- Limit access to lethal means. If there are firearms in the home, store them locked and unloaded, ideally outside the home during a rough period. Lock up medications, including lithium and over-the-counter pain relievers, and keep only small amounts on hand.
- Write a crisis plan together while your teen is well: their personal warning signs, what helps, who to call, the nearest emergency room, and who stays with them.
- Save 988 in every phone. Your teen can call or text 988 or chat at 988lifeline.org on their own, any hour.
- Know the escalation signs: several nights of little sleep, rising agitation or recklessness, talk of hopelessness or death, or beliefs that are out of touch with reality.
- Keep alcohol and drugs out of reach, since they can trigger episodes and interact with medication.
If you are ever unsure whether something is an emergency, treat it as one: call 911 or go to the emergency room. Willow & Stone provides outpatient, scheduled care; if a higher level of care is needed (for example during severe mania or psychosis), we help you find it.
Supporting your teen and the rest of the family
A teen with bipolar disorder is still your teen. It helps to separate the illness from the person: the irritability during an episode is a symptom, not a verdict on your relationship. Many parents find it easier to talk about specific changes (“you’ve slept four hours a night this week”) than about labels.
Involve your teen in the plan as much as their age and state allow. Teens are more likely to stick with treatment they helped shape, and they deserve to understand what is happening in their own body. Siblings need simple, honest explanations too, and parents need support of their own; family-focused therapy and parent groups can help with both. Our page on parenting a teen with bipolar disorder has practical scripts and routines.
What to do now
- Check safety first. If any warning sign in the box at the top applies, get emergency help today.
- Start a daily log of mood, sleep, energy and major events for two to four weeks. Note when changes began and how long they lasted.
- Write down family history: relatives with bipolar disorder, depression, suicide or substance problems.
- List every medication, supplement and substance your teen uses, including vaping and cannabis.
- See your pediatrician to check for medical causes such as thyroid problems.
- Book an evaluation with a clinician experienced in youth mood disorders, and bring your log and school observations.
Not sure whether it is time? Our page on when to seek psychiatric help for your teen can help you decide.
At Willow & Stone, Dr. Stacey Forbes, DNP, APRN, PMHNP-BC, sees young people from age 10, in person in Arlington, Texas, and by telehealth in Texas, New Mexico, Florida, Alaska, Arizona, Colorado and Washington (your teen needs to be in one of those states during the visit). Medication options are discussed at the evaluation and labs are ordered as needed. See how teen bipolar treatment works here or our page on bipolar disorder treatment at Willow & Stone.
Where to next: every page in the teen guide
Signs and diagnosis in young people
Treatment, family and school
Common Questions
Can a child have bipolar disorder?
Yes. NIMH calls the idea that children cannot have bipolar disorder a misperception. Still, most people are diagnosed in late adolescence or adulthood, and in younger children constant irritability and outbursts are far more often explained by DMDD, ADHD, anxiety or other conditions. A diagnosis in a child should come only after careful observation over time.
How can I tell if my teen is bipolar or just moody?
Look for episodes rather than moods: days to weeks when mood, energy and sleep change together, with a clearly reduced need for sleep, faster talk, unusual risk-taking or a deep low, all different from your teen’s usual self and noticed in more than one setting. Ordinary moodiness passes within hours and fits the situation. Only a careful evaluation can tell for sure.
Is there a bipolar test for teens?
There is no test that diagnoses bipolar disorder in teens. NIMH notes that no blood test or brain scan can do it. Clinicians sometimes use parent-report rating scales, which help organize what you have noticed, but NICE advises against using questionnaires to identify bipolar disorder in young people in primary care. Diagnosis rests on history and observation over time.
Is lithium safe for teens, and what age can you take it?
Some lithium products are FDA-approved for bipolar I disorder in children 7 and older, for both acute episodes and maintenance; the extended-release Lithobid label still says safety is not established under 12. Lithium needs regular blood levels and kidney and thyroid checks, and dehydration or illness can push levels up. Whether it suits your teen is a decision to make with the prescriber.
Can a child have both ADHD and bipolar disorder?
Yes. The two often occur together; in adults, about 1 in 6 people with bipolar disorder also has ADHD, and bipolar disorder tends to start earlier when ADHD is present. Because restlessness and distractibility appear in both, the clinician looks at whether symptoms are steady from early childhood or come in episodes. Treatment order matters when both are present.
What is the best medication for bipolar disorder in teens?
No medication is best for every teen. Several are FDA-approved for young people at specific ages, including lithium, aripiprazole, risperidone, quetiapine, asenapine, cariprazine and, for bipolar depression, lurasidone. According to a 2023 summary of the CANMAT/ISBD 2018 guidelines, lithium and several antipsychotics are first-line options for mania in youth. The choice depends on the episode type, side effects and your teen’s health.
Can a 16-year-old have bipolar disorder?
Yes. Mid-to-late adolescence is a common time for bipolar disorder to begin. In NIMH’s national adolescent survey (data from 2001–2004), lifetime prevalence was 3.1% at ages 15–16 and 4.3% at 17–18. A first episode in a teen, especially depression with a family history of bipolar disorder, deserves careful follow-up rather than a quick label either way.
How can I help my teenager with bipolar disorder?
Keep treatment steady, protect a regular sleep and wake schedule, and help your teen track mood and early warning signs. Make a crisis plan together while they are well, lock up medications and remove firearms, and save 988 in every phone. Family-focused therapy can teach the whole household calmer ways to talk and solve problems. Take care of your own support too.
Related reading
Sources & Further Reading
- NIMH: Bipolar Disorder in Children and Teens (NIH Pub. No. 23-MH-8081, revised 2023)
- NIMH: Bipolar Disorder statistics (adolescent data, NCS-A 2001–2004)
- AACAP Facts for Families No. 38: Bipolar Disorder in Children and Teens
- NIMH: Disruptive Mood Dysregulation Disorder (DMDD)
- American Psychiatric Association: Highlights of Changes from DSM-IV-TR to DSM-5 (2013)
- NICE CG185: Bipolar disorder, children and young people (updated 2 Sept 2025)
- Baweja et al. Disruptive mood dysregulation disorder: current insights. Neuropsychiatr Dis Treat 2016
- Miklowitz et al. Family-focused treatment for adolescents with bipolar disorder. Am J Psychiatry 2014
- Miklowitz et al. Family-focused therapy for youth at high risk for bipolar disorder. JAMA Psychiatry 2020
- FDA label: lithium carbonate (DailyMed, 2026)
This article is general education, not a diagnosis or advice for your situation. Do not start, stop, or change a medication without talking to the clinician who prescribes it; stopping a mood stabilizer suddenly can trigger relapse.
If you need help right now
Willow & Stone is an outpatient practice and is not an emergency service. If you or someone you care about is in immediate danger, call 911.
For urgent mental health support at any hour, call or text 988 to reach the Suicide & Crisis Lifeline, or text HOME to 741741 for the Crisis Text Line. Both are free, confidential, and available 24/7 nationwide.
Dr. Stacey Forbes, DNP, APRN, PMHNP-BC
Board-certified Psychiatric-Mental Health Nurse Practitioner and founder of Willow & Stone Integrative Mental Health. Nearly two decades of clinical experience; integrative, root-cause psychiatry in person in Arlington and by telehealth. Licensed in Texas, New Mexico, Florida, Alaska, Arizona, Colorado & Washington.
About Dr. Forbes →