Bipolar Disorder in Children: Helping Your Child Prevent Manic Episodes

How do I help my child manage a manic episode?

Know the warning signs

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 things that may trigger those changes.

General behaviors linked with a manic episode include:

• Abnormal happiness (euphoria).
• Extreme irritability or silliness.
• Long-lasting or intense outbursts or tantrums.
• Unrealistic feelings of self-importance. (These feelings are called delusions of grandeur.)
• Intense energy levels that last a long period of time.
• A decreased need for sleep.
• Increased talkativeness that is hard 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 or pursuing a hobby. For example, a child who likes to write poetry may stay up all night writing pages of poems.
• 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). These may include hearing voices or being paranoid.

Managing manic episodes

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:

• Keep a stable sleep pattern. Your child should go to bed around the same time each night and wake up around the same time each morning. Changing sleep patterns can cause chemical changes in the body that trigger mood episodes.
• Keep a regular daily routine. Your child should follow a routine of trying to do the same things every day at about the same times.
• 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. But this will make the mood changes worse. Even small amounts can interfere with sleep, mood, or medicines used to treat bipolar disorder. Nonprescription medicines 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. Remember, though, that these mood changes can sometimes be upsetting to loved ones. 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.
• Continue treatment. It may be tempting for your child to stop treatment because he or she feels better. Or maybe your child enjoys the euphoric feeling of a manic episode. But it is very important to continue treatment as prescribed to avoid the unpleasant consequences linked with mania. If you have concerns about treatment or the side effects of your child's medicines, talk with your doctor. Do not adjust the medicine on your own.