Identifying Mania in Kids and Teens

Mania is a high-energy condition that often results in risky and out-of-character behavior. A manic episode, which can last from a week to several months, can be confusing and dangerous. And because mania is rarely diagnosed in children, it’s hard to know what to do if you suspect that your child is having a manic episode. Learning about the symptoms of mania and how it shows up in children and teens can help you know what to look out for — and when to get your child help.

Mania, which can take the form of an unusually heightened or irritable mood, is often known as a symptom of bipolar disorder. But it can also be a sign of other mental health disorders or occur on its own.

Some of the most common indicators of a manic episode include:

• Racing thoughts
• Prolonged and fast-paced speech
• Excitability
• Becoming easily distracted
• An increase in intense and goal-directed activity (like staying up all night working on a project)
• Exaggerated self-confidence
• A decreased need for sleep

It’s important to be aware that none of these behaviors by themselves mean that somebody is manic. “In true mania, a group of symptoms need to be present most of the day, nearly every day, for at least a week,” explains Joanna Stern, PsyD, a clinical psychologist at the Child Mind Institute. “And they have to represent a significant, noticeable change from the child’s usual behavior.”

Identifying mania in kids can be challenging since descriptions tend to be based on adult behavior. “People may think of unrestrained buying sprees, sexual indiscretions, or foolish business investments,” says Dr. Stern, “But mania often looks different in kids and teens.”

We tend to associate mania with euphoria and other feel-good emotions. But children are more likely to show signs of irritability and aggression. Their increased energy level may come out in angry outbursts or tantrums. On its own, this could be seen as normal developmental behavior, especially for teens. They tend to experiment with new behaviors and “try on” different personalities. These changes are adaptive and help teens develop a stronger sense of individual identity.

In order to separate this normal behavior pattern from mania, paying attention to the degree of change is key. Mania can often show up as excessive involvement in activities that have a high potential for painful consequences. While it may be typical for teenagers to act like they’re invincible to some extent, the inflated sense of self that comes with mania is much more drastic and can present serious safety risks.

“It’s the child who thinks, ‘I’m the smartest kid to ever live,’ or ‘I can climb up on the roof and jump off into my friend’s pool, and that’s going to be fine because I’m amazing and nothing’s going to happen to me,’” Dr. Stern notes.

Another thing to keep in mind is that having an irregular sleep schedule, which is common for teenagers, is distinct from the decreased need for sleep, which is characteristic of mania. Many teens regularly stay up late, but they ultimately get tired and crash after missing enough sleep. In contrast, during a manic episode, a teenager can go on for days or weeks with little to no sleep and still maintain a high level of energy.

Many symptoms of mania overlap with other mental health disorders. Knowing the difference can help you make sure that your child gets the right kind of treatment.

For instance, the irritability that many manic children display is also a hallmark of childhood depression. But while people with depression may be prescribed antidepressants to help ease their symptoms, those who are manic and/or diagnosed with bipolar disorder tend to benefit from a different class of medications called mood stabilizers. Treating undiagnosed mania with antidepressants is often counterproductive, as it can actually make symptoms more pronounced and extreme.

Mania can also be mistaken for ADHD. High energy levels, frustration and distractibility, risky behavior, and lack of sleep can look like symptoms of ADHD — inattention, hyperactivity, and impulsivity. But while kids with ADHD frequently act out impulsively and without a clear purpose, the behavior of manic children tends to be highly goal-directed. For instance, they might be staying up all night to write a whole novel or design an entire fashion line.

Mania’s episodic nature also sets it apart from both ADHD and depression. While symptoms of those disorders generally don’t go away unless treated, manic episodes come and go over time. Because of this, behavioral changes during manic episodes are noticeable and jarring, often seeming totally out of character.

Paying attention to sudden changes in a child’s behavior can help parents assess whether they should be evaluated for mania. “It’s really important to know what your kid’s baseline is,” Stern underscores. “If you’ve got a really energetic kid with an ADHD diagnosis, it might not be abnormal for them to be really elevated. But if you have a much quieter, more reserved kid who is suddenly bouncing off the walls and talking a mile a minute, that could potentially be an indication of a manic episode.”

Some episodes of mania can be so severe they include psychotic symptoms — breaks from reality such as hallucinations or delusions. When this happens, it can be misdiagnosed as schizophrenia.

An episode of mania can be triggered by:

• The onset of bipolar disorder most often appears in late adolescence. The mania can seem to come out of the blue. The behavior can be so extreme and erratic that the patient ends up hospitalized — or even arrested. Bipolar disorder is the most common cause of mania.
• A side effect of a medication (such as some antidepressants), alcohol, or recreational drugs.
• Another mental health problem, including seasonal affective disorder.
• The result of a brain injury or neurological condition.

If you suspect that your child might be having a manic episode, it’s important to get them to a doctor. In most cases, this means going to the emergency room, where your child can be evaluated and, if necessary, admitted to an in-patient facility and started on medication.

If your child’s mania is the onset of bipolar disorder, it will require long-term medical care. Medication, usually mood stabilizers, is typically the first line of treatment for bipolar disorder. Finding a regimen that works takes time. Regular visits to the psychiatrist are necessary to ensure your child is getting a treatment that works for them.

The most effective form of treatment also includes specialized psychotherapy. Your child’s therapist can help them recognize how mania feels different from their baselines. “Subjective feelings are really important for kids to pay attention to,” says Stern. “When children are more aware of what is going on in their brain, they have an easier time pointing out when something’s not right and knowing when to ask a trusted adult for help.”