Bipolar Disorder involves marked changes in both mood and energy. Persistent states of extreme sadness or irritability which are accompanied by low energy are called depression (or depressive episodes), while persistent states of extreme elation or agitation which are accompanied by high energy are called mania (or manic episodes).

However, the disorder may look different in children than it does in adults. Children will usually have an ongoing, continuous mood disturbance which is a mix of depression and mania. This rapid and severe cycling between both moods produces chronic irritability and few clear periods of wellness between bipolar episodes.

A diagnosis of Pediatric Bipolar Disorder is made using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria used to diagnose adults with Bipolar Disorder, and for which there is no lower age limit. However, it becomes more difficult to apply the DSM-IV criteria to very young children.

Behaviors reported by parents of these children may include:

• an expansive or irritable mood
• extreme sadness or lack of interest in play
• explosive, length, and often destructive rages
• rapidly changing moods lasting a few hours to a few days
• defiance of authority
• separation anxiety
• hyperactivity, agitation, and distractibility
• sleeping too little or sleeping too much
• bed wetting and night terrors
• strong and frequent cravings, often for sweets and carbohydrates
• excessive involvement in multiple projects and activities
• impaired judgment, impulsivity, racing thoughts, and pressure to keep talking
• dare-devil behaviors (such as jumping off roofs or out of moving cars)
• inappropriate or precocious sexual behavior
• hallucinations and delusions
• grandiose belief in their own abilities that defy the laws of logic (ability to fly, for example)

Symptoms of Pediatric Bipolar Disorder can emerge as early as infancy. Mothers often report that children who were later diagnosed with the disorder were extremely difficult to settle as infants and slept erratically. They also seemed extraordinarily clingy, and from a very young age often had uncontrollable, seizure-like tantrums or rages that were out of proportion to any event. The word 'No' often triggered these rages.