Some kids become overly happy and excited or giddy or overly irritable and angry. They may feel like they can do things that no one else can do (grandiosity). They may sleep less than usual or not at all, do many things at once, have more energy, talk faster and express many ideas (some realistic and some unrealistic), and be easily distracted. They may do things that are impulsive when manic, like spend a great deal of money unwisely or drive recklessly.
Kids may experience the symptoms of depression at other times, which can include feeling very sad, down, irritable, or anxious, losing interest in people or things, sleeping too much or being unable to sleep, having little or no appetite, having trouble concentrating or making decisions, feeling fatigued or low in energy, moving or talking slowly, feeling very bad or guilty about oneself, or contemplating suicide or actually carrying out suicide attempts.
Many children with bipolar illness have “mixed” symptoms, in which they feel manic and depressed at the same time. They may feel (or act) irritable, sped up, “tired but wired,” and unable to sleep; at the same time they may feel worthless, have suicidal thoughts, or may lose interest in everything. Some children alternative rapidly between these different extremes of mood. Diagnosis can be challenging, and often requires extended periods of observation to confirm.