I dont have first hand knowledge of pediatric bipolar but heres some insights from a website:
Sleep inertia is a transitional state of lowered arousal occurring immediately after awakening from sleep and producing a temporary decrement in any subsequent performance. Studies show that sleep inertia can last from a few minutes to four hours. Youngsters with bipolar disorder are far closer to the latter than the former.
The "phase delay" of their 24-hour rhythms often makes these youngsters sluggish in the morning; more activated as afternoon gives way to evening; and then the rocket thrusters go off as bedtime approaches. Their energy level can climb so high, their thoughts often race, and they are unable to shut down and get to sleep. The next morning this same pattern begins again.
In addition to morning sluggishness and the anxiety, many kids with bipolar disorder have difficulty interpreting social cues and may feel that other kids are finding them odd or out of step.
Few children with bipolar disorder feel that they can relate to the outside world. In many ways they have difficulty relating to themselves. They don't feel like they fit in, even with people who care for them. Especially during depression, the world seems to be passing them by, as if there were a barrier between them and everything else. Even in a room full of people they can feel totally alone.
Like adults, many of the children and adolescents suffer seasonal dips or accelerations in mood: they may start the school year off well, but as the days of autumn shorten, the slow-down and lethargy of depression may catch them out, and the concentration that school demands begins to elude them. They may not care what the assignments are and lack the energy to contemplate them. Conversely, the lengthening days of early spring and the increase in intensity of the daylight may promote periods of increased energy.
The anger associated with bipolar disorder in children is different. It is an internal state that requires no outside prompting. It has a fuel all its own. This internal anger is so reactive but with higher intensity and less restraint."
One of the children we interviewed for our book gave a fascinating description as to how he feels when a rage gathers. He explained:
It comes out so quickly; faster than a knee-jerk reaction. It's like electricity shoots through me. It's like being struck with lightening. I feel rage and hurt and a need to strike back. I would be raging every day, multiple times a day, verbally abusive, nasty, negative, but very careful not to show it to the outside world.
Not all children tantrum and rage, but whether they do or not, most are prone to boredom. They can't seem to get invested in anything and whine and complain constantly about being bored. Because the children feel helpless and so often out-of-control, they desperately need to reconnect and escape from the intolerable feelings inside. Often they become provocative-they shake things up with other people to add that much needed spark that makes them feel involved and in control.
Despite the parents' best efforts to establish a slow-down of the day and to help settle the child for sleep, two factors will work against this happening: As we mentioned above, the minds and bodies of these youngsters are more active in the evening hours; and many of them are absolutely terrified of going to sleep.
They are prone to night terrors where predators stalk them, chase them, and kill them or their families in particularly violent and horrific ways.
Those are just snippets from this site:
bipolarchild.com/newsletters/0605.htmlI do know that stims seem to make the bipolar symptoms worse. The mood disorder should be gotten under control first & then the ADHD symptoms. I hope that helped a little. Sorry I did not have more to offer.
