For children old enough to benefit, the second leg of treatment is individual therapy, which includes social-rhythms work—learning to balance meals, sleep, studies and recreation. If a triggering incident such as a divorce or death kicked the condition off, the doctor can help the child process that too.

The last, perhaps hardest element of treatment is family therapy. Bipolar disorder, like Schizophrenia, depression and certain anxiety conditions, is powerfully influenced by surroundings. When an identical twin suffers from bipolar, the other twin has only a 65% chance of developing it too. Conversely, adopted children with no genetic legacy for bipolar have a 2% chance of coming down with the condition if they are raised in a home with one nonbiological bipolar parent. Clearly, something is in play besides mere genes, and that something is environment. Raise a child in a steady and stable home, and you reduce the odds that the illness will gain a toehold, which is why counselors work hard to teach parents and kids how to minimize family discord.

One strategy is to avoid too much negatively expressed emotion. Tough love, for example, is a good idea in principle, but in some situations it can do more harm than good, especially if it makes kids who can't control their behavior feel worse about themselves. When family arguments do break out, they need to be conducted in a controlled way. Psychology professor David Miklowitz of the University of Colorado encourages families to avoid what he calls the "three volley," a provocation followed by a rejoinder, then a rebuttal. Hold the volleys to just one or two, and you'll avoid some domestic breakdowns.

The most important thing parents and siblings can do is simply to serve as the eyes and ears of the bipolar child. A teen in a depression can't see the hope beyond the gloom. A child in a manic cycle can't see the quiet reality behind the giddiness. It's up to people whose compasses are more reliably functioning to step in and point the way. Says Dr. Gary Sachs, director of the Bipolar Treatment Center at Boston's Massachusetts General Hospital and principal investigator for the STEP-BD project: "Treatment is modeled on Homer's Odyssey. When Odysseus gets blown off course, he asks the help of his crew."

In the future, kids should be getting yet more assistance as they sail. At the Stanley Research Center, in Massachusetts General Hospital, investigators are beginning a yearlong study of at least 10 bipolar drugs, comparing the merits of each and the ways they can best be combined. Others are looking at such unconventional treatments as omega-3 fatty acids, found in fish oil, which may inhibit the same brain receptors that lithium affects. Elsewhere, researchers are running brain scans to determine which lobes and regions are involved in bipolar disorder and how to target them more accurately with drugs. Investigators also hope to develop a blood test that will allow bipolar disorder to be spotted as simply as, say, high cholesterol, eliminating years of incorrect diagnoses and misguided treatments.

Getting all this work done right—and getting the treatments to the kids who need it—is one of the newest and most challenging goals of the mental-health community. Doctors who recognize bipolar disorder and know how to handle it are in critically short supply. Growing up is hard enough for children who are bipolar. The last thing they need is a misdiagnosis and treatment for something they don't have.

—Reported by Dan Cray and Jeffrey Ressner/Los Angeles, Jeanne DeQuine/Miami, Melissa Sattley/Texas, Cristina Scalet/New York and Maggie Sieger/Chicago

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