child’s normal behavior, the grandiosity criterion should be considered satisfied. 
One of the most common features is a decreased need for sleep (Criterion B2) and is
distinct from insomnia in which the individual wants to sleep or feels the need to sleep but
is unable. The individual may sleep little, if at all, or may awaken several hours earlier than
usual, feeling rested and full of energy. When  the sleep disturbance is severe, the individ-
ual may go for days without sleep, yet not feel  tired. Often a decreased need for sleep her-
alds the onset of a manic episode.
Speech can be rapid, pressured, loud, and diff icult to interrupt (Criterion B3). Individ-
uals may talk continuously and without regard for others’ wi shes to communicate, often
in an intrusive manner or without concern for the relevance of what is said. Speech is
sometimes characterized by jokes, puns, amus ing irrelevancies, and theatricality, with
dramatic mannerisms, singing, and excessive gesturing. Loudness and forcefulness of
speech often become more important than what  is conveyed. If the individual’s mood is
more irritable than expansive, speech may be  marked by complaints, hostile comments, or
angry tirades, particularly if attempts are ma de to interrupt the individual. Both Criterion
A and Criterion B symptoms may be accompanie d by symptoms of the opposite (i.e., de-
pressive) pole (see “with mixed features” specifier, pp. 149–150).
Often the individual’s thoughts race at a rate faster than they can be expressed through
speech (Criterion B4). Frequently there is flight  of ideas evidenced by a nearly continuous flow
of accelerated speech, with abrupt shifts from one topic to another. When flight of ideas is se-