128 Bipolar and Related Disorders
tion among euphoria, dysphoria,  and irritability). In children, happiness, silliness and
“goofiness” are normal in the context of spec ial occasions; however, if these symptoms are
recurrent, inappropriate to the context, and beyond what is expected for the developmen-
tal level of the child, they may meet Criterion A. If the happiness is unusual for a child (i.e.,
distinct from baseline), and the mood change occurs at the same ti me as symptoms that
meet Criterion B for mania, diagnostic certainty is increased; however, the mood change
must be accompanied by persistently increased activity or energy levels that are obvious
to those who know the child well.
During the manic episode, the individual may engage in multiple overlapping new
projects. The projects are often initiated with little knowledge of the topic, and nothing seems
out of the individual’s reach. The increased activity levels may manife st at unusual hours of
the day.
Inflated self-esteem is typicall y present, ranging from uncritical self-confidence to marked
grandiosity, and may reach delusi onal proportions (Criterion B1).  Despite lack of any partic-
ular experience or talent, the individual may embark on comple x tasks such as writing a novel
or seeking publicity for some im practical invention. Grandiose delusions (e.g., of having a
special relationship to a famous person) are co mmon. In children, overe stimation of abilities
and belief that, for example, they are the best at  a sport or the smartest in the class is normal;
however, when such beliefs are present despite cl ear evidence to the contrary or the child at-
tempts feats that are clearly dangerous and, most important,  represent a change from the
child’s normal behavior, the grandiosity criterion should be considered satisfied.