Bipolar disorder in children: Wikis


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This article is an expansion of a section entitled Children from within the main article: Bipolar disorder



Childhood bipolar is a controversial diagnosis. In professional classifications such as the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) [1] or the World Health Organization's International Classification of Diseases (ICD)[2] bipolar disorder is classified with adult onset disorders. However, as far back as the 1920s, Kraepelin [3] showed in a retrospective study of 900 manic-depressive adults that 0.4% had onset of symptoms before the age of ten. In a cohort of bipolar disordered adults, Loranger and Levine [4] retrospectively evaluated 200 adult bipolar patients and found that 0.5% had onset between the ages of five and nine. In a study of 898 adults with bipolar disorder, Goodwin and Jamison [5] found that 0.3% had onset before age 10. This literature supported the existence of childhood onset mania, but also indicated that it may be rare.

This idea was supported by a review of 28 papers by Anthony and Scott [6], which suggested that childhood bipolar disorder was uncommon. In these papers, only three of 60 cases (5%) of purported childhood bipolar disorder met their criteria for bipolar disorder. However, Anthony and Scott’s criteria differed from those currently in use, so the applicability of this work to current views of bipolar disorder is uncertain.

Population and community studies using DSM criteria show that about 1% of youth may have bipolar disorder [7][8]. Studies in clinics using these criteria show that up to 20% of youth referred to psychiatric clinics have bipolar disorder [9][10 ][11]. Many of these children required hospitalization due to the severity of their disorder [12][13].

Because of these dignostic uncertainties, the validity of an early-onset form of bipolar disorder had been debated in the late 20th century. However, since that time, systematic reviews of diagnostic, genetic, neurobiological, treatment and longitudinal research studies [14][15][16][17] have concluded that this disorder can be validly diagnosed in children and adolescents. This consensus of the scientific community is also seen in the appearance of practice parameters for the disorder from the American Academy of Child and Adolescent Psychiatry[18] Findings indicate that the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, and continues to increase. The data suggest that doctors had been more aggressively applying the diagnosis to children, rather than that the incidence of the disorder has increased. The study calculated the number of psychiatric visits increased from 20,000 in 1994 to 800,000 in 2003, or 1% of the population under age 20.[19]

The reasons for this increase in diagnosis are unclear. On the one hand, the recent consensus from the scientific community (see above) will have educated clinicians about the nature of the disorder and the methods for diagnosis and treatment in children. That, in turn, should increase the rate of diagnosis. On the other hand, assumptions regarding behavior, particularly in regard to the differential diagnosis of bipolar disorder, ADHD, and conduct disorder in children and adolescents, may also play a role.

Another factor is that the "consensus" regarding the diagnosis in the pediatric age group seems to apply only to the USA. The British National Institute on Health and Clinical Excellence (NICE) guidelines on bipolar disorder in 2006 [20] specifically described the broadened criteria used in the USA to diagnose bipolar disorder in children as suitable "only for research" and "were not convinced that evidence currently exists to support the everyday clinical use of (pediatric bipolar phenotype) diagnoses" which increase the "risk that medicines may be used to inappropriately treat a bipolar diathesis that does not exist."(p526). A 2002 German survey [21] of 251 child and adolescent psychiatrists (average 15 years clinical experience) found only 8% had ever diagnosed a pre-pubertal case of bipolar disorder in their careers. A similar survey of 199 child & adolescent psychiatrists (av 15 years clinical experience) in Australia and New Zealand [22] also found much lower rates of diagnosis than in the USA and a consensus that bipolar disorder was overdiagnosed in children and youth in the USA. Concerns about overdiagnosis in the USA have also been expressed by American child & adolescent psychiatrists [23][24][25][26] and a series of essays in the book "Bipolar children: Cutting-edge controversy, insights and research" [27] highlight several controversies and suggest the science still lacks consensus with regard to bipolar disorder diagnosis in the pediatric age group.


Although accurately diagnosing all disorders in children is important, for bipolar disorder, it is critical. On the one hand, the antipsychotic drugs sometimes prescribed for the treatment of bipolar disorder may increase risk to health including heart problems, diabetes, liver failure, and death.[28] On the other hand, bipolar disorder is a very disabling disorder which leads to many impairments in children, including cognitive impairment[29][30][31], psychiatric hospitalization[10 ][11][32][33][34], psychosis [10 ][11][35][36] and suicide. Thus, physicians, parents and patients need to weight the potential risks and benefits when treating this disorder[37].

Usual treatment involves medication and psychotherapy[38]

Handbooks for researchers and clinicians

Bipolar Disorder in Childhood ad Early Adolescence. Gellar, B., & BelBello, M. (ed)

Resources for Parents

The Ups and Downs of Raising a Bipolar Child: A Survival Guide for Parents‎ by Judith Lederman, Candida Fink - 2003 - 320 pages

The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder. by Demitri Papolos, Janice Papolos - 2007 - 474 pages

Understanding the Mind of Your Bipolar Child: The Complete Guide to the Development Treatment and Parenting of Children with Bipolar Disorder. by Gregory Thomas Lombardo - 2006 - 364 pages

Straight Talk about Your Child's Mental Health: What to Do When Something Seems Wrong by Stephen V. Faraone - 2003 - 390 pages

Parenting a bipolar child: what to do & why by Gianni Faedda, Nancy B. Austin - 2006 - 278 pages

Child and Adolescent Bipolar Disorder Foundation Family Support Group

Bipolar Disorder Magazine - A website compiled by a former bipolar child containing stories, interviews, articles and more for the parents and friends of bipolar children.

See also


  1. ^ American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition Text Revision (DSM-IV-TR). 1-943
  2. ^ World Health Organization (1979) International classification of diseases. 9th ed.
  3. ^ Kraepelin (1921) Manic-Depressive Insanity and Paranoia.
  4. ^ Loranger and Levine (1978) Age at onset of bipolar affective illness. Archives of General Psychiatry. 35 1345-1348
  5. ^ Goodwin and Redfield Jamison (1990) Childhood and Adolescence. Manic-Depressive Illness. 186-209
  6. ^ Anthony and Scott (1960) Manic-depressive psychosis in childhood. Journal of Child Psychology and Psychiatry. 1 53-72
  7. ^ Hudziak, Althoff, Rettew, Derks and Faraone (2005) The prevalence and genetic architecture of CBCL-juvenile bipolar disorder. Biological Psychiatry. 58 562-8
  8. ^ Lewinsohn, Klein and Seeley (1995) Bipolar disorders in a community sample of older adolescents: Prevalence, phenomenology, comorbidity, and course. Journal of the American Academy of Child and Adolescent Psychiatry. 34 454-463
  9. ^ Weller, Weller, Tucker and Fristad (1986) Mania in prepubertal children: Has it been underdiagnosed? Journal of Affective Disorders. 11 151-154
  10. ^ a b c Wozniak, Biederman, Kiely, Ablon, Faraone, Mundy and Mennin (1995) Mania-like symptoms suggestive of childhood onset bipolar disorder in clinically referred children. Journal of the American Academy of Child and Adolescent Psychiatry. 34 867-876
  11. ^ a b c Wozniak, Biederman, Mundy, Mennin and Faraone (1995) A pilot family study of childhood-onset mania. Journal of the American Academy of Child and Adolescent Psychiatry. 34 1577-1583
  12. ^ Carlson, Bromet, Driessens, Mojtabai and Schwartz (2002) Age at onset, childhood psychopathology, and 2-year outcome in psychotic bipolar disorder. Am J Psychiatry. 159 307-9.
  13. ^ Meyer, Carlson, Wiggs, Martinez, Ronsaville, Klimes-Dougan, Gold and Radke-Yarrow (2004) A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder. Dev Psychopathol. 16 461-76
  14. ^ Biederman (2003) Pediatric bipolar disorder coming of age. Biological Psychiatry. 53 931-934
  15. ^ Biederman, Mick, Faraone, Spencer, Wilens and Wozniak (2003) Current concepts in the validity, diagnosis and treatment of paedatric bipolar disorder. International Journal of Neuropsychopharmacology. 6 293-300
  16. ^ Geller and Luby (1997) Child and adolescent bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry. 36 1168-1176
  17. ^ Geller and Tillman (2005) Prepubertal and early adolescent bipolar I disorder: review of diagnostic validation by Robins and Guze criteria. Journal of Clinical Psychiatry. 66 Suppl 7 21-28
  18. ^ (2007) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry. 46 107-125
  19. ^ Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. (September 2007) "National trends in the outpatient diagnosis and treatment of bipolar disorder in youth," Archives of General Psychiatry. 64(9):1032–9. PMID 17768268
  20. ^ National Institute of Health and Clinical Excellence (2006). National clinical pratice guidelines number 38: Bipolar disorder: the management of bipolar disorder in adults, children and adolescents in primary and secondary care. London: National Collaborating Centre for Mental Health.
  21. ^ Meyer TD, Koßmann-Böhm S, Schlottke PF. Do child psychiatrists in Germany diagnose bipolar disorders in children and adolescents? Result from a survey. Bipolar Disorders, 2004; 6: 426 – 431
  22. ^ Parry P, Furber G, Allison S. The paediatric bipolar hypothesis: the view from Australia and New Zealand. Child and Adolescent Mental Health. (in press)
  23. ^ Carlson G, Meyer S. Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: Complexities and developmental issues Development and Psychopathology 2006; 18:939–969
  24. ^ Harris J. Child & adolescent psychiatry: the increased diagnosis of “juvenile bipolar disorder”: what are we treating? Psychiatr Serv 2005; 56: 529 – 531
  25. ^ McClellan J. Commentary: treatment guidelines for child and adolescent bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 2005; 44: 236-239
  26. ^ Laurel Williams. Mental health and children: Too often the system conspires to treat behavioural problems with pills. Los Angeles Times 14 Dec 2008 available at:,0,3774809.story
  27. ^ Bipolar Children: Cutting-edge controversy, insights and research. Childhood in America series. editor Sharna Olfman. 2007. Praeger press. Westport CT.
  28. ^ - New antipsychotic drugs carry risks for children
  29. ^ Glahn, Bearden, Caetano, Fonseca, Najt, Hunter, Pliszka, Olvera and Soares (2005) Declarative memory impairment in pediatric bipolar disorder. Bipolar Disord. 7 546-54
  30. ^ McClure, Treland, Snow, Dickstein, Towbin, Charney, Pine and Leibenluft (2005) Memory and learning in pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry. 44 461-9
  31. ^ Pavuluri, Schenkel, Aryal, Harral, Hill, Herbener and Sweeney (2006) Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients. Am J Psychiatry. 163 286-93
  32. ^ Biederman, Kwon, Wozniak, Mick, Markowitz, Fazio and Faraone (2004) Absence of gender differences in pediatric bipolar disorder: Findings from a large sample of referred youth. Journal of Affective Disorders. 83 207-214
  33. ^ Caetano, Olvera, Hunter, Hatch, Najt, Bowden, Pliszka and Soares (2006) Association of psychosis with suicidality in pediatric bipolar I, II and bipolar NOS patients. J Affect Disord. 91 33-7
  34. ^ Wozniak, Biederman, Kiely, Ablon and Faraone (1993) Prepubertal mania revisited. Scientific Proceedings of the Annual Meeting of the American Academy of Child and Adolescent Psychiatry
  35. ^ Caetano, Olvera, Hunter, Hatch, Najt, Bowden, Pliszka and Soares (2006) Association of psychosis with suicidality in pediatric bipolar I, II and bipolar NOS patients. J Affect Disord. 91 33-7
  36. ^ Wozniak, Biederman, Kiely, Ablon and Faraone (1993) Prepubertal mania revisited. Scientific Proceedings of the Annual Meeting of the American Academy of Child and Adolescent Psychiatry
  37. ^ Goldstein, Birmaher, Axelson, Ryan, Strober, Gill, Valeri, Chiappetta, Leonard, Hunt, Bridge, Brent and Keller (2005) History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk. Bipolar Disord. 7 525-35
  38. ^ The Bipolar Child, 1999. Papolos, Demitri, & Papolos, J., Broadway Books, NY


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