Objectives Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. Methods An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. Results Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. Conclusions As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.

The appearance, the differential diagnosis and the prevalence of bipolar disorder in children and adolescents is discussed. Among adolescents bipolar disorder appears to have a similar prevalence in the US and The Netherlands. However, among children it is frequently diagnosed in the US and hardly in The Netherlands. It is concluded that bipolar disorder tends to start earlier in the US than in the Netherlands. It is hypothesized that this may be related to a higher use of stimulants and antidepressants by US children diagnosed as ADHD or depression, respectively.

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Background Psychotic experiences (PEs) are common in childhood and predictive of poor mental health outcomes, including psychosis, depression, and suicidal behavior. Prior studies indicate that bullying involvement and peer relationship difficulties may be linked to increased risk of PEs. However, most studies relied on self-report measures, while an approach including peer-report measures provides a more valid and comprehensive assessment of bullying and social relationships. This study aimed (1) to examine the prospective association of bullying perpetration and victimization with PEs in childhood, using a peer-nomination method complemented by ratings from mothers and teachers; (2) to investigate the prospective association between children’s social positions within classroom peer networks and PEs in childhood. Methods This study was embedded in the population-based Generation R Study, a birth cohort from Rotterdam, the Netherlands. Peer-reported bullying as well as peer rejection, peer acceptance, and prosocial behavior were obtained using dyadic peer nominations in classrooms, victimization was reported by the child itself (n=925, age=7.5). Bullying involvement was additionally assessed by teacher-reported questionnaire (n=1565, age=7.2) and mother-reported questionnaire (n=3276, age=8.1). Using network analysis, we constructed classroom peer networks for peer rejection, peer acceptance, and prosocial behavior and estimated children’s social positions within each network (i.e., degree centrality, closeness centrality and reciprocity). PEs were assessed at age 10 years with a self-report questionnaire. All analyses were adjusted for relevant potential confounders, including age, sex, ethnicity, and maternal education. Results After adjusting for sociodemographic covariates, higher bullying perpetration and higher victimization scores at 7–8 years were associated with increased risk of PEs at age 10 years for peer/self-report, teacher report, and mother report (bullying perpetration – peer report: OR=1.22, 95% CI 1.05–1.43, p=0.010, teacher report: OR=1.08, 95% CI 0.97–1.14, p=0.15, and mother report: OR=1.11, 95% CI 1.03–1.19, p=0.005; victimization – self report: OR=1.16, 95% CI 1.01–1.34, p=0.036, teacher report: OR=1.13, 95% CI 1.02–1.25, p=0.023, and mother report: OR=1.18, 95% CI 1.10–1.27, p<0.001). Unfavorable positions within the peer rejection network were associated with increased risk of PEs (OR degree centrality=1.25, 95% CI 1.07–1.45, p FDR-corrected =0.036). After correction for multiple testing, there were no significant associations between social positions and PEs within the peer acceptance and the prosocial behavior networks. Discussion This is the first study to demonstrate that peer-reported bullying and peer rejection are associated with increased risk of PEs in childhood. Our findings extend current knowledge of self-perceptions in the context of psychosis vulnerability by offering unique insight into peer perceptions of bullying and social relationships. The consistent findings across child, mother, and teacher ratings provide important support for the role of bullying victimization and perpetration in the development of PEs. In addition, our findings showed that children with negative peer perceptions, i.e., children who are rejected by their peers, were at increased risk of PEs. School-based interventions aimed at preventing and eliminating bullying and social exclusion may help to prevent the development of PEs, and, hence, prevent the onset of severe mental health outcomes.

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