Does Bipolar Disorder Exist in Children? A Selected Review

Abstract

Although there is increasing recognition that a substantial proportion of patients with bipolar disorder (BD) experience an onset of illness in adolescence, significant controversy remains over the validity of the diagnosis in very young children. In careful studies of adult patients dating from Kraepelin, first mood episodes not uncommonly occurred during adolescence. Some of these early-onset patients experienced subthreshold mood disturbances or predisposing temperaments earlier in childhood. Earlier onsets of BD have been reported in more recent clinical and community samples of children. Several factors possibly contributed to these earlier onsets, including exposure to psychotropics, bias in favour of a mood rather than a psychotic diagnosis, and recognition of softer-spectrum BDs. However, the validity of the diagnosis of BD in impulsive, irritable, labile, or behaviourally dysregulated children remains to be proven. Studies of high-risk children of well-characterized parents with BD have demonstrated that BD most often debuts as a depressive episode in mid to late adolescence and that activated episodes are rare prior to age 12 years. Some children manifest antecedent nonspecific psychopathology in early childhood. Therefore, as currently diagnosed, BD does not manifest as such typically until at least adolescence.

Amygdala and Hippocampal Volumes in Relatives of Patients with Bipolar Disorder: A High—Risk Study

“…The above-mentioned positive studies focused on patients with very early onset of BD, as early as 10 years of age or younger, a frequent rapid cycling, almost ubiquitous presence of comorbid conditions, predominantly ADHD, accompanied by exposure to psychostimulants. The cluster of mood lability, irritability, impulsivity, and attention deficits, which constitutes the phenotype of pediatric BD, as diagnosed in these studies, may not be continuous with adult classical bipolar illness, which presents with different behavioural symptoms 42 and a lack of hippocampal or amygdala volume changes. 20 The diagnostic controversies in children can be bypassed by the high-risk design, where offspring of parents with clear-cut primary mood disorders are followed.…”

Overdiagnosis of Bipolar Disorder: A Critical Analysis of the Literature

“…Specifically in regard to BD, a recent study documented a fortyfold increase in the diagnosis of bipolar disorder in children [25]. ADHD symptoms, such as irritability, rapid or impulsive speech, physical restlessness, impaired attention, and sometimes defiant or oppositional behavior, can be mistakenly interpreted as resulting from BD [26, 27].…”

The structural neuroimaging of bipolar disorder

“…It is unsurprising therefore that the symptomatic manifestation of juvenile psychiatric disorder is variable, presenting diagnostic challenges to both clinicians and researchers attempting to understand the developmental course of mental illness (Carlson & Meyer, 2006). Comorbidity, especially with ADHD and substance abuse is prevalent and there is ongoing debate about the relationship between bipolar disorder as manifest in adults and that identified in prepubertal children (Chang, 2007;Duffy, 2007).…”