Does bipolar disorder exist in children? A selected review

Area of Science:

• Child and Adolescent Psychiatry
• Mood Disorders
• Neurodevelopmental Disorders

Background:

• Bipolar disorder (BD) diagnosis in children is debated.
• Early onset of BD is increasingly recognized, with some adult patients reporting adolescent onset.
• Subthreshold mood disturbances or temperamental predispositions may precede full-blown BD in childhood.

Purpose of the Study:

• To examine the validity of diagnosing bipolar disorder (BD) in very young children.
• To review evidence regarding the age of onset for bipolar disorder.
• To differentiate between early childhood psychopathology and established BD.

Main Methods:

• Review of historical and recent clinical and community samples of children.
• Analysis of studies on high-risk children with parents diagnosed with BD.
• Examination of factors potentially contributing to earlier BD onsets.

Main Results:

• Bipolar disorder (BD) most commonly debuts as a depressive episode in mid to late adolescence in high-risk children.
• Activated episodes of BD are rare before age 12.
• Antecedent nonspecific psychopathology may be present in early childhood.

Conclusions:

• The diagnosis of bipolar disorder (BD) in impulsive, irritable, or behaviorally dysregulated children requires further validation.
• As currently diagnosed, BD typically manifests in adolescence, not in early childhood.
• Early childhood symptoms may represent nonspecific psychopathology rather than overt BD.