Recognizing and Managing Bipolar Disorder in Children

Bipolar disorder affects people of all ages, including preschool-aged children. Two major difficultiesin diagnosing children with bipolar disorder are its overlap with attention-deficit/hyperactivitydisorder (ADHD) and its developmentally distinct presentation from that in adults, with high rates ofirritability, chronicity, and mixed states. Comorbid conditions are common in bipolar disorder and, inaddition to ADHD, include depression, anxiety disorders, oppositional defiant disorder, and conductdisorder. Family studies have helped to confirm the validity of bipolar disorder in children. In terms oftreatment, children do not appear to respond well to conventional mood stabilizers alone. However,using an atypical antipsychotic either alone or in addition to another mood stabilizer has shown utilityin treating manic symptoms, depression in mixed states, and aggression. Amphetamine salts havebeen helpful in treating bipolar children with comorbid ADHD, but no data are available on treatingcomorbid depression in bipolar children. Because childhood-onset mania is commonly chronic ratherthan episodic, highly comorbid, and characterized by high rates of irritability, future clinical trialsshould examine the overlap of mania with other disorders in children to determine routes to accuratediagnosis and treatment.