ABSTRACT
Pediatric bipolar disorder is a severe, chronic, and disabling illness that adversely impacts the child’s psychosocial development including family, social, and academic functioning. Prevalence of bipolar disorder is about 1% in adolescents. Diagnosis of bipolar disorder in children and younger adolescents is a challenge, as symptoms may differ from those typically observed in late adolescence and adulthood. One main area of debate centers around the core mood symptom of pediatric mania. The presence of classic cardinal symptoms of euphoria and/or grandiosity characterized by distinctive developmental expressions is emphasized by one view, while another view stresses the distinctly assaultive and persistent irritability of pediatric mania. The non-episodic, continuous, rapid cycling pattern and the high rate of mixed mania pose additional diagnostic challenge, as clinicians may not be able to rely on the typical presence of mood swings to make the diagnosis. Frequent occurrence of comorbid disorders exhibiting symptom overlap with pediatric mania, such as attention deficit hyperactivity disorder (ADHD) may further complicate the diagnosis. Appreciation of current evidence combined with exercise of good clinical judgment may help clinicians optimally diagnose a substantial number of psychiatrically referred youths who present with a complex and severe symptomatology suggestive of bipolar disorder.
