Bipolar disorder in children is more common than has been acknowledged previously. However, the clinical presentation, particularly when of early onset, is more often atypical, co-morbid with other conditions and lacking in discrete episodes compared with adult-onset illness. This article reviews the literature on pre-pubertal bipolar disorder, particularly when co-morbid with ADHD, using a Medline search and other sources. Four clinical cases are presented highlighting some of the diagnostic dilemmas associated with co-morbidity.
American Psychiatric Association
. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association Press.
2.
Anthony, J.
, & Scott, P. (1960). Manic-depressive psychosis in childhood. Child Psychology and Psychiatry, 4, 53-72.
3.
Biederman, J.
, Faraone, S. V., Mick, E., Wozniak, J., Chen L., Ouellette, C., Marrs, A., Moore, P., Garcia, J., Mennin, D., & Lelon, E. (1996). Attention deficit hyperactivity disorder and juvenile mania: An overlooked comorbidity?Journal of the American Academy of Child and Adolescent Psychiatry, 35, 997-1008.
4.
Biederman, J.
, Klein, R. G., Pine, D. S., & Klein, D. F. (1998). Debate forum. Resolved: Mania is mistaken for ADHD in prepubertal children. Affirmative: Biederman, J., Negative: Klein, R.G., Pine, D.S., & Klein, D.F.Journal of the American Academy of Child and Adolescent Psychiatry, 37(10), 1091-1099.
5.
Borchardt, C. M.
, & Bernstein, G. A. (1995). Co-morbid disorders in hospitalised adolescents compared with unipolar depressed adolescents. Child Psychiatry and Human Development, 26, 11-18.
6.
Butler, F. S.
, Arrendondo, D. E., & McCloskey, V. (1995). Affective co-morbidity in children and adolescents with attention deficit hyperactivity disorder. Annals of Clinical Psychiatry, 7, 51-55.
7.
Carlson, G. A.
(1983). Bipolar disorders in childhood and adolescence. In D.P. Cantwell & G. Carlson (Eds.), Affective disorders in childhood and adolescence: An update. New York: Spectrum.
8.
Carlson, G. A.
(1999). Letter to the editor: Juvenile mania versus ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 38(4), 353-354.
9.
Carlson, G. A.
, & Kashani, J.H. (1988). Manic symptoms in non-referred adolescent population. Journal of Affective Disorders, 15, 219-226.
10.
Esquirol, E.
(1845). Mental maladies: A treatise on insanity. Philadelphia: Lea and Blanchard.
11.
Faraone, S. V.
, Biederman, J., Mennin, B. A., Wozniak, J., & Spencer, T. (1997). Attention- deficit hyperactivity disorder with bipolar disorder: A familial subtype?Journal of the American Academy of Child and Adolescent Psychiatry, 36(10), 1378-1387.
12.
Geller, B.
, & Luby, J. (1997). Child and adolescent bipolar disorder: A review of the last ten years?Journal of the American Academy of Child and Adolescent Psychiatry, 36(9), 1168-1176.
13.
Geller, B.
, Sun, K., Zimmerman, B., Luby, J., Frazier, J., & Williams, M. (1995). Complex and rapid cycling in bipolar children and adolescents: A preliminary study. Journal of Affective Disorders, 34, 259-268.
14.
Grigoroiu-Sebanescu, M.
, Christodorescu, D., Jipescu, I., Totoescu, A., Marinescu, E., & Ardeleau, V. (1989). Psychopathology in children aged 10-17 of bipolar parents: Psychopathology rate and correlates of the severity of the psychopathology. Journal of Affective Disorders, 16, 167-179.
15.
Koehler-Troy, C.
, Strober, M., & Malenbaum, R. (1986). Methylphenidate induced mania in a prepubertal child. Journal of Clinical Psychiatry, 47, 566-567.
16.
Kovacs, M.
, & Pollock, M. (1995). Bipolar disorder and comorbid conduct disorder in childhood and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 715-723.
17.
Max, J. E.
, Richards, L., & Hamdan-Allen, G. (1995). Case study: Antimanic effectiveness of dexamphetamine in a brain injured adolescent. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 472-476.
18.
Miklowitz, D. J.
, Goldstein, M. J., Neuchterlein, K. H., Synder, K. S., & Mintz, J. (1988). Family factors and the course of bipolar affective disorder. Archives in General Psychiatry, 45, 225-231.
19.
Sadler, W.
(1952). Juvenile manic activity. Nervous Disorders of Childhood, 9, 363-368.
20.
Strober, M.
, DeAntonia, M., Schmidt-Lacker, S., Freeman, R., Lampert, C., & Diamond, J. (1998). Early childhood attention deficit disorder predicts poorer response to acute lithium therapy in adolescent mania. Journal of Affective Disorders, 51(2): 145-151.
21.
Strober, M.
, Morrell, W., Lampert, C., & Burroughs, J. (1990). Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: A five-year naturalistic study. Journal of the American Academy of Child and Adolescent Psychiatry, 147, 457-461.
22.
Strober, M.
, Schmidt-Lackner, S., Freeman, R., Bower, S., Lampert, C., & DeAntonia, M. (1995). Recovery and relapse in adolescents with bipolar affective illness: a five-year naturalistic, prospective follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 34(6), 724-731.
23.
Weinberg, W. A.
, & Brumback, R. P. (1976). Mania in childhood: Case studies and literature review. American Journal of Diseases in Childhood, 130, 380-385.
24.
Wozniak, J.
, Biederman, J., Kiely, K., Ablon, J. S., Faraone, S. V., Mundy, E., & Mennin, D. (1995). Mania like symptoms suggestive of childhood onset bipolar disorder in clinically referred children. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 867-876.
25.
Zahn-Waxler, C.
, Mayfield, A., Radke-Yarrow, M., McKnow, D., Cytryn, L., & Davenport, Y. (1988). A follow up investigation of offspring of parents with bipolar disorder. Americian Journal of Psychiatry, 145, 506-509.
