Bipolar disorder in children, or pediatric bipolar disorder (PBD), is a rare and controversial mental disorder in children and adolescents. PBD is hypothesized to be like bipolar disorder (BD) in adults, thus is proposed as an explanation for periods of extreme shifts in mood called mood episodes. These shifts alternate between periods of depressed or irritable moods and periods of abnormally elevated moods called manic or hypomanic episodes. Mixed mood episodes can occur when a child or adolescent with PBD experiences depressive and manic symptoms simultaneously. Mood episodes of children and adolescents with PBD deviate from general shifts in mood experienced by children and adolescents because mood episodes last for long periods of time (i.e. days, weeks, or years) and cause severe disruptions to an individual's life. There are three known forms of PBD: Bipolar I, Bipolar II, and Bipolar Not Otherwise Specified (NOS). Just as in adults, bipolar I is also the most severe form of PBD in children and adolescents, and can impair sleep, general function, and lead to hospitalization. Bipolar NOS is the mildest form of PBD in children and adolescents. The average age of onset of PBD remains unclear, but reported ages of onset range from 5 years of age to 19 years of age. PBD is typically more severe and has a poorer prognosis than bipolar disorder with onset in late-adolescence or adulthood.
Since 1980, the has specified that the criteria for bipolar disorder in adults can also be applied to children. However, the exact criteria for diagnosing pediatric bipolar disorder, especially bipolar NOS, remains controversial and heavily debated. As a result, there are big differences in how commonly PBD is diagnosed across clinics and in different countries; in the United States, PBD is often misdiagnosed. Identifying bipolar disorder in youth is challenging. In particular, PBD and ADHD have many overlapping symptoms at the surface, such as the hyperactivity characteristic of the manic episodes that occur in PBD. As a result, many children and adolescents with PBD are instead diagnosed with ADHD. Misdiagnosis of PBD can lead to complications in youth and adolescents as different disorders require different types of medications that may make symptoms of PBD more severe.
Diagnosis
Diagnosis is made based on a clinical interview by a psychiatrist or other licensed mental health practitioner. There are no blood tests or brain scans to diagnose bipolar disorder. Obtaining information on family history and the use of questionnaires and checklists are helpful in making an accurate diagnosis. Commonly used assessment tools include the K-SADS (Kiddie Schedule for Affective Disorders and Schizophrenia), the Diagnostic Interview Schedule for Children (DISC), and the Child Mania Rating Scale (CMRS).
Signs and symptoms
In both the American Psychiatric Association's and the World Health Organization's , the same criteria used to diagnose bipolar disorder in adults are used to make the diagnosis in children with some adjustments to account for differences in age and developmental stage. For example, the DSM-5 specifies that in children, depressive episodes can manifest as persistently irritable moods.
In diagnosing manic episodes, it is important to compare the changes in mood and behavior to the child's normal mood and behaviors at baseline instead of to other children or adults. For example, grandiosity (i.e., unrealistic overestimation of one's intelligence, talent, or abilities) is normal at varying degrees during childhood and adolescence. Therefore, grandiosity is only considered symptomatic of mania in children when the beliefs are held despite being presented with concrete evidence otherwise or when they lead to a child attempting activities that are clearly dangerous, and most importantly, when the grandiose beliefs are an obvious change from that particular child's normal self-view in between episodes.
Controversy
The diagnosis of childhood bipolar disorder is controversial, although it is recognized that bipolar disorder typical symptoms are dysfunctional and have negative consequences for minors with the condition. Main discussion is centered on whether what is called bipolar disorder in children refers to the same disorder than when diagnosing adults, and the related question on whether adults' criteria for diagnosis are useful and accurate when applied to children. More specifically, main discussion over diagnosis in children circles around mania symptomatology and its differences between children and adults.
Diagnostic criteria may not correctly separate children with bipolar disorder from other problems such as ADHD, and emphasize fast mood cycles.