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Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

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Abstract

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted.

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Acknowledgment

This study was supported by Grants R01 MH073953 (Dr. Birmaher), R01 MH073967 (Dr. Findling), R01 MH073801 (Dr. Fristad), and R01 MH073816 (Dr. Kowatch) from the National Institutes of Mental Health, Bethesda, MD, USA.

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Correspondence to Mary A. Fristad.

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Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.

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Case Western Reserve University, Cleveland, OH: Christine A. Demeter, MA (Department of Psychiatry); Robert L. Findling, MD (Departments of Psychiatry and Pediatrics); Sarah McCue Horwitz, PhD (Department of Pediatrics, Stanford University, Stanford, CA); Eric A. Youngstrom, PhD (Departments of Psychology and Psychiatry, University of North Carolina, Chapel Hill, NC); Ohio State University, Columbus, OH: L. Eugene Arnold, MD (Department of Psychiatry); Mary A. Fristad, PhD, ABPP (Departments of Psychiatry and Psychology); Cincinnati Children’s Hospital Medical Center, OH: Robert A. Kowatch, MD, PhD (Department of Pediatrics); University of Pittsburgh, Pittsburgh, PA: David Axelson, MD; Boris Birmaher, MD; Mary Kay Gill, RN, MSN (Department of Psychiatry).

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Danner, S., Fristad, M.A., Arnold, L.E. et al. Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues. Clin Child Fam Psychol Rev 12, 271–293 (2009). https://doi.org/10.1007/s10567-009-0055-2

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