Recognizing and managing bipolar disorder in children.

Bipolar disorder affects people of all ages, including preschool-aged children. Two major difficulties in diagnosing children with bipolar disorder are its overlap with attention-deficit/hyperactivity disorder (ADHD) and its developmentally distinct presentation from that in adults, with high rates of irritability, chronicity, and mixed states. Comorbid conditions are common in bipolar disorder and, in addition to ADHD, include depression, anxiety disorders, oppositional defiant disorder, and conduct disorder. Family studies have helped to confirm the validity of bipolar disorder in children. In terms of treatment, 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 utility in treating manic symptoms, depression in mixed states, and aggression. Amphetamine salts have been helpful in treating bipolar children with comorbid ADHD, but no data are available on treating comorbid depression in bipolar children. Because childhood-onset mania is commonly chronic rather than episodic, highly comorbid, and characterized by high rates of irritability, future clinical trials should examine the overlap of mania with other disorders in children to determine routes to accurate diagnosis and treatment.