Diagnosis and management of childhood bipolar disorder in the primary care setting.

Early-onset bipolar disorder (BD) is often misdiagnosed and inadequately treated because of the varying constellation of symptoms that occur across different developmental stages, the variety of disorders with similar presentation, and the frequent comorbidities. The etiology of BD is complex, but research confirms the major role that genetics and environment play in its development. The pediatrician initially identifies most cases, with subsequent referral to mental health providers. A complex case involving a child initially diagnosed with attention deficit hyperactivity disorder (ADHD) and later found to have comorbid childhood BD is considered, illustrating diagnostic considerations and appropriate behavioral and psychopharmacological intervention.