Classification issues of bipolar disorders in childhood.

As systematic interviewing has become more widespread, it has been possible to identify significant populations of children and adolescents who meet adult criteria for depression. The difficulties associated with identifying correctly the phenomenology of major depression in children are reviewed. The significance of separation anxiety, anorexia, attention deficit and conduct disorder, as 'depressive equivalents' is discussed, although a change in mood or ability to experience pleasure appear to carry greater diagnostic weight. While the identification of mania and hence of bipolar disorder in children is more difficult, the appearance of a definite maniac syndrome in preadolescence is relatively uncommon. Data are reviewed suggesting the existence of an alternative and more common form of bipolar disorder in childhood, characterized by affective lability, irritability and explosive behavior. However, available data do not support the view that attention deficit disorder and 'emotionally unstable character disorder' are variants of bipolar syndromes.