Practitioner review: the assessment of bipolar disorder in children and adolescents.
BACKGROUND
An increasing number of youth are being diagnosed with, and treated for, bipolar disorder (BD). Controversy exists about whether youth with non-episodic irritability and symptoms of attention deficit hyperactivity disorder (ADHD) should be considered to have a developmental presentation of mania.


METHODS
A selective review of the literature related to this question, along with recommendations to guide clinical assessment.


RESULTS
Data indicate differences between youth with episodic mania and those with non-episodic irritability in longitudinal diagnostic associations, family history, and pathophysiology. In youth with episodic mania, elation and irritability are both common during manic episodes.


CONCLUSIONS
In diagnosing mania in youth, clinicians should focus on the presence of episodes that consist of a distinct change in mood accompanied by concurrent changes in cognition and behavior. BD should not be diagnosed in the absence of such episodes. In youth with ADHD, symptoms such as distractibility and agitation should be counted as manic symptoms only if they are markedly increased over the youth's baseline symptoms at the same time that there is a distinct change in mood and the occurrence of other associated symptoms of mania. Although different techniques for diagnosing comorbid illnesses have not been compared systematically, it appears most rational to diagnose co-occurring illnesses such as ADHD only if the symptoms of the co-occurring illness are present when the youth is euthymic.
Baroni
Argelinda
A
Section on Bipolar Spectrum Disorders, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
Lunsford
Jessica R
JR
Luckenbaugh
David A
DA
Towbin
Kenneth E
KE
Leibenluft
Ellen
E
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D001921:Brain / Q000503:physiopathology; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D008279:Magnetic Resonance Imaging; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D011595:Psychomotor Agitation / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015203:Reproducibility of Results