title: Facial emotion recognition in childhood-onset bipolar I disorder: an evaluation of developmental differences between youths and adults.
abstract: OBJECTIVE
  Bipolar disorder (BD) is a severe mental illness with high healthcare costs and poor outcomes. Increasing numbers of youths are diagnosed with BD, and many adults with BD report that their symptoms started in childhood, suggesting that BD can be a developmental disorder. Studies advancing our understanding of BD have shown alterations in facial emotion recognition both in children and adults with BD compared to healthy comparison (HC) participants, but none have evaluated the development of these deficits. To address this, we examined the effect of age on facial emotion recognition in a sample that included children and adults with confirmed childhood-onset type-I BD, with the adults having been diagnosed and followed since childhood by the Course and Outcome in Bipolar Youth study.
  
  
  METHODS
  Using the Diagnostic Analysis of Non-Verbal Accuracy, we compared facial emotion recognition errors among participants with BD (n = 66; ages 7-26 years) and HC participants (n = 87; ages 7-25 years). Complementary analyses investigated errors for child and adult faces.
  
  
  RESULTS
  A significant diagnosis-by-age interaction indicated that younger BD participants performed worse than expected relative to HC participants their own age. The deficits occurred both for child and adult faces and were particularly strong for angry child faces, which were most often mistaken as sad. Our results were not influenced by medications, comorbidities/substance use, or mood state/global functioning.
  
  
  CONCLUSIONS
  Younger individuals with BD are worse than their peers at this important social skill. This deficit may be an important developmentally salient treatment target - that is, for cognitive remediation to improve BD youths' emotion recognition abilities.
authors.affiliation: Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, East Providence, RI, USA.|Department of Psychiatry and Human Behavior, Division of Child Psychiatry, Brown University Alpert Medical School, East Providence, RI, USA.
authors.forename: Ezra
authors.identifier: http://orcid.org/0000-0001-5887-1392
authors.initials: E
authors.lastname: Wegbreit
authors.affiliation: Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, East Providence, RI, USA.|Department of Psychiatry and Human Behavior, Division of Child Psychiatry, Brown University Alpert Medical School, East Providence, RI, USA.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Weissman
authors.affiliation: Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, East Providence, RI, USA.|Department of Psychiatry and Human Behavior, Division of Child Psychiatry, Brown University Alpert Medical School, East Providence, RI, USA.
authors.forename: Grace K
authors.initials: GK
authors.lastname: Cushman
authors.affiliation: Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, East Providence, RI, USA.|Department of Psychiatry and Human Behavior, Division of Child Psychiatry, Brown University Alpert Medical School, East Providence, RI, USA.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Puzia
authors.affiliation: Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, East Providence, RI, USA.|Department of Psychiatry and Human Behavior, Division of Child Psychiatry, Brown University Alpert Medical School, East Providence, RI, USA.
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Kim
authors.affiliation: Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Leibenluft
authors.affiliation: Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, East Providence, RI, USA.|Department of Psychiatry and Human Behavior, Division of Child Psychiatry, Brown University Alpert Medical School, East Providence, RI, USA.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Dickstein
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology*; D016022:Case-Control Studies; D002648:Child; D002657:Child Development; D004644:Emotions; D005145:Face; D005149:Facial Expression; D000066499:Facial Recognition; D005260:Female; D006801:Humans; D008297:Male; D012938:Social Perception; D055815:Young Adult
keywords: adolescents; bipolar disorder; child psychiatry; development; emotion; face