title: Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder.
abstract: Greater understanding of cognitive function in children and adolescents with bipolar disorder (BD) is of critical importance to improve our ability to design targeted treatments to help with real-world impairment, including academic performance. We sought to evaluate cognitive performance among children with either BD type I, II, or "not otherwise specified" (NOS) participating in multi-site Course and Outcome of Bipolar Youth study compared to typically developing controls (TDC) without psychopathology. In particular, we sought to test the hypothesis that BD-I and BD-II youths with full threshold episodes of mania or hypomania would have cognitive deficits, including in reversal learning, vs. those BD-NOS participants with sub-threshold episodes and TDCs. N = 175 participants (BD-I = 81, BD-II = 11, BD-NOS = 28, TDC = 55) completed Cambridge Neuropsychological Automated Testing Battery (CANTAB) tasks. A priori analyses of the simple reversal stage of the CANTAB intra-/extra-dimensional shift task showed that aggregated BD-I/II participants required significantly more trials to complete the task than either BD-NOS participants with sub-syndromal manic/hypomanic symptoms or than TDCs. BD participants across sub-types had impairments in sustained attention and information processing for emotionally valenced words. Our results align with prior findings showing that BD-I/II youths with distinct episodes have specific alterations in reversal learning. More broadly, our study suggests that further work is necessary to see the interaction between neurocognitive performance and longitudinal illness course. Additional work is required to identify the neural underpinnings of these differences as targets for potential novel treatments, such as cognitive remediation.
authors.affiliation: Department of Psychiatry and Human Behavior, Division of Child-Family Psychiatry, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA. Daniel_Dickstein@brown.edu.|PediMIND Program, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI, 02915, USA. Daniel_Dickstein@brown.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Dickstein
authors.affiliation: Department of Psychiatry, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: David
authors.initials: D
authors.lastname: Axelson
authors.affiliation: Department of Psychiatry and Human Behavior, Division of Child-Family Psychiatry, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Weissman
authors.affiliation: Department of Psychiatry and Human Behavior/Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Shirley
authors.initials: S
authors.lastname: Yen
authors.affiliation: Department of Psychiatry and Human Behavior, Division of Child-Family Psychiatry, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Hunt
authors.affiliation: Department of Child Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Medical Center, Toronto, ON, Canada.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Goldstein
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Tina R
authors.initials: TR
authors.lastname: Goldstein
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Fangzi
authors.initials: F
authors.lastname: Liao
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Gill
authors.affiliation: Department of Psychiatry and Human Behavior/Butler Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Hower
authors.affiliation: Department of Psychiatry, Center for Autism, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Frazier
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rasim S
authors.initials: RS
authors.lastname: Diler
authors.affiliation: Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Youngstrom
authors.affiliation: Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Fristad
authors.affiliation: Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH, USA.
authors.forename: L Eugene
authors.initials: LE
authors.lastname: Arnold
authors.affiliation: Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Findling
authors.affiliation: Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York City, NY, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Horwitz
authors.affiliation: Department of Psychiatry, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kowatch
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.affiliation: Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Strober
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.affiliation: Butler Hospital, Providence, RI, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Keller
mesh_terms: D000293:Adolescent; D001288:Attention / Q000502:physiology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D002648:Child; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D010775:Photic Stimulation / Q000379:methods; D011597:Psychomotor Performance / Q000502:physiology; D012193:Reversal Learning / Q000502:physiology
keywords: Adolescent; Bipolar disorder; Child; Cognitive performance; Reversal learning