MANIA-LIKE SYMPTOMS SUGGESTIVE OF CHILDHOOD-ONSET BIPOLAR DISORDER INCLINICALLY REFERRED CHILDREN

Objective: To examine the prevalence, characteristics, and correlates of mania among referred children aged 12 or younger. Many case reports challenge the widely accepted belief that childhood-onset mania is ra re. Sources of diagnostic confusion include the variable developmental expression of mania and its symptomatic overlap with attention-defici t hyperactivity disorder (ADHD). Method: The authors compared 43 child ren aged 12 years or younger who satisfied criteria for mania, 164 ADH D children without mania, and 84 non-ADHD control children. Results: T he clinical picture was fully compatible with the DSM-III-R diagnosis of mania in 16% (n = 43) of referred children. All but one of the chil dren meeting criteria for mania also met criteria for ADHD. Compared w ith ADHD children without mania, manic children had significantly high er rates of major depression, psychosis, multiple anxiety disorders, c onduct disorder, and oppositional defiant disorder as well as evidence of significantly more impaired psychosocial functioning. In addition, 21% (n = 9) of manic children had had at least one previous psychiatr ic hospitalization. Conclusions: Mania may be relatively common among psychiatrically referred children. The clinical picture of childhood-o nset mania is very severe and frequently comorbid with ADHD and other psychiatric disorders. Because of the high comorbidity with ADHD, more work is needed to clarify whether these children have ADHD, bipolar d isorder, or both.