Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions, ultra-rapid or ultradian cycling

Background: In contrast to differential diagnosis (ddx) of older adolescent and adult bipolarity (BP), which includes schizophrenia and substance use disorders, the main ddx of prepubertal and early adolescent BP is attention -deficit disorder with hyperactivity (ADHD). To address this ddx issue, and to provide prepubertal mania manifestations, interim baseline data are pre sented from the National Institute of Mental Health (NIMH)-funded study 'Ph enomenology and Course of Pediatric Bipolarity'. Methods: Data are from the first 60 BP and the first 60 ADHD cases from 270 consecutively ascertained subjects (90 BP, 90 ADHD and 90 community controls). Comprehensive assessm ents included the Washington University at St. Louis Kiddie and Young Adult -Schedule for Affective Disorders and Schizophrenia - Lifetime and Present Episode Version-DSM-IV (WASH-U-KSADS) blindly administered by nurses to mot hers about their offspring and to children/adolescents about themselves. Ca seness was established by consensus conferences that included diagnostic an d impairment data, teacher and school reports, agency records, Videotapes a nd medical charts. Results: Mean baseline age of BP cases was 11.0+/-2.7 ye ars and the mean age at onset of BP was 8.1+/-3.5 years. Elated mood, grand iosity, hypersexuality, decreased need for sleep, racing thoughts and all o ther mania items except hyperenergetic and distractibility were significant ly and substantially more frequent among BP than ADHD cases (e.g., elation: 86.7% BP vs. 5.0% ADHD; grandiosity: 85.0% BP vs. 6.7% ADHD). In the BP gr oup, 55.0% had grandiose delusions, 26.7% had suicidality with plan/intent and 83.3% were rapid, ultra-rapid or ultradian cyclers. Limitations: Sites for consecutive case ascertainment from the lowest socioeconomic status cla sses were unavailable due to current health care policies. Clinical relevan ce: Prepubertal and early adolescent BP cases differentiate from ADHD by ma nia-specific criteria and commonly present with ultra-rapid or ultradian cy cling. (C) 1998 Elsevier Science B.V. All rights reserved.