Affective illness in children and adolescents: Patterns of presentation inrelation to pubertal maturation and family history

Affective illness is now recognized as a common problem in all age groups, and the various patterns have been well documented in adults. The objective of this study was to evaluate the patterns of affective illness in childre n and determine changes with increasing age and family history. One hundred children/adolescents with affective illness (72 boys and 28 girls; age ran ge 2-20 years; mean age 10 years), who were consecutively referred to the P ediatric Behavioral Neurology Program, Children's Medical Center at Dallas, were evaluated for the pattern and course of affective illness symptoms, f amily history, and pubertal stage. Seven patterns of affective illness were identified. In the 65 prepubertal children (Tanner stage 1), disorders wit h hypomanic/manic symptomatology were most common (47/65, 72%): mania (2/65 , 3%), hypomania (8/65, 12%), cyclothymia (11/65, 17%), juvenile rapid-cycl ing bipolar disorder/ultradian cycling bipolar disorder (8/65, 12%), and dy sthymia with bipolar features (18/65, 28%). In contrast, the 26 fully puber tal adolescents (Tanner stages 3-5) had a predominance of patterns with onl y depressive symptomatology (16/26, 61%): dysthymia (4/26, 15%) and depress ion (12/26, 46%), along with juvenile rapid-cycling bipolar disorder/ultrad ian cycling bipolar disorder (6/26, 23%). Affective illness, alcoholism, an d drug abuse were prominent in the family histories, regardless of the chil d's pattern of symptoms. Family histories of character disorder and Briquet 's syndrome were also common, but thought disorder, suicide, and homicide w ere infrequent. This study supports the clinical observation that the prese ntation of affective illness changes with age: manic features predominate i n younger children, whereas depressive symptomatology is more evident with pubertal maturation.