Difficulties in diagnosing manic disorders among children and adolescents.

Four factors are delineated that account for the difficulties in identifying and diagnosing manic disorders among children and adolescents. These factors are the low base rate of the disorder, its variable clinical presentation within and across episodes, its symptomatic overlap with more common disorders of childhood, and the constraints placed on symptom expression by the developmental stage of a child. Each of these factors is discussed in terms of its impact on the likelihood of recognizing mania, and strategies are proposed to improve diagnostic accuracy.