Diagnostic issues in childhood bipolar disorder.

The field of psychiatry has largely discounted the existence of bipolar disorder (BD) in children and viewed adolescent-onset BD as uncommon until recently. Evidence demonstrating that a significant number of adults with BD report symptom onset before age 19 has led to an explosion in the recognition of childhood BD over the past decade. Because children and adolescents, including preschoolers, are being diagnosed with BD in rapidly increasing numbers, the criteria for mania are being adjusted in children and adolescents to accommodate various presentations of emotional dysregulation into the paradigm of BD. Still, it has yet to be seen whether these presentations will develop in adulthood into what we have traditionally considered to be BD. This blurring of the diagnostic lines has led to significant controversy in the field of child and adolescent psychiatry. This article introduces current thinking about this controversial diagnosis through two case examples.