Bipolar disorder in prepubertal children in a special educational setting: is it rare?

The author undertook a comprehensive clinical reevaluation of five prepubertal children attending a special educational class for emotionally disturbed children in a day program. The children had failed to improve or had continued to worsen despite years of treatment in multiple settings. This extensive reevaluation and observation, spanning many months, revealed that all of the children met DSM-III-R criteria for bipolar disorder (lifetime prevalence). None of the children had been previously diagnosed with this disorder. The author's finding suggests that bipolar disorder may be more common in severely problematic prepubertal children than is generally recognized. The implications of this and related issues are discussed.