Okada Yu, Miyawaki Dai, Kusaka Hiroto, Asada Nobuyoshi, Iwakura Yoshihiro, Yanagihara Erika, Asada Naomi, Kanemoto Eri, Terakawa Hiroki, Inoue Koki
Osaka City Med J. 2016 Dec;62(2):103-110.
Children with autism spectrum disorder (ASD) have varied comorbidities. With regard to comorbidity, there has been increasing interest in bipolar disorder (BP) in children. However, the prevalence of BP with ASD has varied because of the methodological differences used. Therefore the adequate criteria for determining BP in children are still debated. The purpose of this study is to identify reliable prevalence of BP and to evaluate a variety of subclinical BP symptoms in children with ASD.
This is a cross-sectional and case-control study. The participants were 110 referred children aged 6-15 years: 46 with ASD (the case group), 64 without ASD (the control group). We used the strict operational criteria for diagnosing BP, and assessed the presence of subclinical BP symptoms using a semi-structured diagnostic interview.
None of the children were diagnosed with BP in the case group, although two children were diagnosed with BP in the control group. Based on the subclinical BP symptoms, the prevalence of elation/expansive mood and racing thoughts was significantly higher in the case group than in the control group: 26.1% versus 3.1% (p<.001) and 32.6% versus 9.4% (p=0.002), respectively.
Our finding indicates that school-aged ASD children frequently present subclinical BP symptoms. It is important to be aware of over-diagnosis of BP, even though the children present subclinical BP symptoms, and to provide -the children with effective treatments.
自闭症谱系障碍（ASD）患儿存在多种共病情况。关于共病，儿童双相情感障碍（BP）越来越受到关注。然而，由于所用方法的差异，ASD合并BP的患病率有所不同。因此，确定儿童BP的适当标准仍存在争议。本研究的目的是确定BP的可靠患病率，并评估ASD患儿各种亚临床BP症状。
这是一项横断面病例对照研究。参与者为110名6至15岁的转诊儿童：46名患有ASD（病例组），64名未患ASD（对照组）。我们使用严格的操作标准诊断BP，并通过半结构化诊断访谈评估亚临床BP症状的存在情况。
病例组中无儿童被诊断为BP，而对照组中有两名儿童被诊断为BP。基于亚临床BP症状，病例组中情绪高涨/夸大和思维奔逸的患病率显著高于对照组：分别为26.1%对3.1%（p<0.001）和32.6%对9.4%（p=0.002）。
我们的研究结果表明，学龄期ASD儿童经常出现亚临床BP症状。即使儿童出现亚临床BP症状，也要注意避免对BP的过度诊断，并为儿童提供有效的治疗，这一点很重要。
