Number, Severity, and Quality of Symptoms Discriminate Early-Onset Bipolar Disorder from Attention-Deficit/Hyperactivity Disorder

Abstract

Because more than one quarter of adults with bipolar disorder in the United States started showing symptoms before age 13 years and such early onset carries a poor prognosis into adulthood, it is important to recognize the illness early and treat it effectively. Because of the high comorbidity of childhood onset bipolar disorder with attention-deficit/hyperactivity disorder (ADHD), diagnosis is often difficult. To reveal the earliest prodromal symptoms, we had the parents of children with a clear-cut diagnosis of bipolar disorder or ADHD at an average age of 9 years rate the symptoms that occurred in each year of their child’s life. Following our previous report of decreased sleep and periods of mood elevation discriminating the two groups, we now report that a greater number of dysfunctional symptoms emerged more rapidly in the children who developed bipolar disorder compared to those who developed ADHD. In addition to a positive family history of bipolar illness, the more fulminant onset of multiple manic and dyscontrol symptoms outside of the domain of ADHD provides another clue to a bipolar diagnosis in very young children. [ Psychiatr Ann . 2014; 44(9):416–422.]