History Of Childhood Attention-deficit Hyperactivity Disorder Research Articles

Neuropsychological profiles of adult bipolar disorder patients with and without comorbid attention-deficit hyperactivity disorder

BackgroundComorbid attention-deficit/hyperactivity disorder (ADHD) is common in bipolar disorder and associated with worse outcomes. Cognitive testing might be a tool to identify this group. Here we compare the neuropsychological profiles of bipolar disorder patients with (BD + cADHD) and without (BD − cADHD) childhood attention-deficit hyperactivity disorder.MethodsAdult patients with BD − cADHD (n = 66), BD + cADHD (n = 32), and healthy controls (n = 112) were tested using a comprehensive battery of neuropsychological tests. Patients underwent rigorous diagnostic assessments for bipolar disorder and ADHD, as well as a parental interview to establish childhood ADHD.ResultsThe neuropsychological profiles of the groups were similar, except that the BD + cADHD group performed significantly worse on working memory. Working memory did not differ between those in the BD + cADHD group who only had a history of childhood ADHD and those that still met criteria for ADHD in adulthood.ConclusionsCognitive testing had limited power to differentiate between bipolar disorder adults with and without childhood ADHD. The BD + cADHD subgroup cannot explain the significant cognitive heterogeneity seen in bipolar disorder patients.

Preliminary evidence of altered gray matter volume in subjects with internet gaming disorder: associations with history of childhood attention-deficit/hyperactivity disorder symptoms.

Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid with Internet gaming disorder (IGD). Although childhood ADHD symptoms may decline during late brain maturation, structural alterations in some brain areas may persist into adulthood. This study investigated whether young adults with IGD and a history of childhood ADHD symptoms had gray matter volume (GMV) alterations that were distinct from subjects without a history of childhood ADHD. As an exploratory investigation, we conducted a whole-brain voxel-based morphometry with the diffeomorphic anatomical registration using an exponentiated Lie algebra algorithm and applied an uncorrected threshold at the voxel level for multiple comparisons. GMVs of IGD subjects with a history of childhood ADHD (IGDADHD+ group; n = 20; 24.5 ± 2.5years) were compared to those of subjects without a history of childhood ADHD (IGDADHD- group; n = 20; 23.9 ± 2.5years) and controls (n = 20; 22.7 ± 2.4years). Compared with controls, both IGD groups had a smaller GMV in the right anterior cingulate cortex, the left inferior frontal gyrus, and the left insula, yet had a larger GMV in the right angular gyrus. The IGDADHD+ group had a larger GMV in the right precuneus than the IGDADHD- group and controls. When controlling for other comorbid psychiatric symptoms, the IGDADHD+ group also had a smaller GMV in the right inferior frontal gyrus. In conclusion, we found that young adults with IGD and a history of childhood ADHD symptoms had characteristic GMV alterations, which may be linked with their manifestation of childhood ADHD.

Is adult-onset attention deficit/hyperactivity disorder frequent in clinical practice?

Recent population-based longitudinal studies concluded that most adults with attention deficit/hyperactivity disorder (ADHD) symptoms would not have a childhood history of ADHD, leading to the concept of adult-onset ADHD. In a large, well-characterized clinical population of 446 adults with a primary complaint of ADHD, we reported a low frequency of adult-onset ADHD (6.9%), being a primary isolated condition in 2.8%. They had less severe symptoms and tendencies for higher hypersomnolence disorder comorbidity than patients with typical childhood-onset ADHD. Our findings reinforce the requirement to exclude other disorders that might overlap with ADHD or mimic ADHD symptoms in adulthood onset patients.

Neonatal rotenone lesions cause onset of hyperactivity during juvenile and adulthood in the rat

Attention deficit hyperactivity disorder (ADHD) is characterized by behavioral and cognitive symptoms. Longitudinal studies demonstrated that the symptoms remains clinically significant for the majority of ADHD children into adulthood. Furthermore, a population-based birth cohort provided the initial evidence of adult ADHD that lacks a history of childhood ADHD. We previously demonstrated that neonatal exposure to bisphenol A, an environmental chemical caused hyperactivity in the juvenile. Here, we extend to examine other chemical such as rotenone, a dopaminergic toxins. Oral administration of rotenone (3mg/kg) into 5-day-old male Wistar rats significantly caused hyperactivity at adulthood (8∼11 weeks old; p<0.05). It was about 1.3∼1.4-fold more active in the nocturnal phase after administration of rotenone than control rats. Higher dose (16mg/kg) or repeated lower dose of rotenone (1mg/kg/day for 4days) caused hyperactivity in the juvenile. Furthermore, DNA array analyses showed that neonatal exposure to rotenone altered the levels of gene expression of several molecules related to apoptosis/cell cycle, ATPase, skeletal molecule, and glioma. Bivariate normal distribution analysis indicates no correlation in gene expression between a hyperactivity disorder model and a Parkinson’s disease model by rotenone.Thus, we demonstrate a rotenone models of ADHD whose onset varies during juvenile and adulthood.

Clinical and functional implications of a history of childhood ADHD in first-episode psychosis

There is mounting evidence indicating that a childhood history of attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for psychotic disorders, including schizophrenia. However, the implications of such a history on the symptomatic and functional outcomes of patients with psychotic disorders are still not well documented. This study examined the prevalence of childhood ADHD in patients with first episode psychosis (FEP) consecutively admitted to a specialized early intervention clinic covering a well-defined catchment area, and compared patients with and without a history of childhood ADHD on socio-demographic, clinical, and functional outcomes over a six to twelve months period. Out of 179 patients with FEP, 27 (15%) were treated for ADHD during childhood, consistent with previous literature indicating an association between childhood ADHD and psychosis. FEP patients with childhood history of ADHD had lower academic achievement, earlier onset of psychosis, and higher rates of childhood conduct and learning disorder. While the two groups had similar scores on psychopathology and functioning at baseline, patients with childhood ADHD showed significantly less improvement in positive and negative symptoms, as well as social and occupational functioning. These results strongly indicate that a history of childhood ADHD in FEP is more frequent than that reported in the general population and predictive of poorer clinical response to treatment. This emphasizes the need for actively screening for a history of ADHD in FEP patients and for treatments that are tailored for these patients.

The impact of attention-deficit hyperactivity disorder across the lifespan on substance use disorders

Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children, but persists into adulthood with a prevalence rate up to 4.4% in the general population. The association between ADHD and substance use disorders (SUDs) is getting more into the scientific focus. However, the impact of ADHD on SUD regarding the economic system and healthcare is still underestimated. Aim of the work The aim of this study was to analyze the impact of childhood and adult ADHD on SUD by comparing the SUD clinical outcome between a group of SUD inpatients having a history of childhood ADHD and another group of SUD inpatients having concurrent adult ADHD. Participants and methods A cross-sectional comparative study was conducted at the Addiction Treatment Center at El Maamoura Mental Hospital. In all, 102 adult male patients were assessed using a clinical psychiatric interview and psychometric assessment using the Arabic version of Wender Utah Rating Scale for retrospective assessment of symptoms of childhood ADHD. Also, the Arabic version of the Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. Results Sixty-four patients out of the total studied sample had a history of childhood ADHD. Of them, only 36 patients fulfilled the DSM-IV-TR criteria for adult ADHD. The presence of adult ADHD was associated with an earlier mean age of onset of SUD (13.22 vs. 14.86 years), a larger number of hospital admissions (4.21 vs. 6.83 times), and a shorter mean period of abstinence (124.53 vs. 271.50 days) than patients with a history of childhood ADHD. Conclusion In comparison with childhood ADHD, the presence of adult ADHD among patients with SUD was associated with a more complicated course of SUDs and a poorer clinical outcome.

Differential Associations Between Alcohol Expectancies and Adolescent Alcohol Use as a Function of Childhood ADHD

Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for experiencing alcohol-related problems. However, previous research has not examined alcohol expectancies, a widely studied risk factor for alcohol use, in this population. The current study examined mean differences in alcohol expectancies for adolescents with and without a history of childhood ADHD. The differential association between alcohol expectancies and alcohol use 1 year later as a function of ADHD status was also examined. Two hundred and eighty-six adolescents ages 11-17 (ADHD: n = 165; non-ADHD: n = 121) reported their alcohol expectancies and alcohol use over a 1-year period as part of the Pittsburgh ADHD Longitudinal Study. Individuals with a history of ADHD had lower mean levels of alcohol expectancies compared with individuals without ADHD. Specifically, at Time 1, individuals with ADHD reported lower levels of sociability, cognitive and behavioral impairment, and liquid courage expectancies than individuals without ADHD. Further, the association between negative alcohol expectancies at Time 1 and alcohol use at Time 2 differed for individuals with and without a history of ADHD. These findings highlight the possibility that individuals with a history of ADHD may rely less on explicit cognitions, such as alcohol expectancies, when making decisions to drink alcohol. This is consistent with the dual process model of alcohol cognitions that has posited that individuals with decreased executive control may rely more on implicit cognitions about alcohol.

Determining the Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) in Patients with Bipolar Disorder Type I (BID) within Their Remission Phase

Background: There have been several studies conducted on the relationship between bipolar mood disorder and attention deficit hyperactivity disorder (ADHD) during the recent years, and in most of them the rate of this association had been estimated as 22-90% and had been reported as noticeable. The goal of this study is to determine the prevalence of ADHD in patients with Bipolar mood disorder type I (BID).&#x0D; Materials and Methods: In this Cross-sectional study, 152 patients with BID that were referred to psychiatric clinic of Tehran psychiatric Institute for a better observation and treatment were included. Two questionnaires, Wender’s for childhood ADHD and Conner’s’ for adulthood ADHD were filled by the patients.&#x0D; Results: 102 patients (67%) were males and 50 were females. The average age of patients at the time of our study (with the minimum of 17 and maximum of 76) was 33.5±10.9. The prevalence of ADHD in our patients was 11.8%. 46 people (30.9%) had a history of childhood ADHD. 21 persons had adult ADHD from whom only 3 ones mentioned a history of childhood ADHD (which means 18 people of our adulthood ADHD had no history of childhood ADHD).&#x0D; Conclusion: Since some treatments lead to improvement of ADHD and worsening of BID, investigations on their correlations and their alternative treatments seemed to be necessary. This study showed a significant correlation between ADHD and BID, which was similar to the results of other studies in this field.

2709 – Impact of attention-deficit hyperactivity disorder “ADHD” across lifespan on substance use disorders “SUD”

Introduction Attention-deficit hyperactivity disorder (ADHD) affects not only children but persists for up to 4.4% in the general population. Comorbidity is common among adults with ADHD, including substance abuse. Objectives Assessment of impact of both childhood and adult ADHD on SUD. Aim The aim of this study was to estimate prevalence rate of past history of childhood ADHD and current adult ADHD among substance use inpatients and to compare between the two groups regarding onset and severity of substance use disorder. Methods This cross-sectional comparative study was conducted in addiction treatment center at El Maamoura psychiatric hospital. One hundred and two adult males were assessed using Arabic version of Wender Utah Rating Scale (WURS) for retrospective assessment of symptoms of childhood ADHD. Arabic version of Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist was used to screen for adult ADHD. DSM IV TR criteria were used for final diagnosis. Results Sixty Four patients of the total studied sample had past history of childhood ADHD. Of which, only 36 patients fulfilled the DSM - IV TR criteria for adult ADHD. Presence of adult ADHD was associated with an earlier mean age of onset of SUD (13.22 vs. 14.86 years), larger number of hospital admissions, (4.21 vs. 6.83 times) and a shorter mean period of abstinence (124.53 vs. 271.50 days). Conclusions In comparison to childhood ADHD, presence of adult ADHD was associated with a more complicated course of substance use disorders and poorer outcome.

Possible association of the DRD4 gene with a history of attention‐deficit/hyperactivity disorder in women with bulimia nervosa

Up to one-third of patients with bulimia nervosa (BN) report a history of attention-deficit/hyperactivity disorder (ADHD) symptoms, and the dopaminergic genes, especially the dopamine receptor D4 (DRD4), have been associated independently with both binge eating and ADHD. The purpose of this study was to (1) compare the frequency of DRD4 exon III VNTR variants in 157 BN probands and equal number of healthy controls; (2) assess transmission of DRD4 alleles in 68 families of patients with BN; and (3) explore the possible role of DRD4 gene in childhood ADHD history in a subgroup of 81 women with BN. Our results showed that the BN probands and controls did not differ in DRD4 allele frequency. We also did not find evidence for preferential transmission of any DRD4 variant to the affected offspring with BN. However, the presence of either the 2-repeat or 7-repeat allele was associated with a history of childhood ADHD in BN (p = .038, odds ratio = 3.2). Our findings suggest that although DRD4 may not be associated with the diagnosis of BN, its variants are associated with a history of childhood ADHD in BN probands. This may have relevance for the understanding, prevention, and treatment of BN that evolves in the context of childhood ADHD.

Retrospective Evaluation of Attention Deficit Hyperactivity Disorder with the Wender Utah Rating Scale in a Sample of Spanish Prison Inmates

The aim of this study is to determine the prevalence of childhood history of attention deficit hyperactivity disorder (ADHD) in a sample of prison inmates. This is a descriptive, cross-sectional study, which consisted of a sample of 100 inmates from penitentiary centers in Madrid. The instruments used were the Wender Utah Rating Scale (WURS), the International Personality Disorder Examination, and a questionnaire of demographic, penitentiary, and toxicological data. For statistical analysis, the SPSS program was used with confidence interval estimation of 95%. The mean score of the WURS was 65.7 points. Fifty percent of the sample surpassed the cut-off point of 32 for the 25 best discriminative items in the Spanish validated version. A significant association was found between a childhood history of ADHD and antisocial and borderline personality disorders. The disorder was also found to be associated with autoaggressive behavior, more probability to be sanctioned in prison, and have a history of substance dependence.

Childhood Stimulant Treatment and Teen Depression: Is There a Relationship?

Recent preclinical data have raised the possibility that prepubertal treatment of attention-deficit/hyperactivity disorder (ADHD) with stimulant medication might increase risk for later depression. The current longitudinal study investigated whether children with ADHD who were treated with stimulant medication displayed heightened levels of adolescent depression. Adolescents diagnosed with ADHD during childhood who had received a minimum of 1 year of treatment with stimulant medication were compared to adolescents with a childhood history of ADHD who were never treated with stimulants and a demographically matched comparison group on self-reports of depressive symptoms and diagnoses of depressive disorders. Both subgroups with childhood ADHD reported significantly higher dimensional ratings of depression and categorical rates of depressive disorders relative to the comparison group (all p<0.05), yet those who were and were not medicated did not differ from one another. Results indicate that, while childhood ADHD increases risk for adolescent depression, stimulant treatment for ADHD neither heightens nor protects against such risk.

Lower CSF HVA and 5-HIAA in bipolar disorder type 1 with a history of childhood ADHD

Bipolar disorder with childhood attention-deficit hyperactivity disorder (ADHD) is a subphenotype characterized by earlier age of onset, more frequent mood episodes, more suicide attempts, and more interpersonal violence than pure bipolar patients. The aim of this study was to test the biological validity of using childhood ADHD to subgroup bipolar disorder. The monoamine metabolites, homovanillinic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) were determined in the cerebrospinal fluid (CSF) of 53 euthymic patients with bipolar disorder type 1, with (N = 17) and without (N = 36) a history of childhood ADHD. In addition to structured clinical interviews, childhood ADHD was assessed by a next of kin using the Autism-Tics, ADHD and other comorbidities questionnaire (A-TAC), and by patients themselves using the Wender Utah rating scale (WURS-25). Current ADHD symptoms were assessed by the Brown attention-deficit disorder scale (Brown ADD). Bipolar patients with childhood ADHD had significantly lower CSF concentration (mean +/- SD nmol/l) of HVA (89.0 +/- 32.5 vs. 115.8 +/- 47.1, P = 0.039) and 5-HIAA (88.7 +/- 38.5 vs. 116 +/- 47.9, P = 0.021) than pure bipolar patients. CSF MHPG did not differ between the groups. The WURS-25 score correlated negatively with both HVA (r = -0.27, P = 0.048) and 5-HIAA (r = -0.30, P = 0.027). Likewise, the Brown ADD total score correlated negatively with both HVA (r = -0.34, P = 0.013) and 5-HIAA (r = -0.35, P = 0.011). These findings indicate different monoaminergic function in patients with and without childhood ADHD in bipolar disorder type 1. This lends biological support to the notion that those with childhood ADHD represent a valid subphenotype of bipolar disorder.

A history of childhood attention‐deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD

The occurrence of comorbid attention-deficit hyperactivity disorder (ADHD) might have an impact of the course of the bipolar disorder. Patients with bipolar disorder (n = 159) underwent a comprehensive evaluation with respect to affective symptoms. Independent psychiatrists assessed childhood and current ADHD, and an interview with a parent was undertaken. The prevalence of adult ADHD was 16%. An additional 12% met the criteria for childhood ADHD without meeting criteria for adult ADHD. Both these groups had significantly earlier onset of their first affective episode, more frequent affective episodes (except manic episodes), and more interpersonal violence than the bipolar patients without a history of ADHD. The fact that bipolar patients with a history of childhood ADHD have a different clinical outcome than the pure bipolar group, regardless of whether the ADHD symptoms remained in adulthood or not, suggests that it represent a distinct early-onset phenotype of bipolar disorder.

Influence of childhood adhd history on personality traits of pathological gamblers

Background and aims:Different personality factors have been investigated in connection with addictive disorders such as pathological gambling. “Impulse control”, proposed as a dimension of personality in modern “Big Five” models, has been associated with pathological gambling. Pathological gamblers have a high prevalence of childhood attention-deficit/hyperactivity disorder (ADHD), which is also associated with high impulsivity. Based on a five-factor personality model, our objective was to compare different personality dimensions in a group of pathological gamblers with childhood ADHD history, a group of pathological gamblers without such history and a control group. Special emphasis was placed on the factor “emotional stability”, which includes the subdimensions “emotion control” and “impulse control”.Methods:A sample of 30 pathological gamblers with childhood ADHD history (ADHD+PG group), 33 pathological gamblers without ADHD history (ADHD-PG group) and 42 control subjects were assessed using the Big Five Questionnaire (BFQ). The different BFQ dimensions and subdimensions were compared.Results:For the “emotional stability” factor, the T-scores obtained indicated statistically significant differences between groups (ADHD+PG group: 44.1; ADHD-PG group: 51.9; control group: 57.9; ANOVA, p<0.001). Scheffe´s post hoc analysis showed the ADHD+PG group to be less emotionally stable than both the ADHD-PG (p=0.002) and the control groups (p<0.001); the ADHD-PG group also scored lower on this “emotional stability” factor than the control group (p=0.015).Conclusions:Pathological gamblers with a history of childhood ADHD exhibit differential personality traits. ADHD history is associated with a lower score on the “emotional stability” factor, which includes the subdimensions “emotion control” and “impulse control”.

An overlooked vulnerability in a defendant: Attention deficit hyperactivity disorder and a miscarriage of justice

Aim. To describe the implications of a Court of Appeal murder case involving a 15‐year‐old youth. His attention‐deficit hyperactivity disorder (ADHD) was not identified at trial, but 8 years later it was and his conviction was quashed.Method. An analysis of the judgments by the Court of Appeal at an earlier hearing (1997) and in 2004, together with a review of how the relatively new diagnostic concept of ADHD, can be employed to aid assessment of important vulnerable qualities.Results. One of the primary effects of ADHD in the case was to ‘affect’ the IQ scores, making it look as if the defendant was suffering from mental retardation and so masking his other more relevant vulnerabilities.Conclusions. ADHD symptoms are relevant to contended issues around adverse inferences and fitness to plead and stand trial. A comprehensive ADHD assessment, including neuropsychological testing, is necessary where there are indications of a history of childhood ADHD.

Impulsivity and Sustained Attention in Pathological Gamblers: Influence of Childhood ADHD History

Pathological gambling (PG) has been associated to both impulsiveness and attention deficit/hyperactivity disorder (ADHD) in different studies. Our objective was to compare different impulsivity and sustained attention variables, using both behavioural tasks and self-administered questionnaires, in a group of pathological gamblers with a history of childhood ADHD (PG-ADHD; n = 16), a group of pathological gamblers without this history (PG-non-ADHD; n = 39), and a control group (n = 40). As instruments of measure, we used the stop signal task (to evaluate inhibitory control/impulsivity), the differential reinforcement of Low Rate Responding Task (delay of gratification/impulsivity) and the Continuous Performance Test (sustained attention). The Barratt Impulsivity Scale (BIS-11) was used as a self-administered questionnaire to measure impulsiveness. Our results show that patients in the PG-ADHD group exhibit a significantly lower capacity to delay gratification than those in the PG-non-ADHD and control groups, and less inhibitory control than patients in the PG-non-ADHD group. On self-administered questionnaires such as the BIS-11 the PG-ADHD group obtained higher scores than the PG-non-ADHD and control groups. However, no differences were found with respect to sustained attention using the CPT. Our results suggest a possible selective implication of the prefrontal cortex in PG, which would be especially evident in those with a childhood history of ADHD.

Preliminary evidence of the association between the history of childhood attention‐deficit/hyperactivity disorder and smoking treatment failure

Smoking rates are elevated among individuals with attention-deficit/hyperactivity disorder (ADHD). The association of ADHD diagnosis and smoking treatment outcome has not been examined. The present study examined abstinence rates among 428 adult smokers participating in two randomized controlled trials. Treatments included nicotine replacement, antidepressants, and psychological interventions. Childhood ADHD was assessed retrospectively by diagnostic interview. In a survival analysis, ADHD status predicted time to relapse after controlling for gender, history of depression, and baseline smoking variables. Only 1 of 47 participants with a history of childhood ADHD remained abstinent by week 52, compared with 18% of those who had no history of childhood ADHD (adjusted OR=0.36, 95% CI=0.28-0.45). The current findings provide preliminary evidence for an association between childhood ADHD and smoking cessation treatment failure. Further investigation is warranted.

Substance use, substance abuse, and LD among adolescents with a childhood history of ADHD.

A clinic-referred sample of 109 children with attention-deficit/hyperactivity disorder (ADHD) was followed into adolescence for the ascertainment of alcohol and other drug use and abuse. Learning disability (reading or math) in childhood was examined as a predictor of adolescent substance use and substance use disorder for alcohol and marijuana. No statistically significant group differences for children with LD versus those without LD emerged even after using different methods to compute LD. IQ/achievement discrepancy scores were similarly not predictive of later use or abuse. However, children with ADHD who had higher IQs and higher levels of academic achievement in childhood were more likely to try cigarettes, to smoke daily, and to have their first drink of alcohol or first cigarette at an early age. Children with ADHD who had higher reading achievement scores were less likely to have later alcohol use disorder. Although these findings are necessarily preliminary, due to the small number of children interviewed, the pattern of results suggests that level of cognitive functioning--rather than discrepancy between IQ and achievement--is important for the prediction of later substance use and abuse, at least in this clinic-referred sample of children with ADHD. Further, different mechanisms of risk related to cognitive functioning may be operating for experimentation with legal drugs such as alcohol and tobacco, regular cigarette smoking, and problematic alcohol use.

Psychiatric Phenomenology of Child and Adolescent Bipolar Offspring

To establish prodromal signs of and risk factors for childhood bipolar disorder (BD) by characterizing youths at high risk for BD. Structured diagnostic interviews were performed on 60 biological offspring of at least one parent with BD. Demographics, family histories, and parental history of childhood disruptive behavioral disorders were also assessed. Fifty-one percent of bipolar offspring had a psychiatric disorder, most commonly attention-deficit/hyperactivity disorder (ADHD), major depression or dysthymia, and BD. BD in offspring tended to be associated with earlier parental symptom onset when compared with offspring without a psychiatric diagnosis. Bipolar parents with a history of childhood ADHD were more likely to have children with BD, but not ADHD. Offspring with bilineal risk had increased severity of depressed and irritable mood, lack of mood reactivity, and rejection sensitivity, while severity of grandiosity, euphoric mood, and decreased need for sleep were not preferentially associated with such offspring. Bipolar offspring have high levels of psychopathology. Parental history of early-onset BD and/or childhood ADHD may increase the risk that their offspring will develop BD. Prodromal symptoms of childhood BD may include more subtle presentations of mood regulation difficulties and less presence of classic manic symptoms.