The longitudinal course of children and adolescents with bipolar
disorder (BP) is manifested by frequent changes in symptom polarity with a
fluctuating course showing a dimensional continuum of bipolar symptom
severity from subsyndromal to mood syndromes meeting full Diagnostic
and Statistical Manual of Mental Disorders criteria. These rapid
fluctuations in mood appear to be more accentuated than in adults with BP,
and combined with the high rate of comorbid disorders and the child's
cognitive and emotional developmental stage, may explain the difficulties
encountered diagnosing and treating BP youth. Children and adolescents
with early-onset, low socioeconomic status, subsyndromal mood symptoms,
long duration of illness, rapid mood fluctuation, mixed presentations,
psychosis, comorbid disorders, and family psychopathology appear to have
worse longitudinal outcome. BP in children and adolescents is associated
with high rates of hospitalizations, psychosis, suicidal behaviors,
substance abuse, family and legal problems, as well as poor psychosocial
functioning. These factors, in addition to the enduring and rapid
changeability of symptoms of this illness from very early in life, and at
crucial stages in their lives, deprive BP children of the opportunity for
normal psychosocial development. Thus, early recognition and treatment of
BP in children and adolescents is of utmost importance.This work was supported in part by grant MH59929 from the
National Institute of Mental Health. The authors thank Carol Kostek for
her assistance with manuscript preparation and Editha Nottelmann, PhD, and
Regina James, MD, for their continued support.