Pediatric Bipolar Disorder: Part I -- Is it related to classical Bipolar

A new diagnosis for children has emerged in the last decade: Pediatric Bipolar Disorder. Children who, in the past, would have been given other diagnoses are now being relabeled as Pediatric Bipolar. This paper examines whether the children being labeled Pediatric Bipolar belong to the same population as well-characterized Bipolar I disorder of the past. We begin with a description of well-characterized Bipolar I adults of the past. Retrospective studies examining the childhood characteristics of adults with Bipolar are reviewed. Then we examine the types of children receiving the diagnosis of Pediatric Bipolar and delineate how the behavior of these children differs from the pattern of behavior exhibited by adults with classical Bipolar, thus raising the question of whether Pediatric Bipolar is a childhood manifestation of classical Bipolar. Next we discuss the changes in the DSM IV which greatly expanded the types of persons included under the Bipolar label. Then we review studies examining the children of parents with well-characterized Bipolar I and studies examining children of parents meeting criteria under the expanded definition of Bipolar. We conclude that only children of parents meeting criteria for Bipolar under the expanded definition are similar to children being diagnosed with Pediatric Bipolar, while the children of parents with classical Bipolar I are not similar. Because the new people added to the traditional Bipolar population do not share a genetic diathesis with the traditional Bipolar diagnosed person of the past, we question the usefulness of having broadened the Bipolar label to children and, perhaps, their parents. We end with the studies suggesting that some children meeting criteria for bipolar behavior will grow out of this behavior.