The adult criteria describe a disorder of fluctuating mood cycles, consisting of episodes of elevated mood and increased goal-directed activity or energy (mania) lasting at least 1 week, and episodes of lowered mood and activity (depression); an episode of mania is necessary for a diagnosis to be made.
An uncommon condition in children that becomes more frequent in teens, approaching the rate seen in adults.
A serious illness with recurrent episodes, leading to considerable impairment and an increased risk of suicide.
Diagnosis can be controversial, as criteria overlap with other childhood conditions such as ADHD and comorbid oppositional defiant disorder.
First-line treatment for manic episodes is antipsychotic therapy; the evidence base in children and adolescents is small, and comes mostly from industry-supported trials.
Medications have potentially serious adverse effects, so the risks and possible benefits need to be carefully assessed.
Bipolar disorder in children encompasses bipolar I disorder (manic episodes with or without depressive episodes) and bipolar II disorder (depressive episodes with periods of milder, briefer, and less impairing mania, called hypomania).
Bipolar I disorder, which has been most specifically studied in youth, is a chronic disorder of fluctuating mood, consisting of episodes of elevated mood and increased goal-directed activity or energy (mania) lasting at least 1 week, and episodes of lowered mood and activity (depression). Other symptoms of mania include distractibility, grandiosity, disinhibition, flight of ideas, hyperactivity, reduced sleep, and talkativeness. Varying diagnostic approaches have been proposed in children, but the implications of these approaches for treatment and prognosis remain unclear.  Many children exhibiting chronic nonepisodic irritability and severe temper outbursts have been diagnosed with bipolar disorder in the US, despite the lack of distinct mood episodes. Disruptive mood dysregulation disorder (DMDD), a new diagnosis in the DSM-5, aims to address this over-diagnosis and treatment of bipolar disorder in children;  however, the inclusion of this new diagnostic entity has also raised concerns regarding inappropriate diagnosis and over-treatment of irritability with a category that remains poorly validated.  Despite concerns regarding over-diagnosis, there is also evidence that diagnoses of bipolar disorder can be significantly delayed  and under-treated. 
Bipolar I disorder is discussed here.
Consultant Child and Adolescent Psychiatrist
Lancashire Care NHS Foundation Trust
Faculty of Biology, Medicine and Health
University of Manchester
BD is a member of NIHR HTA panel, and has previously received HTA funding. She is a clinical advisor to NHSE and an occasional advisor to NICE. BD serves as Vice Chair of Royal College of Psychiatrists child and adolescent faculty, and as Editor on Child and Adolescent Mentalis. BD is an author of references cited in this topic.
Professor of Psychiatry
Ohio State Wexner Medical Center
Nationwide Children's Hospital
Center for Innovation in Pediatric Practice
RAK is on the data safety monitoring committee for Forrest and Pfizer, but receives no compensation for taking part; he is also an author of references cited in the this topic.
Dr Bernadka Dubicka and Dr Robert A. Kowatch would like to gratefully acknowledge Dr Gabrielle A. Carlson, a previous contributor to this monograph. GAC is an author of a number of references cited in this monograph.
Division of Child & Adolescent Psychiatry
Department of Psychiatry & Behavioral Sciences
University of Washington
JM is an author of a number of references cited in this monograph.
Child and Adolescent Psychiatrist
Emeritus Professor of Psychiatry
The Werry Centre for Child and Adolescent Mental Health
Department of Psychological Medicine
University of Auckland
JW is an author of a number of references cited in this monograph.
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