I. Description of the problem. Childhood or pediatric-onset bipolar disorder is now the focus of an increasing number of research studies due to the high degree of disability associated with the symptoms and the suggestion of a higher prevalence than once thought. Up until the mid-1990s, the condition was thought to be so uncommon that it was generally not included in the training of child and adolescent psychiatrists or pediatric clinicians and was not considered in the differential diagnosis of a moody child. Because of an increase in diagnoses and medication prescriptions, there are concerns that the diagnosis may be over used, inappropriately subjecting some children to mood-stabilizing medications. The increase in diagnoses may be an accurate reflection of the prevalence of bipolar disorder in children. In fact, it may be an underestimate of real psychiatric illness in youth, and many children who could benefit from psychiatric intervention may never come to clinical attention. Factors such as symptom overlap with attention-deficit/hyperactivity disorder (ADHD) and developmentally different presentation from the classic form of bipolar disorder have led to its underdiagnosis in the past.

II. Making the diagnosis. There is no definitive test for bipolar disorder. Despite advances in neuroimaging and in identifying candidate genes, there are currently no biological markers for this disorder. Like other psychiatric disorders, the diagnosis is made clinically, by asking about the specific symptoms in a developmentally appropriate manner. Research studies often use the Young Mania Rating Scale, but this scale was designed for use in adult inpatients and is not as useful in children and adolescents.