{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T19:35:58Z","timestamp":1781897758607,"version":"3.54.5"},"reference-count":104,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T00:00:00Z","timestamp":1668384000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Acta Neuropsychiatr."],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S092427082200028X_as1\"><jats:title>Objectives:<\/jats:title><jats:p>Paediatric bipolar disorder \u2013 bipolar disorder occurring in prepubertal children \u2013 is a diagnosis subject to considerable controversy. Whilst historically considered to be very rare, proponents since the 1990s have argued that mania can present differently in children and, as such, is much more common than previously thought. Such proposals raise questions about the validity of proposed phenotypes and potential risks of iatrogenic harm.<\/jats:p><\/jats:sec><jats:sec id=\"S092427082200028X_as2\"><jats:title>Methods:<\/jats:title><jats:p>I critically examine the construct of paediatric bipolar disorder using Robins and Guze\u2019s (1970, <jats:italic>American Journal of Psychiatry<\/jats:italic><jats:bold>126<\/jats:bold>, 983\u2013987) influential criteria for the validity of a psychiatric diagnosis. I review, in turn, evidence relating to its clinical description, delimitation from other conditions, follow-up studies, family studies, laboratory studies, and treatment response.<\/jats:p><\/jats:sec><jats:sec id=\"S092427082200028X_as3\"><jats:title>Results:<\/jats:title><jats:p>Across domains, existing research highlights significant challenges establishing the diagnosis. This includes significant heterogeneity in operationalising criteria for children; variable or poor inter-rater reliability; difficulty distinguishing paediatric bipolar disorder from other conditions; large differences in rates of diagnosis between the United States of America and other countries; limited evidence of continuity with adult forms; and a lack of evidence for proposed paediatric phenotypes in children at genetic high-risk of the condition. Laboratory and treatment studies are limited, but also do not provide support for the construct.<\/jats:p><\/jats:sec><jats:sec id=\"S092427082200028X_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Evidence for the more widespread existence of paediatric bipolar disorder and its various proposed phenotypes remains weak. The ongoing popularity of the diagnosis, most evident in America, may reflect social pressures and broader limitations in psychiatric nosology. The uncertainty around the diagnosis highlights the need for careful longitudinal assessment of children potentially affected.<\/jats:p><\/jats:sec>","DOI":"10.1017\/neu.2022.28","type":"journal-article","created":{"date-parts":[[2022,11,14]],"date-time":"2022-11-14T09:27:57Z","timestamp":1668418077000},"page":"96-103","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":10,"title":["Paediatric bipolar disorder and its controversy"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7224-1896","authenticated-orcid":false,"given":"Michael H.","family":"Connors","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,11,14]]},"reference":[{"key":"S092427082200028X_ref86","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-017-0071-y"},{"key":"S092427082200028X_ref101","doi-asserted-by":"publisher","DOI":"10.1093\/ijnp\/pyz034"},{"key":"S092427082200028X_ref67","first-page":"CD004048","article-title":"Lithium for acute mania","volume":"6","author":"McKnight","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"S092427082200028X_ref73","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12306"},{"key":"S092427082200028X_ref57","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2021.02.010"},{"key":"S092427082200028X_ref82","doi-asserted-by":"publisher","DOI":"10.1017\/S0924270800035602"},{"key":"S092427082200028X_ref90","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.08121849"},{"key":"S092427082200028X_ref19","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1906193"},{"key":"S092427082200028X_ref76","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(14)00075-3"},{"key":"S092427082200028X_ref83","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2011.04.006"},{"key":"S092427082200028X_ref15","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12243"},{"key":"S092427082200028X_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.8.956"},{"key":"S092427082200028X_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S0006-3223(00)00911-2"},{"key":"S092427082200028X_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2006.11.006"},{"key":"S092427082200028X_ref33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7893.2011.00276.x"},{"key":"S092427082200028X_ref39","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12899"},{"key":"S092427082200028X_ref31","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12316"},{"key":"S092427082200028X_ref12","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.63.2.175"},{"key":"S092427082200028X_ref29","doi-asserted-by":"publisher","DOI":"10.1177\/070674370705200702"},{"key":"S092427082200028X_ref32","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-020-00185-2"},{"key":"S092427082200028X_ref49","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-019-0634-7"},{"key":"S092427082200028X_ref52","first-page":"209","article-title":"Pediatric bipolar disorder: an object of study in the creation of an illness","volume":"19","author":"Healy","year":"2007","journal-title":"International Journal of Risk and Safety in Medicine"},{"key":"S092427082200028X_ref50","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2010.1"},{"key":"S092427082200028X_ref45","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.65.10.1125"},{"key":"S092427082200028X_ref60","volume-title":"Poster presented at the 65th American Academy of Child and Adolescent Psychiatry (AACAP)","author":"Larios","year":"2018"},{"key":"S092427082200028X_ref61","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-017-1050-7"},{"key":"S092427082200028X_ref85","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.126.7.983"},{"key":"S092427082200028X_ref89","first-page":"397","article-title":"Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up","volume":"49","author":"Stringaris","year":"2010","journal-title":"Journal of the American Academy of Child and Adolescent Psychiatry"},{"key":"S092427082200028X_ref17","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.12873"},{"key":"S092427082200028X_ref95","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.10m06290"},{"key":"S092427082200028X_ref36","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-017-0106-4"},{"key":"S092427082200028X_ref30","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2012.11111725"},{"key":"S092427082200028X_ref98","unstructured":"World Health Organization (2018) International Classification of Diseases for Mortality and Morbidity Statistics, 11th edn. Geneva: World Health Organization."},{"key":"S092427082200028X_ref11","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2009.08101569"},{"key":"S092427082200028X_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2012.03.010"},{"key":"S092427082200028X_ref100","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12494"},{"key":"S092427082200028X_ref16","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-032813-153702"},{"key":"S092427082200028X_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2013.06.001"},{"key":"S092427082200028X_ref48","volume-title":"Manic-Depressive Illness","author":"Goodwin","year":"1990"},{"key":"S092427082200028X_ref94","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12358"},{"key":"S092427082200028X_ref59","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2018.09.251"},{"key":"S092427082200028X_ref43","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-200012000-00018"},{"key":"S092427082200028X_ref38","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13244"},{"key":"S092427082200028X_ref103","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.09m05161yel"},{"key":"S092427082200028X_ref75","doi-asserted-by":"publisher","DOI":"10.1186\/s40345-021-00225-5"},{"key":"S092427082200028X_ref93","first-page":"18r12180","article-title":"Updated meta-analysis of epidemiologic studies of pediatric bipolar disorder","volume":"80","author":"Van Meter","year":"2019","journal-title":"Journal of Clinical Psychiatry"},{"key":"S092427082200028X_ref104","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v69n0608"},{"key":"S092427082200028X_ref47","doi-asserted-by":"publisher","DOI":"10.1192\/bjpo.bp.116.004234"},{"key":"S092427082200028X_ref22","doi-asserted-by":"publisher","DOI":"10.1037\/a0015919"},{"key":"S092427082200028X_ref58","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-192104000-00057"},{"key":"S092427082200028X_ref99","doi-asserted-by":"publisher","DOI":"10.1097\/00004583-199507000-00010"},{"key":"S092427082200028X_ref8","doi-asserted-by":"publisher","DOI":"10.1177\/0004867418797419"},{"key":"S092427082200028X_ref18","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2008.0108"},{"key":"S092427082200028X_ref55","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1980.01780190097012"},{"key":"S092427082200028X_ref27","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12155"},{"key":"S092427082200028X_ref65","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"S092427082200028X_ref51","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2021.04.011"},{"key":"S092427082200028X_ref72","doi-asserted-by":"publisher","DOI":"10.1111\/camh.12231"},{"key":"S092427082200028X_ref35","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12690"},{"key":"S092427082200028X_ref23","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci11030341"},{"key":"S092427082200028X_ref70","volume-title":"Bipolar Disorder: A Portrait of a Complex Mood Disorder","author":"Parry","year":"2012"},{"key":"S092427082200028X_ref79","doi-asserted-by":"publisher","DOI":"10.1080\/15374416.2017.1280805"},{"key":"S092427082200028X_ref62","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2006.16.456"},{"key":"S092427082200028X_ref91","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2014.02.013"},{"key":"S092427082200028X_ref1","first-page":"1105","article-title":"Adult outcomes of childhood dysregulation: a 14-year follow-up study","volume":"49","author":"Althoff","year":"2010","journal-title":"Journal of the American Academy of Child and Adolescent Psychiatry"},{"key":"S092427082200028X_ref7","first-page":"81","volume-title":"Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment","author":"Barkley","year":"2015"},{"key":"S092427082200028X_ref92","volume-title":"The Maudsley Prescribing Guidelines in Psychiatry","author":"Taylor","year":"2018"},{"key":"S092427082200028X_ref102","doi-asserted-by":"publisher","DOI":"10.1177\/0706743715625935"},{"key":"S092427082200028X_ref56","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2015.05.017"},{"key":"S092427082200028X_ref71","unstructured":"Parry, P (2021) \u2018Paediatric bipolar disorder\u2019: why did it occur, the iatrogenic consequences, and the implications for medical ethics and psychiatric nosology. Doctoral dissertation, Flinders University, Adelaide. Available at https:\/\/theses.flinders.edu.au\/view\/e8c15152-a279-4e61-88ce-e96080a908da\/1 (accessed 20 March 2022)."},{"key":"S092427082200028X_ref34","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v61n0906"},{"key":"S092427082200028X_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-5215.2009.00430.x"},{"key":"S092427082200028X_ref37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2017.01.008"},{"key":"S092427082200028X_ref4","first-page":"489","article-title":"The course of monopolar depression and bipolar psychoses","volume":"76","author":"Angst","year":"1973","journal-title":"Psychiatria, Neurologia, Neurochirurgia"},{"key":"S092427082200028X_ref9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1601-5215.2007.00185.x"},{"key":"S092427082200028X_ref78","doi-asserted-by":"publisher","DOI":"10.1097\/01.chi.0000170554.23422.c1"},{"key":"S092427082200028X_ref84","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2007.164.2.309"},{"key":"S092427082200028X_ref3","doi-asserted-by":"publisher","DOI":"10.1159\/000285131"},{"key":"S092427082200028X_ref96","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12734"},{"key":"S092427082200028X_ref46","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.12556"},{"key":"S092427082200028X_ref81","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2012.12070999"},{"key":"S092427082200028X_ref25","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.2504"},{"key":"S092427082200028X_ref74","doi-asserted-by":"publisher","DOI":"10.1177\/1359104519836700"},{"key":"S092427082200028X_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2006.08.042"},{"key":"S092427082200028X_ref6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.2006.00984.x"},{"key":"S092427082200028X_ref21","first-page":"20m13764","article-title":"Diagnostic stability in bipolar disorder: a follow-up study in 130,000 patient-years","volume":"82","author":"Cegla-Schvartzman","year":"2021","journal-title":"Journal of Clinical Psychiatry"},{"key":"S092427082200028X_ref97","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2017.17090972"},{"key":"S092427082200028X_ref24","doi-asserted-by":"publisher","DOI":"10.1192\/bjpo.bp.115.001933"},{"key":"S092427082200028X_ref2","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5)","year":"2013"},{"key":"S092427082200028X_ref54","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2014.02.008"},{"key":"S092427082200028X_ref53","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.3.022806.091532"},{"key":"S092427082200028X_ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2014.12.008"},{"key":"S092427082200028X_ref44","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(95)00023-G"},{"key":"S092427082200028X_ref68","doi-asserted-by":"publisher","DOI":"10.1177\/070674371205701103"},{"key":"S092427082200028X_ref66","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)31544-0"},{"key":"S092427082200028X_ref87","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2021.01.017"},{"key":"S092427082200028X_ref88","doi-asserted-by":"publisher","DOI":"10.1080\/15622975.2021.1935317"},{"key":"S092427082200028X_ref77","doi-asserted-by":"publisher","DOI":"10.1016\/j.chc.2021.04.007"},{"key":"S092427082200028X_ref80","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2017.01.022"},{"key":"S092427082200028X_ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s00787-007-0649-5"},{"key":"S092427082200028X_ref64","doi-asserted-by":"publisher","DOI":"10.1177\/0004867420920365"},{"key":"S092427082200028X_ref63","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01045-4"},{"key":"S092427082200028X_ref69","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.64.9.1032"},{"key":"S092427082200028X_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2011.07.005"}],"container-title":["Acta Neuropsychiatrica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S092427082200028X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T11:15:46Z","timestamp":1678187746000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S092427082200028X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,14]]},"references-count":104,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["S092427082200028X"],"URL":"https:\/\/doi.org\/10.1017\/neu.2022.28","relation":{},"ISSN":["0924-2708","1601-5215"],"issn-type":[{"value":"0924-2708","type":"print"},{"value":"1601-5215","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,14]]},"assertion":[{"value":"\u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of Scandinavian College of Neuropsychopharmacology","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}