Consistent with Kraepelin’s early descriptions (1921) (1), it is now recognized that bipolar disorder (BP) occurs in children and adolescents. However, many children and adolescents with BP have very short and frequent periods of syndromal or subsyndromal mania, hypomania, or depression, making their diagnosis especially difficult.

Pediatric BP severely affects the normal development and psychosocial functioning of the child and increases the risk for suicide, psychosis, substance abuse, as well as for behavioral, academic, social, and legal problems. However, it takes on average of 10 years to identify and begin treatment of BP (2), indicating the need for timely detection and treatment of this serious illness.

The goal of this chapter is to review the clinical picture, epidemiology, differential diagnosis, course and prognosis, risk factors, and pharmacological and psychosocial treatment of pediatric BP.

For the purposes of this chapter the word youth, unless specified, denotes children and adolescents.

Research into the phenomenology of pediatric bipolar disorder is relatively new and has led to substantial debate about how BP presents in children and adolescents. Clear consensus does not exist on key issues such as: 1) the necessity of cardinal symptoms (e.g., elated mood and/or grandiosity) for a bipolar diagnosis; 2) the role of irritable mood in pediatric BP; 3) the requirement of clearly demarcated mood episodes; 4) the temporal relation between manic and depressive symptoms and mood cycling patterns; 5) the validity and importance of manic symptoms that do not meet the DSM-IV symptom or duration thresholds for a manic, hypomanic, or mixed episode; and 6) the best way to attribute potential symptoms of mania that also commonly present in other pediatric psychiatric disorders. Though the diagnostic features of BP in youth has provoked considerable controversy, it is important to note that many of these issues have not been settled in the adult bipolar literature and the conceptualization of BP will continue to evolve as more research becomes available.