Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-26T09:05:33.500Z Has data issue: false hasContentIssue false
  • English
  • Français

Defining and validating bipolar disorder in the preschool period

Published online by Cambridge University Press:  25 October 2006

JOAN LUBY  and
ANDY BELDEN
JOAN LUBY
Affiliation:
Washington University, St. Louis
ANDY BELDEN
Affiliation:
Washington University, St. Louis
Get access Rights & Permissions [Opens in a new window]

Abstract

The clinical characteristics and adaptive functioning of preschoolers who met DSM-IV criteria for bipolar disorder versus psychiatric and healthy comparison groups were investigated. A community-based sample of 303 preschoolers (3–6 years of age) and their caregivers was ascertained. Diagnostic classification based on parent report of mania symptoms was made using an age-appropriate psychiatric interview. Results indicated that 26 preschoolers met DSM-IV criteria for bipolar disorder who could be identified based the presence of 13 core age-adjusted mania items. These children could be clearly differentiated from children in two psychiatric groups (DSM-IV disruptive disorders, and major depressive disorder) and a “healthy” comparison group based on a specific symptom constellation. Findings indicated that preschoolers in the bipolar group were significantly more (p < .05) impaired than the two psychiatric and healthy groups based on independent measures. Further, even after controlling for comorbid attention-deficit/hyperactivity disorder (81% comorbidity rate), the bipolar group remained significantly (p < .05) more impaired in multiple domains compared to preschoolers with DSM-IV disruptive disorders and healthy controls. Findings suggested that children as young as 3 years can manifest DSM-IV bipolar disorder when age adjusted symptom descriptions are employed, and that these children can be distinguished from healthy and disruptive disordered preschoolers. Recommendations for future research in this area that integrates developmental and mental health models are made.We gratefully acknowledge Edward Spitznagel for his statistical consultation. We are also grateful to the The Early Emotional Development Program staff, our preschool participants and their parents, and community recruiting sites whose participation and cooperation made this research possible. Funding for the study of preschool depression was provided by NIMH Grant NIMH R01 MH64769-01 (to J.L.).

Type
Research Article
Information
Development and Psychopathology , Volume 18 , Issue 4 , December 2006 , pp. 971 - 988
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Angold, A., & Costello, J. (2000). The Child and Adolescent Psychiatric Assessment (CAPA). Journal of the American Academy of Child & Adolescent Psychiatry, 39, 39–48.Google Scholar
Biederman, J. (1995). Developmental subtypes of juvenile bipolar disorder. Harvard Review of Psychiatry, 3, 227–230.Google Scholar
Biederman, J., Faraone, S. V., Wozniak, J., Mick, E., Kwon, A., & Aleardi, M. (2004). Further evidence of unique developmental phenotypic correlates of pediatric bipolar disorder: Findings from a large sample of clinically referred preadolescent children assessed over the last 7 years. Journal of Affective Disorders, 82(Suppl. 1), S45–S58.Google Scholar
Biederman, J., Mick, E., Bostic, J. Q., Prince, J., Daly, J., Wilens, T. E., et al. (1998). The naturalistic course of pharmacologic treatment of children with manic like symptoms: A systematic chart review. Journal of Clinical Psychiatry, 59, 628–637.Google Scholar
Cicchetti, D., & Toth, S. L. (Eds.). (1995a). Emotion, cognition, and representation. Rochester, NY: University of Rochester Press.
Cicchetti, D., & Toth, S. (1995b). Developmental psychopathology and disorders of affect. In D. Cicchetti & D. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (pp. 369–420). New York: Wiley.
Chang, L., Dodge, K. A., Schwartz, D., & McBrie-Chang, C. (2003). Hash parenting in relation to child emotion regulation and aggression. Journal of Family Psychology, 17, 598–606.Google Scholar
Clark, A. F. (2004a). Childhood and adolescent bipolar disorders. Clinical Approaches in Bipolar Disorders, 3, 55.Google Scholar
Clark, A. F. (2004b). Particular aspects of diagnosis, management, and treatment of bipolar disorders in children and adolescents. Clinical Approaches in Bipolar Disorders, 3, 49–54.Google Scholar
Cole, P. M., Barrett, K. C., & Zahn-Waxler, C. (1992). Emotion displays in two-year-olds during mishaps. Child Development, 63, 314–324.Google Scholar
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific construct: Methodological challenges and directions for child development research. Child Development, 75, 317–333.Google Scholar
Cole, P. M., Michel, M. K., & O'Donnell-Teti, L. (1994). The development of emotion regulation and dysregulation: A clinical perspective. Monographs of the Society for Research in Child Development, 59, 73–100.Google Scholar
Cole, P. M., Zahn-Waxler, C., & Smith, K. (1994). Expressive control during a disappointment: Variations related to preschoolers' behavior problems. Developmental Psychology, 30, 835–846.Google Scholar
Damon, W., & Hart, D. (1988). Self-understanding in childhood and adolescence. Cambridge Studies in Social and Emotional Development, xii, 205.Google Scholar
Denham, S. A. (1998). Emotional development in young children. New York: Guilford Press
Dodge, K. A., Coie, J. D., Pettit, G. S., & Price, J. M. (1990). Peer status and aggression in boys' groups: Developmental and contextual analyses. Child Development, 61, 1289–1309.Google Scholar
Egger, H. L., Ascher, B. H., & Angold, A. (1999). The Preschool Age Psychiatric Assessment: Version 1.1. Unpublished manuscript, Duke University Medical Center, Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences.
Egger, H. L., Erkanli, A., Keeler, G., Potts, E., Walter, B. K., & Angold, A. (2006). Test–retest reliability of the Preschool Age Psychiatric Assessment (PAPA). Journal of Child and Adolescent Psychiatry, 45, 1–13.Google Scholar
Egger, H. L., Fenichel, E., Guedeney, A., Wise, B. K., & Wright, H. H. (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood: Revised edition (DC: 0–3R). Washington, DC: Zero to Three Press.
Eisenberg, N., Cumberland, A., Spinrad, T. L., Fabes, R. A., Shepard, S. A., Reiser, M., et al. (2001). The relations of regulation and emotionality to children's externalizing and internalizing problem behavior. Child Development, 72, 1112–1134.Google Scholar
Eisenberg, N., & Fabes, R. A. (Eds.). (1992). Emotion, regulation, and the development of social competence (Vol. 14, p. 311). Thousand Oaks, CA: Sage.
Eisenberg, N., Losoya, S., Fabes, R. A., Guthrie, I. K., Reiser, M., Murphy, B., et al. (2001). Parental socialization of children's dysregulated expression of emotion and externalizing problems. Journal of Family Psychology, 15, 183–205.Google Scholar
Eyberg, S. M. (1988). Parent–child interaction therapy: Integration of traditional and behavioral concerns. Child and Family Behavior Therapy, 10, 33–46.Google Scholar
Faraone, S. V., Biederman, J., Mennin, D., Wozniak, J., & Spencer, T. (1997). Attention-deficit hyperactivity disorder with bipolar disorder: A familial subtype? Journal of Child and Adolescent Psychiatry, 36, 1378–1387.Google Scholar
Faraone, S. V., Biederman, J., & Monuteaux, M. C. (2001). Attention deficit hyperactivity disorder with bipolar disorder in girls: Further evidence for a familial subtype? Journal of Affective Disorders, 64, 19–26.Google Scholar
Findling, R. L., Gracious, B. L., McNamara, N. K., Youngstrom, E. A., Demeter, C. A., Branicky, L. A., et al. (2001). Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder. Bipolar Disorders, 3, 202–210.Google Scholar
Fox, N. A., & Field, T. M. (1989). Individual differences in preschool entry behavior. Journal of Applied Developmental Psychology, 10, 527–540.Google Scholar
Geller, B., & Luby, J. (1997). Child and adolescent bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1168–1176Google Scholar
Geller, B., Sun, K., Zimerman, B., Luby, J., Frazier, J., & Williams, M. (1995). Complex and rapid cycling in bipolar children and adolescents: A preliminary study. Journal of Affective Disorders, 34, 259–268.Google Scholar
Geller, B., & Tillman, B. (2005). Prepubertal and early adolescent bipolar I disorder: Review of diagnostic validation by Robins and Guze criteria. Journal of Clinical Psychiatry, 66(Suppl. 7), 21–28.Google Scholar
Geller, B., Zimerman, B., Williams, M., Bolhofner, K., Craney, J., Delbello, M., et al. (2000). Diagnostic characteristics of 93 cases of a prepubertal and early adolescent bipolar disorder phenotype by gender, puberty and comorbid attention deficit hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 10, 157–164.Google Scholar
Geller, B., Zimerman, B., Williams, M., Delbello, M., Bolhofner, K., Craney, J., et al. (2002). DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention deficit hyperactivity and normal controls. Journal of Child and Adolescent Psychopharmacology, 12, 11–25.Google Scholar
Geller, B., Zimerman, B., Williams, M., DelBello, M. P., Frazier, J., & Beringer, L. (2002). Phenomenology of prepubertal and early adolescent bipolar disorder: Examples of elated mood, grandiose behaviors, decreased need for sleep, racing thoughts and hypersexuality. Journal of Child and Adolescent Psychopharmacology, 12, 3–9.Google Scholar
Harter, S. (1999). The construction of the self: A developmental perspective. New York: Guilford Press.
Harter, S., & Marold, D. B. (1994). The directionality of the link between self-esteem and affect: Beyond causal modeling. In D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self (Vol. 5, p. 409): Rochester, NY: University of Rochester Press.
Hodges, K. (1994). Child and Adolescent Functional Assessment Scale. Unpublished manuscript, Eastern Michigan University.
Hoffman, M. L. (1984). Interaction of affect and cognition in empathy. In C. E. Izard, J. Kagan, & R. B. Zajonc (Eds.), Emotions, cognition, and behavior (pp. 103–131). Cambridge: Cambridge University Press.
Kagan, J., Snidman, N., & Arcus, D. (1995). The role of temperament in social development. Annals of the New York Academy of Sciences, 771, 485–490.Google Scholar
Kovacs, M. (1985). The Children's Depression Inventory (CDI). Psychopharmacology Bulletin, 21, 995–998.Google Scholar
Leibenluft, E., Charney, D. S., Towbin, K. E., Bhangoo, R. K., & Pine, D. S. (2003). Defining clinical phenotypes of juvenile mania. American Journal of Psychiatry, 160, 430–437.Google Scholar
Lemery, K. S., Essex, M. J., & Smider, N. A. (2002). Revealing the relation between temperament and behavior problem symptoms by eliminating measurement confounding: Expert ratings and factor analyses. Child Development, 73, 867–882.Google Scholar
Lengua, L. J. (2002). The contribution of emotionality and self-regulation to the understanding of children's response to multiple risk. Child Development, 73, 144–161.Google Scholar
Luby, J. (2004). Particular aspects of diagnosis, management, and treatment of bipolar disorders in children and adolescents. Clinical Approaches in Bipolar Disorders, 3, 54–55.Google Scholar
Luby, J. (2005). Response to childhood and adolescent bipolar disorders by A. F. Clark. Clinical Approaches in Bipolar Disorders, 4, 18–19.Google Scholar
Luby, J., & Belden, A. (2006). Mood disorders in the preschool period: Phenomenology and new models for understanding the developmental psychopathology of early onset depression and bipolar disorders. In J. Luby (Ed.), Preschool mental health: A guide for practitioners (pp. 209–230). New York: Guilford Press.
Luby, J., Stalets, M., Blankenship, S., Pautsch, J., & McGrath, M. (in press). Treatment of preschool bipolar disorder: A novel parent–child interaction therapy. In B. Geller & M. DelBello (Eds.), Treatment of childhood bipolar disorder. New York: Guilford Press.
Luby, J., Heffelfinger, A., Koenig-McNaught, A., Brown, K., & Spitznagel, E. (2004). The preschool feelings checklist: A brief and sensitive screening measure for depression in young children. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 708–717.Google Scholar
Luby, J., Heffelfinger, A., Mrakotsky, C., Hessler, M., Brown, K., & Hildebrand, T. (2002). Preschool major depressive disorder: Preliminary validation for developmentally modified DSM-IV criteria. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 928–937.Google Scholar
Luby, J., Heffelfinger, A., Mrakotsky, C., & Hildebrand, T. (1999). Preschool Feelings Checklist. Unpublished manuscript, St. Louis, MO.
McClellan, J. M., & Speltz, M. L. (2003). Psychiatric diagnosis in preschool children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 127–128 [Letter to the editor, 128–130].Google Scholar
Mota-Castillo, M., Torruella, A., Engels, B., Perez, J., Dedrick, C., & Gluckman, M. (2001). Valproate in very young children: An open case series with a brief follow-up. Journal of Affective Disorders, 67, 193–197.Google Scholar
Murphy, J., Pagano, M., Ramirez, A., Anaya, Y., Nowline, C., and Jellinek, M. (1999). Validation of the preschool and early childhood functional assessment scale. Journal of Child and Family Studies, 8, 343–356.Google Scholar
Nottelmann, E. D. (2001). National Institute of Mental Health research roundtable on prepubertal bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 871–878.Google Scholar
Pavuluri, M. N., Brimaher, B., & Naylor, M. (2005). Pediatric bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 846–871.Google Scholar
Pavuluri, M. N., Janicak, P. G., & Carbray, J. (2002). Topiramate plus risperidone for controlling weight gain and symptoms in preschool mania. Journal of Child and Adolescent Psychopharmacology, 12, 271–273.Google Scholar
Plutchik, R. (1993). Emotions and their vicissitudes: Emotions and psychopathology. In M. Lewis & J. Haviland (Eds.), Handbook of emotions (pp. 53–66). New York: Guilford Press.
Robins, E., Guze, S. B., & Samuel, B. (1970). Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia. American Journal of Psychiatry, 126, 983–986.Google Scholar
Shipman, K., & Zeman, J. (2001). Socialization of children's emotion regulation in mother–child dyads: A developmental psychopathology perspective. Development and Psychopathology, 13, 317–336.Google Scholar
Sparrow, S., Carter, A. S., & Cicchetti, D. (1987). Vineland screener. Overview, reliability, validity, administration and scoring. New Haven, CT: Yale University Press.
Stipek, D., Feiler, R., Daniels, D., & Milburn, S. (1995). Effects of different instructional approaches on young children's achievement and motivation. Child Development, 66, 209–223.Google Scholar
Task Force on Research Diagnostic Criteria. (2003). Infancy and preschool: Research diagnostic criteria for infants and preschool children: The process and empirical support. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 1504–1505.Google Scholar
Thompson, R. (1994). Emotion regulations: A theme in search of definition. In N. A. Fox (Ed.), The development of emotion regulation: Biological and behavioral considerations (pp. 25–166). Chicago: University of Chicago Press.
Thompson, R., Goodvin, R., & Meyer, S. (in press). Social development in the preschool years: Psychological understanding, self-understanding, and relationships. In J. L. Luby (Ed.), Preschool mental health: A guide for practitioners. New York: Guilford Press
Thompson, R. A., & Calkins, S. D. (1996). The double-edged sword: Emotional regulation for children at risk. Development and Psychopathology, 8, 163–182.Google Scholar
Tillman, R., & Geller, B. (2003). Definitions of rapid, ultrarapid, and ultradian cycling and of episode duration in pediatric and adult bipolar disorders: A proposal to distinguish episodes from cycles. Journal of Child and Adolescent Psychopharmocology, 13, 267–271.Google Scholar
Tillman, R., & Geller, B. (2005). A brief Screening tool for a prepubertal and early adolescent bipolar disorder phenotype. American Journal of Psychiatry, 162, 1214–1216.Google Scholar
Tumuluru, R. V., Weller, E. B., Fristad, M. A., & Weller, R. A. (2003). Mania in six preschool children. Journal of Child and Adolescent Psychopharmacology, 13, 489–494.Google Scholar
Tuzun, U., Zoroglu, S. S., & Savas, H. A. (2002). A 5-year-old boy with recurrent mania successfully treated with carbamazepine. Psychiatry and Clinical Neurosciences, 56, 589–591.Google Scholar
Wilens, T. E., Biederman, J., Brown, S., Tanguay, S., Monuteaux, M. C., Blake, C., et al. (2002). Psychiatric comorbidity and functioning in clinically referred preschool children and school-age youths with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 262–268.Google Scholar
Wozniak, J. (in press). How cardinal are cardinal symptoms in pediatric bipolar disorder?: An examination of clinical correlates. Biological Psychiatry.
Zahn-Waxler, C., Klimes-Dougan, B., & Slattery, M. J. (2000). Internalizing problems of childhood and adolescence: Prospects, pitfalls, and progress in understanding the development of anxiety and depression. Development and Psychopathology, 12, 443–466.Google Scholar
Zeman, J., Shipman, K., & Suveg, C. (2002). Anger and sadness regulations: Predictions to internalizing and externalizing symptoms in children. Journal of Clinical Child and Adolescent Psychology, 31, 393–398.Google Scholar