Geller, B., Zimmerman B., Williams M., BolhofnerK., Craney JL. Am J Psychiatry 2001 Jan;158 (1):125-7.

DSM-IV Mania Symptoms in a Prepubertal and Early Adolescent Bipolar Disorder Phenotype Compared to Attention-Deficit Hyperactive and Normal Controls.

Barbara Geller, M.D., Betsy Zimerman, M.A., Marlene Williams, R.N., Melissa P. DelBello, M.D., Kristine Bolhofner, B.S., James L. Craney, M.S., M.P.H., Jeanne Frazier, B.S.N., Linda Beringer, R. N., Michael J. Nickelsburg, Ph.D., in Journal of Child and Adolescent Psychopharmacology, Vol. 12, Number 1, 2002.

This paper reports on the differences between prepubertal mania and ADHD. 93 children with mania (with or without ADHD) were compared with 81 children with ADHD (without mood disorders) and 94 control children as part of the National Institute of Mental Health (NIMH)-funded study, "Phenomenology and Course of Pediatric Bipolarity." Five symptoms that are mania-specific in DSM-IV (they do not overlap with ADHD symptoms) and that provided the best discrimination between Bipolar Disorder and ADHD are: Elated Mood (89% of children with BP versus only 14% of children with ADHD), Grandiosity (86% v. 4.9%), Flight of Ideas and/or Racing Thoughts (71% v. 10%), Decreased Need for Sleep (40% v. 6%) and Hypersexuality (43% v. 6%). Of note, 87% of the children with mania had both elated mood and irritability, similar to the percent reproted for adults with mania. A striking finding was how rapidly the children's moods changed from one state to another. 72 of the 93 subjects (77%) cycled an average of 3 times per day (called "ultradian cycling," with a cycle defined as an episode lasting four or more hours). 9 (10%) of the subjects were ultra-rapid cyclers with episodes lasting a few days to a few weeks. None of the subjects had fewer than 5 cycles per year.

Abstract by Martha Hellander, Executive Director of The Balanced Mind Foundation