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Characteristics of children with juvenile bipolar disorder or disruptive behavior disorders and negative mood: Can they be distinguished in the clinical setting?

Daniel F. Connor, MD

Professor of Psychiatry, Division Chief of Child & Adolescent Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA

Leonard A. Doerfler, PhD

Professor of Psychology, Assumption College, Associate Professor of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA

BACKGROUND: Because of continuing controversy over distinguishing juvenile bipolar disorder (JBD) from disruptive behavior disorders (DBDs) in the clinical setting, we investigated whether referred children with a DBD and a negative mood component could be differentiated from those diagnosed with JBD. The distinction is important because treatments differ.

METHODS: In this single-site sample, 96 children with non-attention-deficit/hyperactivity DBD and depression were compared with 27 JBD children and 187 psychiatric comparison children on measures assessing behavior, functional impairment, symptom severity, psychopathology, and comorbid psychiatric diagnosis

RESULTS: Few differences were found between children with DBD and depression and those with JBD on measures of conduct problems, oppositionality, aggression, hostility, and psychopathology. More functional impairment was found in the JBD group who also had higher rates of comorbid posttraumatic stress disorder (PTSD), substance use disorders, and suicidality than the other groups.

CONCLUSIONS: These results do not support the specificity of aggression as a defining criterion for JBD and clinicians assessing such patients also should consider complex DBDs with an associated depressive component in the differential diagnosis. Children with JBD must be specifically assessed for comorbid developmental trauma, substance abuse, and suicidality. The association between JBD and PTSD needs further investigation in clinical research

KEYWORDS: juvenile bipolar disorder, childhood depression, disruptive behavior disorders


CORRESPONDENCE: Daniel F. Connor, MD, Department of Psychiatry/MC 1410, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030 USA E-MAIL:
Annals of Clinical Psychiatry ©2012 Frontline Medical Communications.

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