The diagnosis of bipolar disorder in young children is still controversial and the presentation tends to be atypical when compared with adults. Recently, there has been relative consensus that the childhood form is characterized by rapid cycling, in which multiple cycles occur in the same day (Geller et al.
1995; Luby and Belden
2006). Around 55% of pre-pubertal children with bipolar disorder show a mixed presentation with 77% of them showing rapid cycling continuously for around 3.6 years (Geller et al.
2001). Both long episode duration and daily cycling were reported by different research groups that used various assessment methods providing evidence that these characteristics were not method bound (Axelson et al.
2006; Biederman et al.
2005; Birmaher and Axelson
2006; Findling et al.
2001; Geller et al.
2007,
2008). The controversy is amplified since this picture is opposed to the “classic” bipolar disorder features in adults characterized by circumscribed episodes of mania and depression, with euthymic interepisodes periods. …
