Occult Mood Disorders in 104 Consecutively Presenting Children Referred for the Treatment of Attention-Deficit/Hyperactivity Disorder in a Community Mental Health Clinic. [CME]
J Clin Psychiatry 2003;64:1170-1176
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To ascertain the prevalence of mood
disorders among consecutively evaluated prepubertal children
presenting for the treatment of attention-deficit/hyperactivity
disorder (ADHD) in a community mental health clinic.
Method: 104 children received systematic
assessments designed to identify individuals meeting the DSM-IV
criteria for major depressive disorder (MDD), mania, and ADHD.
"Standard" and "modified" criteria for mania
were employed. Modified criteria, in an effort to minimize
false-positive diagnoses of mania, required the presence of
euphoria and/or flight of ideas. A child meeting the criteria for
MDD or either set of criteria for mania was categorized as having
a mood disorder. Mood disorders in first-degree relatives were
assessed using a systematic interview. Data were gathered from
2000 to 2002.
Results: Sixty-two children (59.6%) had a mood
disorder. Compared with those who did not have a mood disorder,
they were 3.3 times more likely (54.8% vs. 16.7%) to have a
family history of any affective disorder (p < .0001) and 18.3
times more likely (43.5% vs. 2.4%) to have a family history of
bipolar disorder (p < .0001). Twenty (32.3%) of the children
with and none without a mood disorder had psychotic features (p
< .0001). Compared with those meeting only the standard
criteria for mania, those meeting the modified criteria were 9.1
times more likely (69.8% vs. 7.7%) to have a family history of an
affective disorder (p < .0001) and 7.3 times more likely
(55.8% vs. 7.7%) to have a family history of bipolar disorder (p
Conclusion: Children who presumably have ADHD
often have unrecognized affective illness. Our findings support
the view that children meeting the modified criteria for mania
have veritable bipolar disorder. These findings, which were
derived in the course of delivering routine clinical services in
a community mental health clinic, are consistent with those
obtained in research settings suggesting that children presenting
with ADHD often have occult mood disorders, especially
unrecognized bipolarity. We suggest that clinicians encountering
children with prominent features of ADHD inquire about the
presence of euphoria and flight of ideas. We submit that the
presence of these "classic" manifestations of mania
strongly suggests the presence of occult bipolarity, even if
course of illness otherwise markedly deviates from