What differentiates children visiting outpatient mental health services with bipolar spectrum disorder from children with other psychiatric diagnoses?

Objectives: To determine the contribution of parent-reported manic symptoms, family history, stressful life events, and family environment in predicting diagnosis of bipolar spectrum disorders (BPSD) in youth presenting to an outpatient psychiatric clinic. Methods: A total of 707 6- to 12-year-old children [621 with elevated symptoms of mania (ESM+) based on screening via the Parent General Behavior Inventory 10-item Mania Scale (PGBI-10M) and 86 without ESM (ESM-)] received a comprehensive assessment. Results: Of the 629 with complete data, 24% (n=148) had BPSD. Compared to those without BPSD (n=481), children with BPSD: were older (Cohen's d=0.44) and more likely to be female (Cohen's d=0.26); had higher parent-endorsed manic symptom scores at screening (Cohen's d=0.36) and baseline (Cohen's d=0.76), more biological parents with a history of manic symptoms (Cohen's d=0.48), and greater parenting stress (Cohen's d=0.19). Discriminating variables, in order, were: baseline PGBI-10M scores, biological parent history of mania, parenting stress, and screening PGBI-10M scores. Absence of all these factors reduced risk of BPSD from 24% to 2%. Conclusions: History of parental manic symptoms remains a robust predictor of BPSD in youth seeking outpatient care, even after accounting for parent report of manic symptoms in the child at screening. However, the risk factors identified as associated with BPSD, together had limited value in accurately identifying individual participants with BPSD, highlighting the need for careful clinical assessment.