Defining and identifying early onset bipolar spectrum disorder.

Early onset bipolar spectrum disorder (EOBPSD) is difficult to diagnose because of symptom overlap with other disorders and nearly ubiquitous comorbidity. A thorough assessment of EOBPSD should include the following: 1) a timeline of the child's development, from birth to present, showing the episodic nature of EOBPSD; 2) a structured clinical interview determining comorbidity and differential diagnosis; 3) a family history genogram to ascertain familial loading and environmental stressors, which informs case conceptualization; 4) depression and mania rating scales to assess symptom severity and track treatment outcome; 5) global rating scales to obtain cross-informant data and inform broad-based treatments; and 6) a current mood log to document baseline functioning and track treatment outcome. Examples of a timeline, family history genogram, and current mood log are presented. This comprehensive approach to assessing EOBPSD, a severe and possibly lifelong disorder, is strongly advocated. No scale, instrument, or technique alone is adequate to diagnose EOBPSD.