Editorial review: Shifting views on juvenile bipolar disorder and pervasive developmental disorder.

PURPOSE OF REVIEW: To examine the changes in prevalence estimates and concepts of core disorder in two child mental disorders that were once considered rare, and to place these changes in a cultural context.

RECENT FINDINGS: Up to one-quarter of people with bipolar disorder may have experienced onset of symptoms prior to puberty, but the precision of the diagnosis in children is uncertain. An ongoing challenge is differentiating bipolar disorder from other child mental disorders. Reliable markers of persistent bipolarity have yet to be identified. Despite a popular perception, pervasive developmental disorder is unlikely to have increased in the population, but recognition rates have increased as much as ten-fold since 1980. The increase is largely accounted for by shifts in diagnostic practice and in attitudes towards the condition.

SUMMARY: Changes in diagnostic practice and in clinician and public attitude account for much of the apparent variation in the prevalence of child mental disorders.