The question of the validity of the diagnosis of paediatric bipolar disorder centres on the controversy surrounding a proposed pre-pubertal subtype. As pointed out by Malhi & Bell¹, the validity of classical bipolar disorder in adolescence, diagnosed on the basis of expert clinical assessment, is not in question. Nor is there debate around whether or not children with the proposed prepubertal phenotype have serious mental health concerns. Further, longitudinal prospective studies have provided indisputable evidence that antecedent subthreshold mood symptoms and non-mood disorders (i.e. sleep, anxiety) predict bipolar disorder in children at confirmed familial risk². Rather, the controversy centres on the speculation raised by Wozniak et al³ that a presentation in very young children (median age 5, mostly male sex) characterized by explosive temper, chronic irritability, comorbid ADHD and other neurodevelopmental disorders, represents an early developmental variant of bipolar disorder – so called prepubertal bipolar disorder or prepubertal mania.

中文翻译：

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对精神病学 (QuiP) 中一个重要问题的评论：小儿双相情感障碍是否是有效诊断？

儿童双相情感障碍诊断的有效性问题集中在围绕拟议的青春期前亚型的争议上。正如 Malhi & Bell ¹所指出的，根据专家临床评估诊断出的青春期经典双相情感障碍的有效性是没有问题的。也没有关于具有建议的青春期前表型的儿童是否有严重的心理健康问题的争论。此外，纵向前瞻性研究提供了无可争辩的证据，表明先行阈下情绪症状和非情绪障碍（即睡眠、焦虑）可预测已确认有家族风险^{2 的}儿童的双相情感障碍。相反，争议集中在 Wozniak 等人提出的猜测上³幼儿（中位年龄 5 岁，主要是男性）的表现以脾气暴躁、慢性易怒、合并 ADHD 和其他神经发育障碍为特征，代表了双相情感障碍的早期发育变异——所谓的青春期前双相情感障碍或青春期前躁狂症。