Recognizing mania in children and adolescents—age does not matter, but decreased need for sleep does

BackgroundThe diagnosis of pediatric bipolar disorders is a controversial topic. If this is mainly due to a bias against a diagnosis in younger children, then just changing the information about the age of a patient should influence the likelihood of a diagnosis despite otherwise identical symptoms. Therefore, we designed a study to test if the age of a patient will influence diagnostic decisions. We further attempted to replicate an earlier result with regard to “decreased need for sleep” as a salient symptom for mania.MethodsWe randomly sent 1 of 4 case vignettes describing a person with current mania to child/adolescents psychiatrists in Germany. This vignette was systematically varied with respect to age of the patient (6 vs 16 years) and the presence/absence of decreased need for sleep but always included sufficient criteria to diagnose a mania.ResultsOne hundred sixteen responded and, overall, 63.8% of the respondents diagnosed a bipolar disorder in the person described in the vignette. Although age did not affect the likelihood of a bipolar diagnosis, the presence of decreased need for sleep did increase its likelihood. Furthermore, the number of core symptoms identified by the clinicians was closely linked to the likelihood of assigning a bipolar diagnosis.ConclusionCertain symptoms such as the decreased need for sleep, and also elated mood and grandiosity, seem to be salient for some clinicians and influence their diagnoses. Biological age of the patient, however, does not seem to cause a systematic bias against a diagnosis of bipolar disorder in children.