Table 2. Bipolar disorder versus behavior disruptive disorder.

(Reproduced from Birmaher, B. New Hope for Children and Adolescents with BP Disorders, New York: Three Rivers Press, a division of Random House, Inc., 2004, with permission.)

If the behavior problems only occur while the child is in the midst of an episode of mania or depression, and the behavior problems disappear when the mood symptoms improve, the diagnoses of oppositional or conduct disorder should not be made. If a child has “of and on” oppositional or conduct symptoms or these symptoms only appear when the child has mood problems, the diagnosis of BP (or other disorders such as recurrent unipolar depression or substance abuse) should be considered. If the child had oppositional behaviors before the onset of the mood disorders, both diagnoses may be given. If a child has severe behavior problems that are not responding to treatment, consider the possibility of a mood disorder (bipolar and non-bipolar depressions), other psychiatric disorder (e.g., ADHD, substance abuse), and/or exposure to stressors. If a child has behavior problems and a family history of bipolar, consider the possibility that the child has a mood disorder (unipolar major depression or BP disorder). If a child has behavior problems and is having hallucinations and delusions consider the possibility of BP disorder. Also consider the possibility of schizophrenia, use of illicit drugs/alcohol, or medical/neurological conditions.