Inclusion Criteria:
Aged 7–17, with the onset of symptoms before age 12. Abnormal mood (specifically anger or sadness), present at least half of the day most days, and of sufficient severity to be noticeable by people in the child’s environment (e.g., parents, teachers, peers). Hyperarousal, as defined by at least three of the following symptoms: insomnia, agitation, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness. Compared to his/her peers, the child exhibits markedly increased reactivity to negative emotional stimuli that is manifest verbally or behaviorally. For example, the child responds to frustration with extended temper tantrums (inappropriate for age and/or precipitating event), verbal rages, and/or aggression toward people or property. Such events occur, on average, at least three times a week. The symptoms noted in 2–4 above are currently present and have been present for at least 12 months without any symptom-free periods exceeding two months. The symptoms are severe in at least one setting (i.e., violent outbursts, assaultiveness at home, school, or with peers). In addition, there are at least mild symptoms (distractibility, intrusiveness) in a second setting.
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Exclusion Criteria:
The individual exhibits any of these cardinal bipolar symptoms: Elevated or expansive mood. Grandiosity or inflated self-esteem. Episodically decreased need for sleep. The symptoms occur in distinct periods lasting more than 1 day. Meets criteria for schizophrenia, schizophreniform disorder, schizoaffective illness, pervasive development disorder, or PTSD Meets criteria for substance use disorder in the past 3 months IQ<70 The symptoms are due to the direct physiological effects of a drug of abuse, or to a general medical or neurological condition.
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