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Affect regulation is a developmental acquisition that is impacted by environmental factors. For clinicians caring for children and adolescents, it is important to differentiate between normal mood fluctuations and emotions and pervasive mood disorders that significantly impact the child’s global functioning. A careful clinical assessment is necessary to make the diagnosis of mood disorders in children and adolescents, as there are no laboratory or neuroimaging tests that will ascertain the diagnosis. The clinical diagnosis of mood disorders is supported by research data obtained in epidemiological and longitudinal studies, as well as by clinical observations.

This chapter discusses how clinical diagnosis of both depressive and bipolar spectrum disorders is made based on the best available evidence. Additionally, this chapter provides an overview of both psychopharmacologic and psychotherapeutic treatments of depressive and bipolar spectrum disorders.


In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), the pediatric depressive disorders include disruptive mood dysregulation disorder (DMDD), major depressive disorder (MDD), persistent depressive disorder, and premenstrual dysphoric disorder. Within the DSM-V, the bipolar disorders include bipolar I disorder, bipolar II disorder, cyclothymic disorder, and unspecified bipolar disorder.

Prevalence of MDD in children ranges between 0.5% and 1.4% and increases to 11.4% in adolescents, with a male-to-female ratio of 1:1 during childhood and 1:3 during adolescence. The risk for MDD increases significantly after puberty, particularly in females. Disruptive mood dysregulation disorder is a relatively new diagnosis in the DSM-V; hence, the prevalence of this illness has not been clearly established. However, epidemiological studies that used criteria of DMDD retrospectively found the prevalence to range between 0.8% and 3.3%. The rate of DMDD is shown to be higher in males and school-aged children compared to females and adolescents. Studies have found the rate of bipolar spectrum disorders to be as high as 6.7%, with lifetime prevalence of mania to be between 0.1% and 1.7% among adolescents. Bipolar spectrum disorders have a male-to-female ratio of 1:1 throughout the life cycle.


Presentation of Mood Disorder Symptoms

The DSM-V has clearly defined criteria for diagnosing depression and bipolar disorders in adults, children, and adolescents. There are no separate criteria for mood disorders in the pediatric population. However, the manifestations and presentation of mood symptoms in children and adolescents differ from those of adults. These differences likely result from the developmental and neurodevelopmental differences between adults and children in the emotional, cognitive, and physical domains. Therefore, although the DSM-V criteria are utilized to make a diagnosis of a mood disorder in a child or adolescent, clinicians must be aware of the impact of development on the presentation of mood disorders in the pediatric population.

For instance, when children experience depression, parents, caregivers, and schoolteachers may notice the child being more withdrawn; crying more easily and more than usual; ...

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