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Preschool Children of Bipolar Parents Have Eight-fold Increase in Risk for ADHD, Pitt Study Finds

PITTSBURGH, Feb. 4, 2010 – Preschool children of parents with bipolar disorder have an eight-fold increase in the risk for attention deficit hyperactivity disorder (ADHD) and significantly higher rates of multiple psychiatric disorders, compared with children of parents who don’t have the mental illness, according to a study by University of Pittsburgh School of Medicine researchers to be published in the March issue of the American Journal of Psychiatry and currently available online.

“Studies already have shown that the children of bipolar parents are far more likely to develop the disease, although typically not in the preschool years. By identifying ADHD and other developmental issues in this group, we can treat them early and potentially prevent full-blown development of bipolar disorder,” said Boris Birmaher, M.D., lead author of the study and co-director of the Child and Adolescent Bipolar Services at Western Psychiatric Institute and Clinic of UPMC.

According to previously published results from the Pittsburgh Bipolar Offspring Study (BIOS), having parents with bipolar disorder is the best predictor of whether their children will go on to develop the condition. However, until now, little has been known about the effects of having bipolar parents on preschool-aged children.

For the current study, researchers compared 121 children, ages 2 to 5, of 83 parents with bipolar disorder to 102 offspring of 65 parents without bipolar disorder in a demographically matched control group. Parents were assessed for psychiatric disorders, family mental health history, family environment and exposure to negative life events. They also were interviewed about their children. Children were assessed directly for bipolar disorder and other psychiatric disorders by researchers who did not know their parents’ diagnoses.

Compared with the offspring of parents in the control groups, children with bipolar parents had an eight-fold increase in the risk of having ADHD, as well as a six-fold increase in the risk of having two or more other psychiatric disorders. Although only three children had clinically certified full-blown mood disorders, children of bipolar parents, particularly those with ADHD or oppositional defiant disorder, had more subclinical manic and depressive symptoms when comparing with children in the control group.

“Because BIOS is prospectively following all of these children, we will be able to address their developmental issues and delineate the types and severity of symptoms that may predict a possible conversion to bipolar disorder,” said Dr. Birmaher, who also is the endowed chair in Early Onset Bipolar Disease and professor of psychiatry at the University of Pittsburgh School of Medicine. “Also, because almost 70 percent of the children of parents with bipolar disorder in our study did not have any diagnosable psychiatric illnesses and very few appeared to be on the cusp of developing mood disorders, we believe there is a window of opportunity for prevention in the high-risk group of kids.”

The researchers note that these findings have important implications. “Clinicians who treat adults with bipolar disorder should question them about their children’s psychopathology to offer prompt identification and early interventions for any psychiatric problems that may be affecting the children’s functioning,” noted Dr. Birmaher. “Further studies are needed to help determine the clinical, biological and genetic risk factors that may be modified to prevent the development of psychiatric disorders in the children of those with bipolar disorder.”

Co-authors of the Pittsburgh Bipolar Offspring Study include David Axelson, M.D., Kelly Monk, R.N., Catherine Kalas, R.N., Benjamin Goldstein, M.D., Mary Beth Hickey, B.A., Mihaela Obreja, M.S., Mary Ehmann, M.A., Satish Iyengar, Ph.D., Warl Shamseddeen, M.D., David Kupfer, M.D., and David Brent, M.D., all from WPIC and the University of Pittsburgh Department of Psychiatry.

The Pittsburgh Bipolar Offspring Study was supported in part by funding provided by the National Institute of Mental Health.

Western Psychiatric Institute and Clinic (WPIC) is considered to be one of the nation’s foremost university-based psychiatric care facilities and one of the world’s leading centers for research and treatment of mental health disorders. WPIC houses the Department of Psychiatry of the University of Pittsburgh School of Medicine and is the flagship of UPMC Behavioral Health, the psychiatric specialty division of the University of Pittsburgh Medical Center.

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