Previous studies have documented that the children of individuals with bipolar disorder (BPD) are at increased risk for a broad range of psychiatric disorders, including ADHD, disruptive behavior disorders (DBD), depression, anxiety, and bipolar disorder. Most studies of the offspring of parents with BPD (BPDO) have focused on children in late childhood and adolescence. A recent study from Madelaine Abel, PhD and colleagues from the Child Cognitive Behavioral Therapy Program at Mass General Hospital examines the prevalence of psychiatric symptoms and disorders in preschool-aged children (2-5 years old) who have parents with bipolar disorder.
This study included 60 families with a parent with bipolar disorder (78 offspring) and 70 comparison families in which neither parent had a mood disorder (91 offspring). Parent and offspring diagnoses and symptoms were assessed using standardized diagnostic interviews and measures. Clinicians evaluating children were not aware of parental psychiatric diagnoses.
As previous studies have reported, the offspring of parents with bipolar disorder had significant elevations in behavioral, mood and anxiety symptoms and disorders:
The 2- to 5-year old offspring of parents with bipolar disorder had significantly higher rates of psychiatric symptoms and disorders:
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- Overall, 55% of BPDO had at least one psychiatric disorder, compared to only 14% of control non-BPD offspring.
- Preschool-aged BPDO already exhibited significantly higher rates of ADHD (21.8%), conduct disorder (15.4%), oppositional defiant disorder (24.4%), anxiety disorders (30.8%), and mood disorders (10.3%).
Parental psychiatric comorbidity also contributes to children’s risk for psychiatric symptoms and disorders:
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- Parental bipolar disorder was a stronger predictor for child disruptive behavior disorders than comorbid parental DBD. 5.6-fold increase in risk.
- Anxiety symptoms in children were more strongly predicted by comorbid parental anxiety.
The findings of the current study are consistent with other studies of older children and adolescents, demonstrating that at 2 to 5 years of age, the offspring of parents with bipolar disorder have significantly higher rates of psychiatric symptoms and disorders.
What’s Next?
In the existing literature focusing on the children of individuals with bipolar disorder, the youngest children tend to be overlooked, despite research demonstrating that toddlers and preschoolers may also present with identifiable and impairing psychiatric symptoms and disorders, including anxiety and mood disorders. These early symptoms may be harbingers of future psychiatric disorder and have been shown to predict social and academic impairment. Understanding the early indicators of emotional or behavioral dysregulation among very young children at risk for BPD has critical public health importance because it might help identify developmental precursors to bipolar disorder and other psychiatric disorders. Ultimately improving our ability to recognize these early symptoms could facilitate preventative and early intervention efforts among children already at high risk by virtue of having a parent with bipolar disorder.
The findings of the current study highlight the importance of closely monitoring preschool-age children of parents with bipolar disorder for onset of psychiatric symptoms and providing appropriate clinical intervention and support. In this cohort of children 2 to 5 years of age, half of the children already met diagnostic criteria for a psychiatric disorder and would likely benefit from early intervention to reduce the impact of their symptoms on social and academic development.
Further research is needed to determine whether early or preventive interventions can specifically reduce or mitigate risk of psychiatric illness in the children of parents with bipolar disorder. Additionally, the authors note that since almost half of the children did not have a psychiatric diagnosis, future studies should examine genetic and psychosocial factors that confer risk, as well as protection.
Read More
Abel MR, Henin A, Holmén J, Kagan E, Hamilton A, Noyola N, Hirshfeld-Becker DR. Anxiety and Disruptive Behavior Symptoms and Disorders in Preschool-Age Offspring of Parents With and Without Bipolar Disorder: Associations With Parental Comorbidity. J Atten Disord. 2024 Mar;28(5):625-638.
