On 24 April 2026, ACAMH will host a webinar Navigating Diagnostic Challenges in Pediatric Bipolar Disorder.
We caught up with the presenter – Prof Dr. Boris Birmaher, Endowed Chair in Bipolar Disease and Distinguished Professor of Psychiatry at the University of Pittsburgh School of Medicine – about the topic itself, his career, and his hopes for the event.
Looking back at your career, what first got you interested in bipolar disorder, and specifically paediatric bipolar disorder?
I became interested in mood disorders as a medical student – I saw people in periods of mania, and I was fascinated by the amount of energy – physically and mentally – that these people were able to maintain for days without being tired. Then I saw how they’d switch to the opposite, with depression and very low energy. These cycles intrigued me, especially because at that time there were almost no studies about the mechanisms by which people develop this disorder.
Later, when I studied adult psychiatry, I worked in a city with a population where bipolar disorder ran very strongly in many families. Then when I moved to the US, I studied child psychiatry and wanted to understand how to identify children at risk and intervene early to prevent all the psychosocial and developmental problems caused by this illness.
Bipolar disorder is often misunderstood in everyday conversation, the term ‘bipolar’ can be used as an insult or in a very non-scientific way. Is that stigma and misunderstanding a problem?
It’s a while since we shifted from calling this “manic depressive illness” to “bipolar disorder”, but that helped reduce prejudice. I’d say in the last five to ten years especially, awareness has improved, and there’s also more focus on the fact that bipolar disorder can bring positives – for instance, people with it can have artistic tendencies and can be very productive. But people in general don’t understand psychiatric illnesses, and there is still stigma, and assumptions that when you’re in a manic state, you’re violent or dangerous.
As biological studies advance and we understand more about the genetics, people are beginning to see that bipolar illness is like any other illness – it’s not the person’s fault, just as we wouldn’t blame someone for wearing glasses or having diabetes. That understanding is growing, though stigma still exists, especially in countries with less mental health education.
What makes paediatric bipolar disorder particularly challenging to diagnose, and have we made progress in recent years?
I’ll discuss this in more depth in the webinar, but the main challenges among others are the difficulties ascertaining mood symptoms, especially in young children due to their cognitive and emotional developmental stage.
In addition, bipolar disorder often overlaps with other conditions (eg ADHD) whose symptoms overlap with the symptoms of bipolar disorder. Due the above difficulties, you can’t diagnose bipolar in a single 30-minute appointment and without longitudinal follow-up.
In our clinic, because we combine research with clinical work, we have the funding to conduct initial assessments that last hours, and we can see children as frequently as needed. I know that funding is a challenge in many contexts, but it is vital to take the time to observe symptoms over time, seeing how they cluster together and come in episodes – that’s what really indicates bipolar disorder.
You mentioned family history – how strong is the genetic link in bipolar disorder?
Bipolar disorder runs in families quite strongly, but it’s polygenic – it involves many genes, not just one, which makes it harder to identify specific genetic markers.
Having a family history of bipolar doesn’t mean a child will develop it. In our studies following children of parents with bipolar for about 20 years, we found that approximately 25% of these children developed bipolar disorder, compared with 3% in the general community. Children who are at the highest risk usually have initial symptoms such as irritability, anxiety and depression, and subclinical symptoms of mania and their parents have history of developing bipolar disorder at early age.
Interestingly, we do see cases where we’re assessing a child and discover that a parent might have undiagnosed bipolar disorder. We always ask about family history, and sometimes parents have denial about their own condition.
We also find the opposite – parents who say they or a relative have bipolar disorder, but when we ask them to describe the symptoms, but actually that diagnosis turns out to be a misdiagnosis, often because clinicians didn’t have the time or patience to ask the right questions and follow people carefully.
Who do you hope will attend this webinar?
If you work with children and adolescents with any psychiatric disorders who also have mood symptoms, and you want to know if these symptoms may indicate the presence of bipolar disorder and how to make a good differential diagnosis, then it’s definitely for you.
But with the way I present and the topics we’ll cover, it’ll also be relevant to any professionals who don’t directly work in that field, but would benefit from a strong, up-to-date understanding of the evidence around bipolar disorder diagnosis and how we can support affected children and young people, and their families, to navigate its challenges.
Find more content on bipolar disorder on ACAMH Learn, our completely free, online learning resource.