Prospective study of prodromal features for bipolarity in well Amish children

Janice A. Egeland, Jon A. Shaw, Jean Endicott, David L. Pauls, Cleona R. Allen, Abram M. Hostetter, James N. Sussex

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Objective: A prospective study of psychiatrically well Amish children to determine differences in the frequency and pattern of clinical features that may be prodromal for bipolar 1 disorder. Method: Children with a bipolar I parent (n = 100) and children of well parents in a matched control sample (n = 110) were assessed annually for 7 years with semistructured interviews covering medical/developmental features and symptoms/behaviors that are possibly prodromal for bipolarity. Randomized histories of these 210 children were evaluated blindly by 4 clinicians for independent ratings of risk for bipolarity. Results: Thirty-eight percent of the children of bipolar parents were rated as at risk compared with 17% of children in the control sample. Most control sample children with risk ratings had well parents with a bipolar sibling (i.e., family history positive). Children with family histories negative for mental illness rarely received even a low risk rating. Clinical features significantly (p ≤ .05) more frequent among children of a bipolar parent included mood lability, low energy, anxious/worried, hyper-alert, attention problems/distractible and school role impairment, easily excited, sensitivity, somatic complaints, and stubborn/determined. Conclusion: Mini-clusters of early possible predictors suggest a natural history of episodic prodromal features rather than the chronic symptom pattern sometimes described for children at risk for bipolar disorder.

Original languageEnglish (US)
Pages (from-to)786-796
Number of pages11
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number7
StatePublished - Jul 2003


  • Children-at-risk
  • Pediatric bipolar
  • Prodromal features
  • Prospective study

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology


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