Curr Treat Options Psych DOI 10.1007/s40501-016-0095-4 Mood Disorders (S Frangou, Section Editor) Diagnostic Challenges in Youth With Bipolar Disorder Ana Kleinman, MD, PhD 1,* Sheila Cavalcante Caetano, MD, PhD 2 Address *,1 Bipolar Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, S/N, 3º andar, PROMAN, São Paulo, 05403-010, Brazil Email: anakfix@gmail.com 2 Child and Adolescent Psychiatry Unit, Department of Psychiatry, Federal Univer- sity of São Paulo, São Paulo, Brazil * Springer International Publishing AG 2016 This article is part of the Topical Collection on Mood Disorders Keywords Bipolar disorder I Children I Adolescents I Mania in youth I Bipolar disorder diagnosis Opinion statement The purpose of this review is to understand the diagnostic challenges found in children and adolescents with bipolar disorder (BD). BD youth presentation tends to be atypical when compared with adults. BD in children is characterized by a more chronic course, rapid cycling, with multiple cycles in the same day. Cardinal symptoms include elevated mood, grandiosity, and decreased need for sleep, while the most common symptoms are increased energy, distractibility, and pressured speech. Overlapping symptoms with other psychiatric disorders and high rates of comorbidity complicate the diagnosis and can lead to misdiagnosis and inappropriate treatments. Child and adolescent psychiatric field has made significant advances in order to acknowledge BD in this population. Nevertheless, despite the evident growth in scientific literature’s attention toward BD in youth, until today, there is no agreement about the best diagnostic criteria. The controversy has shifted, though, in the last ten years, from whether it can be diagnosed to how it is diagnosed. Introduction The attention of the scientific literature to bipolar disorder (BD) in children and adolescents is evi- dent. This observation is confirmed by the impres- sive growth in publications especially since 2000 (Fig. 1). Nonetheless, until today, there is no con- sensus about the best diagnostic criteria for chil- dren and adolescents with BD. To better perceive the challenges related to this diagnosis in youth,