A rose is a rose is a rose?

This young man presented initially and repeatedly over a period of twenty years with symptoms of irritability, depressed and withdrawn mood, impulsivity, out-of-control behavior, and suicidal ideation and behavior. These symptoms occurred with disabling intensity at ages 3 year, 6 1/2 years, and 8 1/2 years, when he had not yet been adequately diagnosed and treated with appropriate psychopharmacology. Symptoms re-occurred in early adulthood after medication had been discontinued by the patient. While he had symptoms characteristic of ADHD before age seven, these were present episodically and only in the context of significant mood disturbance and behavior disruption, which were more characteristic of mood disorder than oppositional behavior associated with ADHD. His reaction to stimulants alone was significant. His response to Ritalin suggested dysphoria and/or neurovegetative slowing. On Dexedrine, he developed frank visual hallucinations. Both reactions can be typically seen in youths with underlying mood or psychotic disorders. This patient's symptoms and their repeated occurrence, in the face of significant family history of mood disorder, demonstrate the utility of DSM-IV criteria and longitudinal history taking in making the diagnosis of bipolar disorder in prepubertal children.