The increased frequency of diagnosed pediatric bipolar disorder has emerged as one of the greatest controversies in child and adolescent psychiatry. Beginning with reports that 20% of prepubertal of children with Attention-Deficit/Hyperactivity Disorder (ADHD) met criteria for juvenile mania, a view arose that bipolar children were more irritable than euphoric and more chronic than episodic, compared with the typical adult. Concurrently, there was a 4 to 6-fold increase in inpatient discharges and 40-fold increase in office-based visits for pediatric bipolar disorder, although many of these failed to meet formal Diagnostic and Statistical Manual (DSM) criteria. Concerns have been raised that any child with impulsive, volatile behavior is apt to be diagnosed as bipolar.