4.1. At Risk Versus Control Groups
At baseline, the at-risk group had a significantly higher number of manic symptoms endorsed and a higher number of children who had experienced at least one manic symptom. This finding is somewhat surprising given previous literature has observed that manic symptoms usually manifest at later stages in life (Duffy et al., 2019), raising the question of whether the current study accurately captured manic symptoms in this population. Some of the manic symptoms addressed in the semi-structured clinical interviews were irritability, decreased need for sleep, pressured speech, increased thoughts, flight of ideas, agitation, and distractibility. These symptoms are commonly present in attention hyperactivity disorder (ADHD), a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity (Y. Li et al., 2023). There is considerable overlap between these two disorders, and studies have explored ways to distinguish between them (Barden et al., 2023). While this study focuses on the number of symptoms rather than diagnoses, it is possible that ADHD symptoms may have contributed to the observed statistically significant differences in manic symptoms between the at-risk and control groups at baseline. That is, ADHD is much more frequent at the age tested (9-10 years), with an estimated prevalence of 10 to 10.5% among US children and adolescent (Y. Li et al., 2023).
The higher numbers of symptoms and incidences for depression and anxiety within the at-risk group at follow-up are in line with and contribute to previous literature (Duffy, 2018; Duffy et al., 2019; Faedda et al., 2019; Vieta et al., 2018). Specifically, this research aligns with Duffy et al.’s (2019) results and hypothesized trajectory of emerging disorders, given at-risk participants showed a greater number of depressive and anxious symptoms when they were older (11-12) at two-year follow-up, than at baseline (9-10). Furthermore, as per the literature, children with a predisposition to bipolar disorder seem to experience more depressive symptoms and episodes than healthy controls (Duffy, 2018), and half of patients who eventually meet diagnostic criteria for BD have experienced mood symptoms or episodes of major depressive disorder in their youth (Faedda et al., 2019).