Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder

Daniel P. Dickstein, David Axelson, Alexandra B. Weissman, Shirley Yen, Jeffrey I. Hunt, Benjamin I. Goldstein, Tina R. Goldstein, Fangzi Liao, Mary Kay Gill, Heather Hower, Thomas W. Frazier, Rasim S. Diler, Eric A. Youngstrom, Mary A. Fristad, L. Eugene Arnold, Robert L. Findling, Sarah M. Horwitz, Robert A. Kowatch, Neal D. Ryan, Michael StroberBoris Birmaher, Martin B. Keller

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Greater understanding of cognitive function in children and adolescents with bipolar disorder (BD) is of critical importance to improve our ability to design targeted treatments to help with real-world impairment, including academic performance. We sought to evaluate cognitive performance among children with either BD type I, II, or “not otherwise specified” (NOS) participating in multi-site Course and Outcome of Bipolar Youth study compared to typically developing controls (TDC) without psychopathology. In particular, we sought to test the hypothesis that BD-I and BD-II youths with full threshold episodes of mania or hypomania would have cognitive deficits, including in reversal learning, vs. those BD-NOS participants with sub-threshold episodes and TDCs. N = 175 participants (BD-I = 81, BD-II = 11, BD-NOS = 28, TDC = 55) completed Cambridge Neuropsychological Automated Testing Battery (CANTAB) tasks. A priori analyses of the simple reversal stage of the CANTAB intra-/extra-dimensional shift task showed that aggregated BD-I/II participants required significantly more trials to complete the task than either BD-NOS participants with sub-syndromal manic/hypomanic symptoms or than TDCs. BD participants across sub-types had impairments in sustained attention and information processing for emotionally valenced words. Our results align with prior findings showing that BD-I/II youths with distinct episodes have specific alterations in reversal learning. More broadly, our study suggests that further work is necessary to see the interaction between neurocognitive performance and longitudinal illness course. Additional work is required to identify the neural underpinnings of these differences as targets for potential novel treatments, such as cognitive remediation.

Original languageEnglish (US)
Pages (from-to)625-638
Number of pages14
JournalEuropean Child and Adolescent Psychiatry
Issue number6
StatePublished - Jun 1 2016


  • Adolescent
  • Bipolar disorder
  • Child
  • Cognitive performance
  • Reversal learning

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Developmental and Educational Psychology
  • Psychiatry and Mental health


Dive into the research topics of 'Cognitive flexibility and performance in children and adolescents with threshold and sub-threshold bipolar disorder'. Together they form a unique fingerprint.

Cite this