"Text book bipolar" normally refers to bipolar I-- I find it difficult to think that a child is having full blown manic phases. She has barely been alive long enough to meet the frequency and length criteria of the episodes-- if she is only four now, when could this have started?

While I don't disagree that both a diagnosed mental illness and/or traits of other illnesses can be present in someone as young as four, I disagree that a four year old could actually meet the criteria for bipolar disorder.

Phil, I wouldn't quite refrain from diagnosing mental illness in children under 8. There are exceptions. I work in an inpatient hospital that has a children's unit, ages 5 through 12. I have seen children under the age of 8 with suicide attempts, psychoses, and diagnosable depression.

Also, what about the host of disorders that specifically present in childhood? Reactive attachment d/o, separation anxiety d/o, conduct d/o, etc.

I'm wondering more about the nature of this child's mood swings.