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J Affect Disord. 2016 Oct;203:46-54. doi: 10.1016/j.jad.2016.05.046. Epub 2016 May 26.

Reversal-learning deficits in childhood-onset bipolar disorder across the transition from childhood to young adulthood.

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Brown University Alpert Medical School, Department of Psychiatry and Human Behavior, Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, 1011 Veterans Memorial Pkwy, Riverside, RI 02915, United States. Electronic address:
Pediatric Mood, Imaging, and NeuroDevelopment (PediMIND) Program, Bradley Hospital, Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Riverside, RI 02915, USA.
Section on Bipolar Spectrum Disorders, Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.



Bipolar disorder (BD) is a severe mental illness that can have high costs for youths (<18 years old) and adults. Relative to healthy controls (HC), individuals with BD often show impaired attention, working memory, executive function, and cognitive flexibility (the ability to adapt to changing reward/punishment contingencies). In our study of youths and young adults with BD, we investigated 1) how cognitive flexibility varies developmentally in BD, and 2) whether it is independent of other executive function deficits associated with BD.


We measured errors on a reversal-learning task, as well as spatial working memory and other executive function, among participants with BD (N=75) and HC (N=130), 7-27 years old. Regression analyses focused on the effects of diagnosis on reversal-learning errors, controlling for age, gender, IQ, spatial span, and executive function. Similar analyses examined non-reversal errors to rule out general task impairment.


Participants with BD, regardless of age, gender, or cognitive ability, showed more errors than HC on the response reversal stages of the cognitive flexibility task. However, participants with BD did not show more errors on non-reversal stages, even when controlling for other variables.


Study limitations include the cross-sectional, rather than longitudinal, design; inability to measure non-linear age effects; and inclusion of medicated participants and those with psychiatric comorbidity.


Individuals with BD show a specific impairment in reversing a previously rewarded response, which persists across the transition from childhood to young adulthood. Tailored interventions targeting this deficit may be effective throughout this developmentally turbulent time.


Bipolar disorder; Cognitive flexibility; Development; Executive function; Reversal learning

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