Skip to main content

Advertisement

Log in

The Dutch Bipolar Offspring Study: Cognitive Development and Psychopathology

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Various aspects of the relationship between cognitive impairment and bipolar disorder are not clear yet. This study examines cognitive and educational functioning prospectively in offspring at familial risk for bipolar disorder, in order to improve our understanding of the association between cognitive functioning and psychopathology. Bipolar offspring (N = 92) from the prospective Dutch bipolar offspring study were evaluated at adolescence and adulthood for IQ estimate, educational achievement and development of any psychiatric disorder. The main outcome was IQ estimate after 12 years of follow-up (offspring mean age 28 years). Generalized estimating equation (GEE) analyses showed that any lifetime DSM-IV axis I diagnosis was related to a lower cognitive outcome at adulthood as compared to unaffected bipolar offspring. No specific association was found for type of diagnosis. Early onset psychopathology (diagnosis at or before age 15 years) was significantly related to lower IQ estimate at adulthood, indicating a sensitive period for neurocognitive development.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Angst, J., Gamma, A., Rossler, W., Ajdacic, V., & Klein, D. N. (2011). Childhood adversity and chronicity of mood disorders. European Archives of Psychiatry and Clinical Neuroscience, 261(1), 21–27. https://doi.org/10.1007/s00406-010-0120-3.

    Article  PubMed  Google Scholar 

  • Barrett, H. C. (2012). A hierarchical model of the evolution of human brain specializations. Proceedings of the National Academy of Sciences of the United States of America, 109(Suppl 1), 10733–10740. https://doi.org/10.1073/pnas.1201898109.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bearden, C. E., Glahn, D. C., Caetano, S., Olvera, R. L., Fonseca, M., Najt, P., Hunter, K., Pliszka, S. R., & Soares, J. C. (2007). Evidence for disruption in prefrontal cortical functions in juvenile bipolar disorder. Bipolar Disorders, 9(Suppl 1), 145–159. https://doi.org/10.1111/j.1399-5618.2007.00453.x.

    Article  PubMed  Google Scholar 

  • Bora, E. (2015). Developmental trajectory of cognitive impairment in bipolar disorder: comparison with schizophrenia. European Neuropsychopharmacology, 25(2), 158–168. https://doi.org/10.1016/j.euroneuro.2014.09.007.

    Article  PubMed  Google Scholar 

  • Bora, E., & Pantelis, C. (2015). Meta-analysis of cognitive impairment in first-episode bipolar disorder: comparison with first-episode schizophrenia and healthy controls. Schizophrenia Bulletin, 41(5), 1095–1104. https://doi.org/10.1093/schbul/sbu198.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bora, E., Yucel, M., & Pantelis, C. (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders, 113(1–2), 1–20. https://doi.org/10.1016/j.jad.2008.06.009.

    Article  PubMed  Google Scholar 

  • Breslau, J., Lane, M., Sampson, N., & Kessler, R. C. (2008). Mental disorders and subsequent educational attainment in a US national sample. Journal of Psychiatric Research, 42(9), 708–716. https://doi.org/10.1016/j.jpsychires.2008.01.016.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, G. H., & Harris, T. O. (1989). Life events and illness. New York: Guilford Press.

    Google Scholar 

  • Cardoso, T., Bauer, I. E., Meyer, T. D., Kapczinski, F., & Soares, J. C. (2015). Neuroprogression and cognitive functioning in bipolar disorder: a systematic review. Current Psychiatry Reports, 17(9), 75. https://doi.org/10.1007/s11920-015-0605-x.

    Article  PubMed  Google Scholar 

  • Carlson, G. A., & Pataki, C. (2016). Understanding early age of onset: a review of the last 5 years. Current Psychiatry Reports, 18(12), 114. https://doi.org/10.1007/s11920-016-0744-8.

    Article  PubMed  Google Scholar 

  • Carter, T. D., Mundo, E., Parikh, S. V., & Kennedy, J. L. (2003). Early age at onset as a risk factor for poor outcome of bipolar disorder. Journal of Psychiatric Research, 37(4), 297–303.

    Article  PubMed  Google Scholar 

  • de la Serna, E., Vila, M., Sanchez-Gistau, V., Moreno, D., Romero, S., Sugranyes, G., Baeza, I., Llorente, C., Rodriguez-Toscano, E., Sánchez-Gutierrez, T., & Castro-Fornieles, J. (2016). Neuropsychological characteristics of child and adolescent offspring of patients with bipolar disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 65, 54–59. https://doi.org/10.1016/j.pnpbp.2015.08.014.

    Article  Google Scholar 

  • DelBello, M. P., & Geller, B. (2001). Review of studies of child and adolescent offspring of bipolar parents. Bipolar Disorders, 3(6), 325–334.

    Article  PubMed  Google Scholar 

  • Diwadkar, V. A., Goradia, D., Hosanagar, A., Mermon, D., Montrose, D. M., Birmaher, B., Axelson, D., Rajarathinem, R., Haddad, L., Amirsadri, A., Zajac-Benitez, C., Rajan, U., & Keshavan, M. S. (2011). Working memory and attention deficits in adolescent offspring of schizophrenia or bipolar patients: comparing vulnerability markers. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 35(5), 1349–1354. https://doi.org/10.1016/j.pnpbp.2011.04.009.

    Article  Google Scholar 

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). User’s guide for the structured clinical interview for DSM-IV Axis I disorders–clinical version (SCID-CV). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Frias, A., Palma, C., & Farriols, N. (2014). Neurocognitive impairments among youth with pediatric bipolar disorder: a systematic review of neuropsychological research. Journal of Affective Disorders, 166, 297–306. https://doi.org/10.1016/j.jad.2014.05.025.

    Article  PubMed  Google Scholar 

  • Glahn, D. C., Bearden, C. E., Bowden, C. L., & Soares, J. C. (2006). Reduced educational attainment in bipolar disorder. Journal of Affective Disorders, 92(2–3), 309–312. https://doi.org/10.1016/j.jad.2006.01.025.

    Article  PubMed  Google Scholar 

  • Gochman, P. A., Greenstein, D., Sporn, A., Gogtay, N., Keller, B., Shaw, P., & Rapoport, J. L. (2005). IQ stabilization in childhood-onset schizophrenia. Schizophrenia Research, 77(2–3), 271–277. https://doi.org/10.1016/j.schres.2005.04.002.

    Article  PubMed  Google Scholar 

  • Hafeman, D. M., Merranko, J., Axelson, D., Goldstein, B. I., Goldstein, T., Monk, K., Hickey, M. B., Sakolsky, D., Diler, R., Iyengar, S., Brent, D., Kupfer, D., & Birmaher, B. (2016). Toward the definition of a bipolar prodrome: dimensional predictors of bipolar spectrum disorders in at-risk youths. The American Journal of Psychiatry, 173(7), 695–704. https://doi.org/10.1176/appi.ajp.2015.15040414.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hillegers, M. H., Burger, H., Wals, M., Reichart, C. G., Verhulst, F. C., Nolen, W. A., et al. (2004). Impact of stressful life events, familial loading and their interaction on the onset of mood disorders: study in a high-risk cohort of adolescent offspring of parents with bipolar disorder. The British Journal of Psychiatry, 185, 97–101. https://doi.org/10.1192/bjp.185.2.97.

    Article  PubMed  Google Scholar 

  • Hillegers, M. H., Reichart, C. G., Wals, M., Verhulst, F. C., Ormel, J., & Nolen, W. A. (2005). Five-year prospective outcome of psychopathology in the adolescent offspring of bipolar parents. Bipolar Disorders, 7(4), 344–350. https://doi.org/10.1111/j.1399-5618.2005.00215.x.

    Article  PubMed  Google Scholar 

  • Hiller, W., Zaudig, M., Mombour, W., & Bronisch, T. (1993). Routine psychiatric examinations guided by ICD-10 diagnostic checklists (international diagnostic checklists). European Archives of Psychiatry and Clinical Neuroscience, 242(4), 218–223.

    Article  PubMed  Google Scholar 

  • Hollis, C. (2000). Adult outcomes of child- and adolescent-onset schizophrenia: diagnostic stability and predictive validity. The American Journal of Psychiatry, 157(10), 1652–1659. https://doi.org/10.1176/appi.ajp.157.10.1652.

    Article  PubMed  Google Scholar 

  • Immonen, J., Jaaskelainen, E., Korpela, H., & Miettunen, J. (2017). Age at onset and the outcomes of schizophrenia: a systematic review and meta-analysis. Early Intervention in Psychiatry, 11, 453–460. https://doi.org/10.1111/eip.12412.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jepsen, J. R., Fagerlund, B., Pagsberg, A. K., Christensen, A. M., Hilker, R. W., Nordentoft, M., et al. (2010). Course of intelligence deficits in early onset, first episode schizophrenia: a controlled, 5-year longitudinal study. European Child & Adolescent Psychiatry, 19(4), 341–351. https://doi.org/10.1007/s00787-009-0053-4.

    Article  Google Scholar 

  • Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry, 36(7), 980–988. https://doi.org/10.1097/00004583-199707000-00021.

    Article  PubMed  Google Scholar 

  • Kemner, S. M., Mesman, E., Nolen, W. A., Eijckemans, M. J., & Hillegers, M. H. (2015). The role of life events and psychological factors in the onset of first and recurrent mood episodes in bipolar offspring: results from the Dutch Bipolar Offspring study. Psychological Medicine, 45(12), 2571–2581. https://doi.org/10.1017/s0033291715000495.

    Article  PubMed  Google Scholar 

  • Kendler, K. S., Ohlsson, H., Mezuk, B., Sundquist, K., & Sundquist, J. (2016). A Swedish national prospective and co-relative study of school achievement at age 16, and risk for schizophrenia, other nonaffective psychosis, and bipolar illness. Schizophrenia Bulletin, 42(1), 77–86. https://doi.org/10.1093/schbul/sbv103.

    Article  PubMed  Google Scholar 

  • Khandaker, G. M., Barnett, J. H., White, I. R., & Jones, P. B. (2011). A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia. Schizophrenia Research, 132(2–3), 220–227. https://doi.org/10.1016/j.schres.2011.06.017.

    Article  PubMed  Google Scholar 

  • Klimes-Dougan, B., Ronsaville, D., Wiggs, E. A., & Martinez, P. E. (2006). Neuropsychological functioning in adolescent children of mothers with a history of bipolar or major depressive disorders. Biological Psychiatry, 60(9), 957–965. https://doi.org/10.1016/j.biopsych.2006.03.031.

    Article  PubMed  Google Scholar 

  • Klimes-Dougan, B., Jeong, J., Kennedy, K. P., & Allen, T. A. (2017). Intellectual functioning in offspring of parents with bipolar disorder: a review of the literature. Brain Sci, 7(11), 2076–3425 (Print).

    Google Scholar 

  • Kurtz, M. M., & Gerraty, R. T. (2009). A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state. Neuropsychology, 23(5), 551–562. https://doi.org/10.1037/a0016277.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lapalme, M., Hodgins, S., & LaRoche, C. (1997). Children of parents with bipolar disorder: a metaanalysis of risk for mental disorders. Canadian Journal of Psychiatry, 42(6), 623–631.

    Article  PubMed  Google Scholar 

  • Leboyer, M., Henry, C., Paillere-Martinot, M. L., & Bellivier, F. (2005). Age at onset in bipolar affective disorders: a review. Bipolar Disorders, 7(2), 111–118. https://doi.org/10.1111/j.1399-5618.2005.00181.x.

    Article  PubMed  Google Scholar 

  • Legerstee, J. S., van der Reijden-Lakeman, I. A., Lechner-van der Noort, M. G., & Ferdinand, R. F. (2004). Bruikbaarheid verkorte versie wisc-rn in de kinderpsychiatrie. Kind en adolescent, 25(4), 178–182. https://doi.org/10.1007/BF03060926.

    Article  Google Scholar 

  • Lewandowski, K. E., Cohen, B. M., & Ongur, D. (2011). Evolution of neuropsychological dysfunction during the course of schizophrenia and bipolar disorder. Psychological Medicine, 41(2), 225–241. https://doi.org/10.1017/s0033291710001042.

    Article  PubMed  Google Scholar 

  • MacCabe, J. H., Lambe, M. P., Cnattingius, S., Torrang, A., Bjork, C., Sham, P. C., et al. (2008). Scholastic achievement at age 16 and risk of schizophrenia and other psychoses: a national cohort study. Psychological Medicine, 38(8), 1133–1140. https://doi.org/10.1017/s0033291707002048.

    Article  PubMed  Google Scholar 

  • MacCabe, J. H., Lambe, M. P., Cnattingius, S., Sham, P. C., David, A. S., Reichenberg, A., Murray, R. M., & Hultman, C. M. (2010). Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. The British Journal of Psychiatry, 196(2), 109–115. https://doi.org/10.1192/bjp.bp.108.060368.

    Article  PubMed  Google Scholar 

  • Maziade, M., Rouleau, N., Gingras, N., Boutin, P., Paradis, M. E., Jomphe, V., Boutin, J., Letourneau, K., Gilbert, E., Lefebvre, A. A., Dore, M. C., Marino, C., Battaglia, M., Merette, C., & Roy, M. A. (2009). Shared neurocognitive dysfunctions in young offspring at extreme risk for schizophrenia or bipolar disorder in eastern Quebec multigenerational families. Schizophrenia Bulletin, 35(5), 919–930. https://doi.org/10.1093/schbul/sbn058.

    Article  PubMed  Google Scholar 

  • McDonough-Ryan, P., DelBello, M., Shear, P. K., Ris, D. M., Soutullo, C., & Strakowski, S. M. (2002). Academic and cognitive abilities in children of parents with bipolar disorder: a test of the nonverbal learning disability model. Journal of Clinical and Experimental Neuropsychology, 24(3), 280–285. https://doi.org/10.1076/jcen.24.3.280.980.

    Article  PubMed  Google Scholar 

  • Mesman, E., Nolen, W. A., Reichart, C. G., Wals, M., & Hillegers, M. H. (2013). The Dutch bipolar offspring study: 12-year follow-up. The American Journal of Psychiatry, 170(5), 542–549. https://doi.org/10.1176/appi.ajp.2012.12030401.

    Article  PubMed  Google Scholar 

  • Monck, E., & Dobbs, R. (1985). Measuring life events in an adolescent population: methodological issues and related findings. Psychological Medicine, 15(4), 841–850.

    Article  PubMed  Google Scholar 

  • Passos, I. C., Mwangi, B., Vieta, E., Berk, M., & Kapczinski, F. (2016). Areas of controversy in neuroprogression in bipolar disorder. Acta Psychiatrica Scandinavica, 134(2), 91–103. https://doi.org/10.1111/acps.12581.

    Article  PubMed  Google Scholar 

  • Ranning, A., Munk Laursen, T., Thorup, A., Hjorthøj, C., Nordentoft, M. (2015). Serious mental illness and disrupted caregiving for children: a nationwide, register-based cohort study. J Clin Psychiatry, 76(8), 1006–1014.

  • Reichart, C. G., Wals, M., Hillegers, M. H., Ormel, J., Nolen, W. A., & Verhulst, F. C. (2004). Psychopathology in the adolescent offspring of bipolar parents. Journal of Affective Disorders, 78(1), 67–71.

    Article  PubMed  Google Scholar 

  • Sharma, A., Camilleri, N., Grunze, H., Barron, E., Le Couteur, J., Close, A., et al. (2016). Neuropsychological study of IQ scores in offspring of parents with bipolar I disorder. Cognitive Neuropsychiatry, 22(1), 1–11. https://doi.org/10.1080/13546805.2016.1259103.

    Article  Google Scholar 

  • Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A compendium of neuropsychological tests (3rd ed.). New York: Oxford University Press.

    Google Scholar 

  • Tempelaar, W. M., de Vos, N., Plevier, C. M., van Gastel, W. A., Termorshuizen, F., MacCabe, J. H., & Boks, M. P. M. (2017). Educational level, underachievement and general mental health problems in 10 866 adolescents. Academic Pediatrics, 17, 642–648. https://doi.org/10.1016/j.acap.2017.04.016.

    Article  PubMed  Google Scholar 

  • Thorup, A. A. E., Hemager, N., Sondergaard, A., Gregersen, M., Prosch, A. K., Krantz, M. F., et al. (2018). The Danish high risk and resilience study-VIA 11: study protocol for the first follow-up of the VIA 7 cohort −522 children born to parents with schizophrenia spectrum disorders or bipolar disorder and controls being re-examined for the first time at age 11. Frontiers in Psychiatry, 9, 661. https://doi.org/10.3389/fpsyt.2018.00661.

    Article  PubMed  PubMed Central  Google Scholar 

  • Trotta, A., Murray, R. M., & MacCabe, J. H. (2015). Do premorbid and post-onset cognitive functioning differ between schizophrenia and bipolar disorder? A systematic review and meta-analysis. Psychological Medicine, 45(2), 381–394. https://doi.org/10.1017/s0033291714001512.

    Article  PubMed  Google Scholar 

  • Usner, D., & FitzGerald, G. (1999). Analytic implications of changing neuropsychological test versions during a longitudinal study because of aging in a pediatric cohort. Controlled Clinical Trials, 20(5), 476–478.

    Article  PubMed  Google Scholar 

  • Van Meter, A. R., Moreira, A. L., & Youngstrom, E. A. (2011). Meta-analysis of epidemiologic studies of pediatric bipolar disorder. The Journal of Clinical Psychiatry, 72(9), 1250–1256. https://doi.org/10.4088/JCP.10m06290.

    Article  PubMed  Google Scholar 

  • Vreeker, A., Boks, M. P., Abramovic, L., Verkooijen, S., van Bergen, A. H., Hillegers, M. H., et al. (2016). High educational performance is a distinctive feature of bipolar disorder: a study on cognition in bipolar disorder, schizophrenia patients, relatives and controls. Psychological Medicine, 46(4), 807–818. https://doi.org/10.1017/s0033291715002299.

    Article  PubMed  Google Scholar 

  • Wals, M., Hillegers, M. H., Reichart, C. G., Ormel, J., Nolen, W. A., & Verhulst, F. C. (2001). Prevalence of psychopathology in children of a bipolar parent. Journal of the American Academy of Child and Adolescent Psychiatry, 40(9), 1094–1102. https://doi.org/10.1097/00004583-200109000-00019.

    Article  PubMed  Google Scholar 

  • Wals, M., Hillegers, M. H., Reichart, C. G., Verhulst, F. C., Nolen, W. A., & Ormel, J. (2005). Stressful life events and onset of mood disorders in children of bipolar parents during 14-month follow-up. Journal of Affective Disorders, 87(2–3), 253–263. https://doi.org/10.1016/j.jad.2005.04.006.

    Article  PubMed  Google Scholar 

  • Wechsler, D. (1974). Administration and scoring manual for the Wechsler intelligence scale for children-revised. New York: New York The Psychological Corporation.

    Google Scholar 

  • Wechsler, D. (1997). WAIS-III: Wechsler Adult Intelligence Scale, 3rd edn. Administration and Scoring Manual. San Antonio: Psychological Corporation/Harcourt Brace.

    Google Scholar 

  • Wingo, A. P., Harvey, P. D., & Baldessarini, R. J. (2009). Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disorders, 11(2), 113–125. https://doi.org/10.1111/j.1399-5618.2009.00665.x.

    Article  PubMed  Google Scholar 

  • Woodberry, K. A., Giuliano, A. J., & Seidman, L. J. (2008). Premorbid IQ in schizophrenia: a meta-analytic review. The American Journal of Psychiatry, 165(5), 579–587. https://doi.org/10.1176/appi.ajp.2008.07081242.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to the participants and family members who took part in this study.

Funding

The funding of the present work was provided by the following sources: the latest assessment of this study was supported by grant 22963 from the 7FP of the European Commission and 9120818 from the Netherlands Organization for Health Research and Development (Zon-Mw). The Stanley Medical Research Institute and the Netherlands Organisation for Scientific Research (NWO) supported the first three assessments of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Wanda M. Tempelaar.

Ethics declarations

Conflict of Interest

Manon H.J. Hillegers has served in the advisory board of Benecke and has received grants from the Netherlands Organisation for Health Research and Development, NARSAD and the European Union.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants and parents included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 24 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tempelaar, W.M., Mesman, E., Breetvelt, E.J. et al. The Dutch Bipolar Offspring Study: Cognitive Development and Psychopathology. J Abnorm Child Psychol 47, 1559–1567 (2019). https://doi.org/10.1007/s10802-019-00532-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-019-00532-7

Keywords

Navigation