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In a world where circumstances continue to put our patients and families into overdrive, in this issue we look at several kinds of amped-up situations. Dr. Ann Van Meter talks with us about assessment of bipolar disorder and the use of a practical nomogram to help predict whether a patient’s history and symptoms are likely to lead to bipolar disorder. Dr. Joseph Blader reviews his research on more effective and safer treatment of aggression in the context of ADHD. Dr. Rafael Pelayo offers us a more sophisticated approach to sleep problems. We also include a collection of research updates that look at preliminary studies in a variety of overdriven situations: DASH diet treatment of ADHD, treating agitation in the ED, self-injury with ADHD, and IVIG for PANS. For a bit of relief, expert colleagues also get together to give us a picture of the pastoral beauty and broad application of equine-assisted psychotherapy. As always, we welcome your feedback and suggestions.

Most of us need more clarity to better differentiate bipolar disorder from other problems such as ADHD with irritability or other mood problems. In this interview, Dr Ann Van Meter offers a simple methodology for making better predictions about the risk of bipolar illness in children and adolescents based on risk factors and symptomatology.

We often see children and teens who have ADHD with aggressive behavior. The press to treat them often results in polypharmacy with all the attendant risks and complications. This interview with Dr. Joseph Blader discusses research findings that can help us to provide more effective simplified and safer treatment for many of the patients.

Poor sleep is a drag on daily function and a central factor in psychopathology, however typical sleep hygiene advice has little impact in everyday practice. In this article, Dr Rafael Pelayo takes us to the next level of understanding and helping patients and families with straightforward ideas that can begin during everyday office visits.

Clinicians and families often seek natural non-pharmacological approaches to ADHD in children and adolescents. This hope has spawned a growing body of preliminary research on many supplements and diets for ADHD. This research update on a study of the DASH diet offers our thinking about its possible usefulness for our patients.

What medications are best picks for treating agitation in children and adolescents in the emergency department setting? While there is little definitive research on the topic we looked at a retrospective study comparing quetiapine with first line antipsychotics that gives us a start at pulling the threads on this knotty problem.

What is the relationship between ADHD and non-suicidal self-injury? This research update teases out an understanding of these and other common co-morbidities in a manner that suggests a practical approach to dealing with both problems in our child and adolescent patients.