Improved pediatric bipolar screen unveiled

Aug 30 2013

By Eleanor McDermid, Senior medwireNews Reporter

Researchers have developed a screening instrument for detecting bipolar disorder in children and adolescents from the general population.

Sophia Frangou (Ichan School of Medicine at Mount Sinai, New York, USA) and team based the screen on the Child Behavior Checklist (CBCL) because of its cross-cultural generalizability, despite the “limited success” of previous screens based on this tool.

They adopted a different approach, however. Rather than using the summary scores for the existing CBCL behavioral domains, an expert panel selected 19 CBCL items that directly related to the DSM-V diagnostic criteria for mania.

The scale thus generated – the CBCL-Mania Scale (CBCL-MS) – was significantly more accurate for predicting bipolar disorder than two previous CBCL-based tools when tested in 2230 Dutch children participating in the TRacking Adolescents' Individual Lives Survey (TRAILS), 56 of whom were diagnosed with bipolar I disorder by the age of 19 years.

The CBCL-MS had an accuracy of 64%, compared with 63% and 61% for the CBCL-Externalizing Scale and CBCL-Pediatric Bipolar Disorder scale, respectively.

The researchers concede that this accuracy is “moderate” and within the same range as existing instruments. But they say: “Although it could be argued that this… reflects limitations in the CBCL we would suggest that behavioural ratings alone are unlikely to provide us with high levels of accuracy in case identification for [bipolar disorder] or any mental disorder.”

The CBCL-MS was able to distinguish bipolar disorder from major depressive disorder and generalized anxiety disorder, but not from attention deficit hyperactivity disorder.

A point in favor of the CBCL-MS was its “remarkable temporal stability” between the ages of 11, 13, and 16 years, when the children were tested. Factor analysis revealed a four-factor structure, with factors corresponding to distractibility/disinhibition, psychotic symptoms, increased libido, and disrupted sleep, and the structure was almost identical at all testing points.

This “strongly supports the notion that it defines developmentally meaningful dimensions of liability” to bipolar disorder, say the researchers in PLoS One.

They conclude: “The CBCL-MS performed well within the context of a general population sample, it represents an improvement on available scales and could contribute to future public health initiatives for the identification of youth at high risk for [bipolar disorder].”

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