Mental Disorder DSM IV TR

Bipolar Disorder in Children

The CBCL Bipolar Profile and Attention, Mood, and Behavior Dysregulation

Database: Academic Search Premiere

I knew I wanted to review a paper on bipolar disorder in children. I chose the database "Academic Search Premiere." I clicked "advanced search" so I could use more than one term. For my keywords, I chose "bipolar disorder" in one box and "children" in the other. I also checked the boxes that limited my results to full text articles and articles from scholarly journals. When the list of articles appeared, I was able to choose one that sounded interesting and that was published in the last five years.

Bipolar disorder is difficult to diagnose in children, especially before the onset of puberty. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct disorder share features with bipolar disorder. These include impaired attention, talkativeness, high levels of motor activity, impulsivity, irritability, and hostility and aggression. Research shows that behavior checklists are useful in identifying bipolar disorder in children and adolescents.

A specific Child Behavior Check List (CBCL) that uses a semi-structured diagnostic interview has been shown to be effective in differentiating between children with bipolar disorder and ADHD. It has been used with similar results by several research groups, although there have still been mixed results. Researchers have continued to work with the CBCL to refine the checklist to make it more accurate. The purpose of the study by Doerfler, Connor and Toscano was to use a wider range of assessment measures to look at the nature and severity of impairment in children and adolescents who fit the CBCL bipolar disorder profile. In addition to the CBCL, the researchers used standardized measures of aggression and ADHD symptoms, DMS-IV diagnoses, child and adolescent psychiatrists' ratings of impairment and functioning, and children's own self-reporting of their depression. The study by Doerfler et al. compared children and adolescents who fit the CBCL bipolar disorder profile to individuals in the same age group who did not fit the profile.

All the children and adolescents in the sample had been referred to a pediatric psychopharmacology clinic. The sample included 310 children and adolescents, of which the majority (217), were male. The mean age of the subjects was 10.65 years. Ninety-two percent of the subjects were Caucasian; the remaining eight percent of the subjects were a mix of Hispanics, African-Americans, Asians and other ethnic groups. Family incomes ranged from less than $40,000 annually to more than $75,000. Interestingly, although there was no difference in the education of fathers among the children studied, there was a significant different for mother's education in the profile group.

A total of five child and adolescent psychiatrists conducted interviews with the parents/guardians of the referred children. Parents completed the CBCL, which had 118 items to measure children's behavioral and emotional problems. To gauge hyperactive/impulsive behaviors, classroom teachers were asked to complete the 10- Conners Teacher Rating Questionnaire. Parents completed the ADHD Rating Scale-IV. Parents also provided information with respect to special education services, if any, and whether the child had repeated a grade and/or been suspended or expelled from school.