Validation Study of The Bipolar Child Questionnaire V.2.0

Demitri Papolos, M.D., Melissa Cockerham, M.S., and John Hennen, Ph.D.

While there is continuing debate over the validity of the diagnosis of mania in children, since 1994 a number of systematic clinical investigations and family/genetic studies have begun to shed light on the presentation and naturalistic course of childhood-onset bipolar disorder, suggesting a developmentally different presentation in young children as compared to its adult form. Adult-onset and juvenile-onset forms of BPD have certain similar features and comorbidities in common, but in the juvenile form of the disorder, the complexities wrought by the frequent overlap of symptoms with other disorders that are far more commonly diagnosed in childhood has had a confounding affect on clinical diagnostic practice for years. Part of the problem appears to be that the co-occurring conditions, such as attention deficit hyperactivity disorder ,depression, obsessive compulsive disorder and conduct disorder are more easily recognizable to clinicians, and far more commonly diagnosed than bipolar disorder.

A leading source of diagnostic confusion in childhood mania is its symptomatic overlap with attention deficit hyperactivity disorder (ADHD). Systematic studies of children and adolescents show that rates of ADHD range from 60% to 90% in pediatric patients with mania. Because of overlapping symptoms between current DSM-IV diagnostic categories, incomplete and misleading criteria for the diagnosis of childhood-onset bipolar disorder (COPD), as well as a long-standing bias against the diagnosis in childhood, many individuals are commonly first diagnosed with one or another of the co-occurring conditions before COBPD is considered.

This diagnostic confusion can lead to significant adverse effects and poor treatment outcomes, particularly when stimulants and antidepressant medications are introduced in the setting of undiagnosed pediatric bipolar disorder. Therefore, it is imperative that additional clinical methods be developed to assist clinicians in rapidly screening individuals at risk to arrive at appropriate diagnoses. Additionally, future genetic studies will benefit from the development of well-validated and reliable screening instruments.

The Child Bipolar Questionnaire (CBQ) has been developed to serve as a screening inventory of symptoms and common behavioral features of childhood-onset bipolar disorder. The first version of the questionnaire contained 85 items drawn from DSM-IV categories of childhood psychiatric illnesses. This inventory was constructed to score rates of symptoms for specific age ranges retrospectively. 220 parents of children diagnosed according to DSM-IV criteria (revised for the inclusion of ultra-rapid cycling) were administered this questionnaire. The most common positively endorsed symptoms and behaviors were rank ordered according to frequency of occurrence and of these, the 65 highest rated symptoms were included in the CBQ Version 2.0.

The study we propose will assess the validity and potential utility of the CBQ V.2.0 as a screening instrument that can be used by pediatricians and mental health practitioners, including child psychiatrists, psychologists and social workers, as well as for family genetic and offspring studies. We want to assess the ability of this instrument to satisfy three prerequisites for use in such clinical and research settings: (1) identification of core symptom categories related to bipolar disorder (2) use with children and young adolescents, and (3) ability to distinguish between affected and well siblings and control subjects with attention-deficit disorder with hyperactivity.

The CBQ will be administered to 50 parents of children diagnosed with bipolar disorder. Control subjects from a community sample and subjects with attention-deficit disorder with hyperactivity will constitute the comparison groups.

Diagnoses will be according to new research criteria for juvenile-onset bipolar, DSM-IV (revised criteria) by blind semiuctured clinical interview and the affective disorder supplement of the SADS P/L. Parents will be asked to complete behavioral screening tools: Child Bipolar Questionnaire (BCQ), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Overt Aggression Scale (OAS), and the Child Behavioral Check List.

I am considering having my child participate and would like to provide you with some basic information and to have someone contact me.

Partial funding has been provided by The Page Hill Foundation, in honor of Jason Pyne.

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