Diagnostic and measurement issues in the assessment of pediatric bipolar disorder: Implications for understanding mood disorder across the life cycle

Abstract

The goal of this paper is to review assessment research of bipolar disorder in children and adolescents. The review addresses numerous themes: the benefits and costs of involving clinical judgment in the diagnostic process, particularly with regard to diagnosis and mood severity ratings; the validity of parent, teacher, and youth self-report of manic symptoms; how much cross-situational consistency is typically shown in mood and behavior; the extent to which a parent's mental health status influences their report of child behavior; how different measures compare in terms of detecting bipolar disorder, the challenges in comparing the performance of measures across research groups, and the leading candidates for research or clinical use; evidence-based strategies for interpreting measures as diagnostic aids; how test performance changes when a test is used in a new setting and what implications this has for research samples as well as clinical practice; the role of family history of mood disorder within an assessment framework; and the implications of assessment research for the understanding of phenomenology of bipolar disorder from a developmental framework.

The Efficacy and Tolerability of Methylphenidate and Behavior Modification in Children with Attention-Deficit/Hyperactivity Disorder and Severe Mood Dysregulation

“…While the YMRS has normative data in ADHD populations showing that most children with ADHD will not score in the elevated range Fristad et al 1992;Youngstrom et al 2002), it was not designed to identify manic symptoms in children with ADHD. Most rating scales of pediatric BP are plagued by similar limitations due to the inherent difficulties with separating ODD ϩ ADHD from BP at a single time point (Pavuluri et al 2006;Youngstrom et al 2006).…”

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

“…Most experts recommend that assessment of child and adolescent problems include information from the child and parent(s), but significant discrepancies between parent-and child-report are often found (Achenbach et al 1987;De Los Reyes and Kazdin 2005). With respect to the diagnosis of bipolar disorder, Youngstrom et al (2006) found that assessment measures completed by parents provided better information about manic symptoms than child-or teacher-report measures. Moreover, combining information from multiple informants did not provide additional information.…”

AACAP 2006 Research Forum—Advancing Research in Early-Onset Bipolar Disorder: Barriers and Suggestions

“…For instance, severity of illness impacts treatment outcome in ADHD (Hinshaw 2007) and depression (Curry et al 2006). researchers differ on how they elicit, assess, characterize, and count criteria (Youngstrom et al 2006). The degree to which these decisions influence their sample selection and ultimate findings is unclear (Galanter et al 2008).…”

“…What has complicated work up to now is that investigators say they are using the same criteria, methods, and terms but use and define them differently (Youngstrom et al 2006). …”