Further evidence that severe scores in the aggression/anxiety-depression/attention subscales of child behavior checklist (severe dysregulation profile) can screen for bipolar disorder symptomatology: a conditional probability analysis

• Published in: Journal of affective disorders Vol. 165; pp. 81 - 86
• Main Authors: Uchida, Mai, Faraone, Stephen V., Martelon, MaryKate, Kenworthy, Tara, Woodworth, K. Yvonne, Spencer, Thomas J., Wozniak, Janet R., Biederman, Joseph
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier B.V 20.08.2014; Elsevier
• Subjects: Adolescent; Adult and adolescent clinical studies; Aggression; Anxiety Disorders - diagnosis; Anxiety Disorders - psychology; Attention Deficit Disorder with Hyperactivity - diagnosis; Attention Deficit Disorder with Hyperactivity - psychology; Attention deficit hyperactivity disorder; Biological and medical sciences; Bipolar affective disorder; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar disorders; CBCL; Checklist; Checklists; Child; Children; Depression; Depressive Disorder - diagnosis; Depressive Disorder - psychology; Diagnostic testing; Female; Humans; Male; Medical sciences; Miscellaneous; Mood disorders; Probability; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Screening instrument; Severity of illness index; Mood disorders; Bipolar disorder; Severity of illness index; Screening instrument; CBCL; Mood disorder; Affect affectivity; Questionnaire; Aggression; Attention; Psychometrics; Depression; Cognition; Conditional probability; Child Behavior Checklist Achenbach Edelbrock; Medical screening; Symptomatology; Anxiety; Severity score
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2014.04.021

Previous work shows that children with high scores (2SD, combined score≥210) on the Attention Problems, Aggressive Behavior, and Anxious-Depressed (A-A-A) subscales of the Child Behavior Checklist (CBCL) are more likely than other children to meet criteria for bipolar (BP)-I disorder. However, the utility of this profile as a screening tool has remained unclear. We compared 140 patients with pediatric BP-I disorder, 83 with attention deficit hyperactivity disorder (ADHD), and 114 control subjects. We defined the CBCL-Severe Dysregulation profile as an aggregate cutoff score of≥210 on the A-A-A scales. Patients were assessed with structured diagnostic interviews and functional measures. Patients with BP-I disorder were significantly more likely than both control subjects (Odds Ratio [OR]: 173.2; 95% Confidence Interval [CI], 21.2 to 1413.8; P<0.001) and those with ADHD (OR: 14.6; 95% CI, 6.2 to 34.3; P<0.001) to have a positive CBCL-Severe Dysregulation profile. Receiver Operating Characteristics analyses showed that the area under the curve for this profile comparing children with BP-I disorder against control subjects and those with ADHD was 99% and 85%, respectively. The corresponding positive predictive values for this profile were 99% and 92% with false positive rates of<0.2% and 8% for the comparisons with control subjects and patients with ADHD, respectively. Non-clinician raters administered structured diagnostic interviews, and the sample was referred and largely Caucasian. The CBCL-Severe Dysregulation profile can be useful as a screen for BP-I disorder in children in clinical practice.