Variability among research diagnostic interview instruments in the application of DSM-IV-TR criteria for pediatric bipolar disorder.
OBJECTIVE
The DSM-IV-TR criteria for a manic episode and bipolar disorder (BD) were developed for adults but are used for children. The manner in which clinicians and researchers interpret these criteria may have contributed to the increase in BD diagnoses given to youth. Research interviews are designed to improve diagnostic reliability and validity, but vary in how they incorporate DSM-IV-TR criteria for pediatric BD.


METHODS
We examined DSM-IV-TR criteria and the descriptive text for a manic episode and the mania sections of six commonly used pediatric diagnostic research interviews focusing on the following: interpretation of DSM-IV-TR, recommendations for administration, and scoring methods.


RESULTS
There are differences between the DSM-IV-TR manic episode criteria and descriptive text. Instruments vary in several ways including in their conceptualization of the mood criterion, whether symptoms must represent a change from the child's usual state, and whether B-criteria are required to co-occur with the A-criterion. Instruments also differ on recommendations for administration and scoring methods.


CONCLUSIONS
Given the differences between DSM-IV-TR manic episode criteria and explanatory text, it is not surprising that there is considerable variation between diagnostic instruments based on DSM-IV-TR. These differences likely lead to dissimilarities in subjects included in BD research studies and inconsistent findings across studies. The field of child psychiatry would benefit from more uniform methods of assessing symptoms and determining pediatric BD diagnoses. We discuss recommendations for changes to future instruments, interviews, assessment, and the DSM-5.
State University of New York Downstate and the Kings County Hospital Center, 451 Clarkson Avenue, Brooklyn, NY 11203, USA. cathryn.galanter@downstate.edu
Cathryn A
CA
Galanter
Stephanie R
SR
Hundt
Parag
P
Goyal
Jenna
J
Le
Prudence W
PW
Fisher
D000293:Adolescent; D000367:Age Factors; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D003951:Diagnostic Errors / Q000517:prevention & control*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods / Q000592:standards; D008297:Male; D015588:Observer Variation; D018579:Patient Selection; D015203:Reproducibility of Results