title: 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.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Non-clinician raters administered structured diagnostic interviews, and the sample was referred and largely Caucasian.
  
  
  CONCLUSIONS
  The CBCL-Severe Dysregulation profile can be useful as a screen for BP-I disorder in children in clinical practice.
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Mai
authors.initials: M
authors.lastname: Uchida
authors.affiliation: Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: MaryKate
authors.initials: M
authors.lastname: Martelon
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Kenworthy
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: K Yvonne
authors.initials: KY
authors.lastname: Woodworth
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Spencer
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Janet R
authors.initials: JR
authors.lastname: Wozniak
authors.affiliation: Clinical and Research Programs in Pediatric Psychopharmacology and ADHD, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: jbiederman@partners.org.
authors.forename: Joseph
authors.initials: J
authors.lastname: Biederman
mesh_terms: D000293:Adolescent; D000374:Aggression; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology*; D001714:Bipolar Disorder / Q000175:diagnosis*; D057189:Checklist; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D011336:Probability; D011569:Psychiatric Status Rating Scales
keywords: Bipolar disorder; CBCL; Mood disorders; Screening instrument; Severity of illness index