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27-03-2013 | Mental health | Article

CBCL profile identifies severe bipolar I disorder in children


Free abstract

medwireNews: A positive child behavior checklist (CBCL)-severe dysregulation profile, which denotes high scores for attention problems, aggressive behavior, and anxious-depression, could help identify children who are likely to develop a severe form of bipolar I disorder (BD I), according to study results.

The findings showed that such a profile is associated with meaningful correlates of BD I, such as psychiatric comorbidity and dysfunction and familial BD I.

Although the results demonstrate that a positive CBCL-severe dysregulation profile maybe "informative in clinical practice," the researchers say that it "should only be considered as a useful tool, to help identify children at risk for [BD I] and in no way should it be viewed as synonymous with or a replacement for a clinical diagnosis of [BD I]."

Joseph Biederman (Massachusetts General Hospital, Boston, USA) and colleagues analyzed personal and familial correlates of BD I in 140 children, aged an average of 10 years, with the mood disorder and a comparison group of 126 children without BD I or attention-deficit hyperactivity disorder (controls). Of the children with BD I, 80 had a positive CBCL-severe dysregulation profile, defined as a total score of 210 or above on the attention problems, aggressive behavior, and anxious-depressed (A-A-A) subscales.

The researchers note that, although only 62% of children with BD I had a positive CBCL-severe dysregulation profile, 80% of BD I patients with a negative profile had intermediate scores (≥180 and <210) for the A-A-A subscales, compared with only 2% of comparison individuals.

Among patients with BD I, those with a CBCL-positive profile consistently had more severe correlates of BD I than those with a negative profile, including earlier age at BD I onset (5.5 vs 7.0 years) and higher rates of psychiatric hospitalization (39 vs 23%).

They also had higher rates of major depression (89 vs 68%), oppositional defiant disorder (95 vs 78%), social phobia (48 vs 22%), panic disorder (20 vs 5%), and generalized anxiety disorder (54 vs 35%).

Familial correlates were also evident, with first-degree relatives of children with and without a CBCL-positive profile 2.5 and 3.3 times more likely to have BD I, respectively, than those of comparison children, but the difference between those with and without a CBCL-positive profile was not significant.

The researchers comment in the Journal of Affective Disorders that "while the CBCL remains an attractive tool for screening children at risk for adverse outcomes in clinical settings due to its ease of administration, brevity, and reliability… clinicians should not use the CBCL-Severe Dysregulation to make a diagnosis of bipolar disorder."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Lucy Piper, Senior medwireNews Reporter

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