Further Evidence of the Diagnostic Utility of the Child Behavior Checklist for Identifying Pediatric Bipolar I Disorder

Background: Pediatric bipolar (BP) disorder is a prevalent and highly morbid disorder. While structured diagnostic interviews have been developed to aide in the diagnosis of pediatric BP disorder, these tools are lengthy, costly, and not widely available. One possible diagnostic aid is the Child Behavior Checklist (CBCL).

Objective: To assess the diagnostic utility of the Child Behavior Checklist (CBCL)-Bipolar (BP) profile to identify children with a diagnosis of BP-I disorder.

Method: Subjects were derived from four independent datasets of children and adolescents with and without attention deficit hyperactivity disorder (ADHD) and BP-I. Subjects were recruited from pediatric and psychiatric clinics and the community. All subjects had structured clinical interviews with raters blinded to subject ascertainment status. We used an empirically-derived profile from the CBCL consisting of an aggregate t-score from the Attention, Anxiety/Depression, and Aggression subscales (CBCL-BP profile) to operationalize the presence or absence of bipolar symptoms. Receiver operating characteristic (ROC) curves were used to examine the ability of the CBCL-BP profile to identify children with and without a structured interview diagnosis of BP-I disorder.

Results: The sample consisted of 661 subjects (mean age: 11.7 ± 3.3 years, 57% male, and 94% Caucasian). Twenty percent of participants (N=130) met structured interview criteria for a full diagnosis of BP-I disorder. The ROC analysis of the CBCL-BP profile yielded an area under the curve of 0.91. A t-score of ≥195 on the CBCL-BP profile correctly classified 86% of subjects with BP-I disorder with 80% sensitivity, 87% specificity, 61% positive predictive value, 95% negative predictive value.

Conclusion: The CBCL-BP profile efficiently discriminated pediatric subjects with and without a structured interview diagnosis of BP-I disorder. Findings suggest that the CBCL-BP profile may be an efficient tool to help identify children who are very likely to suffer from BP-I disorder.