Diagnostic implications of informant disagreement for manic symptoms.

OBJECTIVE

This study examines diagnoses that occur in an outpatient sample when both parent and teacher endorse significant manic symptoms and when only a parent observes them. We hypothesized that the diagnosis of mania/bipolar (BP) disorder would occur when there is parent/teacher concordance on high mania symptom scores.

METHODS

Subjects were 911 5-18-year-old psychiatrically diagnosed youths with caregiver and teacher completed Child Mania Rating Scales (CMRSs) and Achenbach parent and teacher forms. Parent-teacher concordance on the CMRS was defined as both informants ≥75 percentile on the CMRS; discordance on the CMRS was defined as parent ≥75 percentile and teacher ≤25 percentile. Logistic regression examined factors associated with a child's parent and teacher ratings concordant for high CMRS total scores.

RESULTS

Correlation between parent CMRS (CMRS-P) and teacher CMRS (CMRS-T) scores was r=0.27 (p<0.000). Correlation between the CMRS-P and the Child Behavior Checklist "bipolar/dysregulation" phenotype was r=0.757 and between the CMRS-T and Teacher Report Form "bipolar/dysregulation" phenotype was r=0.786. A total of 66 (7.3%) of the 911 children were diagnosed with BP I (n=20) or II (n=3) or BP disorder not otherwise specified (BPNOS, n=43). If the CMRS-P score was ≥15, 14.7% (vs. 4.4%) had any BP (odds ratio: 3.6; 95% confidence interval: 2.1, 6.2). Teacher agreement or disagreement did not add to diagnostic accuracy for students with BP I or II. BPNOS was more common in children with concordant high CMRS-P and CMRS-T ratings (10.5% vs. 4.8%) but the difference was not statistically significant. However, logistic regression indicated 10-fold greater odds of both parents and teachers, providing high CMRS ratings among children who were diagnosed with externalizing disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, or any combination of these). Children with internalizing disorders (anxiety and depressive disorders) were 3.7 times more likely to have discordant CMRS-P/CMRS-T ratings.

CONCLUSION

Parent and teacher concordance on high mania rating scale scores was most associated with externalizing disorders, and discordance was most associated with internalizing disorders.