Yule Amy, Fitzgerald Maura, Wilens Timothy, Wozniak Janet, Woodworth K Yvonne, Pulli Alexa, Uchida Mai, Faraone Stephen V, Biederman Joseph
Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, MA.
Department of Psychiatry, Harvard Medical School, Boston, MA.
Scand J Child Adolesc Psychiatr Psychol. 2019;7(1):29-36. doi: 10.21307/sjcapp-2019-006. Epub 2019 Jun 6.
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).
To assess the diagnostic utility of the Child Behavior Checklist (CBCL)-Bipolar (BP) profile to identify children with a diagnosis of BP-I disorder.
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.
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.
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.
儿童双相情感障碍是一种常见且病态严重的疾病。虽然已经开发出结构化诊断访谈来辅助儿童双相情感障碍的诊断，但这些工具耗时、成本高且未广泛应用。一种可能的诊断辅助工具是儿童行为清单（CBCL）。
评估儿童行为清单（CBCL）-双相情感障碍（BP）量表对识别诊断为双相情感障碍I型（BP-I）的儿童的诊断效用。
研究对象来自四个独立的数据集，这些数据集包含患有和未患有注意力缺陷多动障碍（ADHD）及双相情感障碍I型的儿童和青少年。研究对象从儿科和精神科诊所及社区招募。所有研究对象均接受了结构化临床访谈，评估者对研究对象的确诊状态不知情。我们使用从CBCL中根据经验得出的量表，该量表由注意力、焦虑/抑郁和攻击性子量表的总T分数组成（CBCL-BP量表）来确定双相情感症状的有无。采用受试者工作特征（ROC）曲线来检验CBCL-BP量表识别有和无结构化访谈诊断为双相情感障碍I型的儿童的能力。
样本包括661名研究对象（平均年龄：11.7±3.3岁，57%为男性，94%为白种人）。20%的参与者（N = 130）符合双相情感障碍I型完全诊断的结构化访谈标准。CBCL-BP量表的ROC分析得出曲线下面积为0.91。CBCL-BP量表的T分数≥195时，正确分类了86%的双相情感障碍I型研究对象，敏感性为80%，特异性为87%，阳性预测值为61%，阴性预测值为95%。
CBCL-BP量表能有效区分有和无结构化访谈诊断为双相情感障碍I型的儿科研究对象。研究结果表明，CBCL-BP量表可能是一种有效的工具，有助于识别极有可能患有双相情感障碍I型的儿童。
