The Child Behavior Checklist (CBCL) and the CBCL-bipolar phenotype are not useful in diagnosing pediatric bipolar disorder

Abstract

Objectives: Previous studies have suggested that the sum of Attention, Aggression, and Anxious/Depressed subscales of Child Behavior Checklist (CBCL-PBD; pediatric bipolar disorder phenotype) may be specific to pediatric bipolar disorder (BP). The purpose of this study was to evaluate the usefulness of the CBCL and CBCL-PBD to identify BP in children <12 years old.

Methods: A sample of children with BP I, II, and not otherwise specified (NOS) (n = 157) ascertained through the Course and Outcome for Bipolar Disorder in Youth (COBY) study were compared with a group of children with major depressive/anxiety disorders (MDD/ANX; n = 101), disruptive behavior disorder (DBD) (n = 127), and healthy control (HC) (n = 128). The CBCL T-scores and area under the curve (AUC) scores were calculated and compared among the above-noted groups.

Results: Forty one percent of BP children did not have significantly elevated CBCL-PBD scores (>or=2 standard deviations [SD]). The sensitivity and specificity of CBCL-PBD >or= 2 SD for diagnosis of BP was 57% and 70-77%, respectively, and the accuracy of CBCL-PBD for identifying a BP diagnosis was moderate (AUC = 0.72-0.78).

Conclusion: The CBCL and the CBCL-PBD showed that BP children have more severe psychopathology than HC and children with other psychopathology, but they were not useful as a proxy for Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV) diagnosis of BP.

Figures

FIG. 1.

Child Behavior Checklist–Pediatric Bipolar Disorder (CBCL-PBD) phenotype and area under the curve (AUC) scores for identifying bipolar diagnosis in all subjects and in subjects with psychopathology. All Subjects = BP + MDD/ANX + DBD + HC Groups, Subjects with Psychopathology = BP + MDD/ANX + DBD Groups. Abbreviations: ROC = Receiver operating characteristics; BP = bipolar disorder; MDD/ANX = major depressive/anxiety disorders; DBD = disruptive behavior disorders; HC = healthy controls.