Elsevier

Biological Psychiatry

Volume 58, Issue 7, 1 October 2005, Pages 569-575
Biological Psychiatry

Advances in the neurobiology of pediatric bipolar disorder
Bipolar Diagnoses in Community Mental Health: Achenbach Child Behavior Checklist Profiles and Patterns of Comorbidity

https://doi.org/10.1016/j.biopsych.2005.04.004Get rights and content

Background

There are converging findings about pediatric bipolar disorder (PBD) in terms of associated comorbidity and behavior problem profiles on the Achenbach Child Behavior Checklist (CBCL). However, no study has examined clinical or demographic characteristics of youths clinically diagnosed with bipolar disorder in a low-income, diverse community clinical sample.

Methods

Archival data (N = 3086 cases) from six urban community mental health centers (CMHC) were reviewed to determine the base rate of bipolar disorder and the demographic and clinical characteristics (comorbidity and CBCL profiles) associated with the diagnosis.

Results

Roughly 6% of the sample received clinical diagnoses of PBD. Patterns of comorbidity and CBCL profiles were highly similar to published samples. However, elevated CBCL scores were not specific to bipolar disorder, since they were also frequently high for nonbipolar cases.

Conclusions

There appears to be substantial convergence between the demographic and clinical characteristics of cases clinically diagnosed with PBD versus those diagnosed with semistructured research interviews, strengthening the validity of both sets of diagnoses. At the same time, the CBCL appears to do poorly discriminating clinical diagnoses of PBD, due to the pervasive externalizing behavior problems in CMHC samples and the variable presentation of PBD cases.

Section snippets

Design

The study involved secondary analysis of archival data. Specifically, behavior checklists and clinical diagnoses that were completed as a routine clinical procedure were anonymized and exported for statistical analysis. The protocol was reviewed and approved by the university and clinical agency Institutional Review Boards of Case Western Reserve University, as well as of Applewood Centers, Inc.

Participants

Participants were 3086 youths and their primary caregiver who presented for mental health services at

Demographics

More than 80% of the participants qualified for Medicaid, and 81% of the primary caregivers had completed less education than a high school diploma or equivalent. Patients were 63% male, 42% African American, 52% European American, and 6 % self-identified as “Other.” Ten percent of the sample self-identified as Hispanic ethnicity (n = 311), of whom 18 self-identified as African American, 113 as European American, and 100 as “Other.” The average patient was 10.5 years old at intake (SD = 3.4).

Clinical Characteristics

Discussion

The goals of the present study were to determine how often bipolar disorder is clinically diagnosed in children and adolescents in a community mental health setting and also to evaluate the similarity of community cases of bipolar disorder to published research samples in terms of demographic patterns, comorbidity, and behavior problem correlates as measured by the Achenbach Child Behavior Checklist. The study also tested whether the CBCL scales could identify bipolar cases in the

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