Diagnostic implications of informant disagreement about rage outbursts: bipolar disorder or another condition?

Abstract

Background: Modest agreement between parent- and teacher-reports of child behavior is a common finding. This study examines diagnoses made when significant disparity occurs in parent- and teacher-reports of rage behaviors.

Methods: Parents and teachers of 911 5-18 year-olds referred for psychiatric outpatient services completed rating scales and received a psychiatric evaluation blind to parent- and teacher-ratings. Children with rage outbursts (n=431, 47.2%) were assessed for diagnosis, family history, and clinical variables.

Results: Children were 12.0 (3.6) years; 26.5% were female. Bipolar disorder was rare (11.2%) in this sample; however, in children with parent- and teacher-reported rages, severe mood dysregulation was the most common condition (54.4%). In parent only reported rages, anxiety disorders were most common (40.6%) diagnoses, and in teacher only reported rages, learning/language disorders were the most common (46.0%) diagnoses.

Conclusion: The context in which a rage outburst occurs may impact the diagnosis; however, diagnosis alone does not explain this difficult and impairing behavior.