Diagnostic profiles and clinical characteristics of youth referred to a pediatric mood disorders clinic

Abstract

Objectives: This study examined the diagnostic profiles and clinical characteristics of youth (ages 6-18 years) referred for diagnostic evaluation to a pediatric mood disorders clinic that specializes in early-onset bipolar disorder.

Method: A total of 250 youth were prescreened in an initial telephone intake, and 73 participated in a full diagnostic evaluation. Trained psychologists administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADSPL) to the child and to at least one parent, and a child psychiatrist conducted a separate pharmacological evaluation. Evaluators then met with a larger clinical team for a consensus diagnosticconference.

Results: Based on consensus diagnoses, 13 of the 73 referred youth (18%) met lifetime DSM-IV-TR criteria for a bipolar spectrum disorder (BSD; bipolar I, II or not otherwise specified disorder, or cyclothymic disorder). Of these 73, 27 (37%) were referred with a community diagnosis of a bipolar spectrum disorder, but only 7 of these 27 (26%) met DSM-IV-TR criteria for a bipolar spectrum diagnosis based on a structured interview and consensus diagnoses. The most common Axis I diagnoses (based on structured interview/consensus) were attentiondeficit/hyperactivity disorder (31/73, 42.5%) and major depressive disorder (23/73, 32%).

Conclusions: When youth referred for evaluation of BSD are diagnosed using standardized interviews with multiple reporters and consensus conferences, the "true positive" rate for bipolar spectrum diagnoses is relatively low. Reasons for the discrepancy between community and research-based diagnoses of pediatric BSD- including the tendency to stretch the BSD criteria to include children with depressive episodes and only 1-2 manic symptoms-are discussed.

Figure 1

Diagnostic Frequencies by Age: Children (6–12 yrs.) compared to Adolescents (13–19 yrs)