Impact of Irritability and Impulsive Aggressive Behavior on Impairment and Social Functioning in Youth with Cyclothymic Disorder

Objective: Research on adults with cyclothymic disorder (CycD) suggests that irritability and impulsive aggression (IA) are highly prevalent among this population. Less is known about whether these behaviors might also distinguish youth with CycD from youth without CycD. Additionally, little is known about how irritability and IA relate to one another, and whether they are associated with different outcomes. This study aimed to compare irritability and IA across diagnostic subtypes to determine whether CycD is uniquely associated with these behaviors, and to assess how irritability and IA relate to youth social and general functioning

Comparing the Diagnostic Accuracy of Five Instruments for Detecting Posttraumatic Stress Disorder in Youth

To compare diagnostic accuracy of five posttraumatic stress disorder (PTSD) measures in a large outpatient sample of youths aged 11 to 18 years

The Effects of Including a Callous Unemotional Specifier for the Diagnosis of Conduct Disorder

“With Significant Callous-Unemotional Traits” has been proposed as a specifier for Conduct Disorder (CD) in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The impact of this specifier on children diagnosed with CD should be considered

Examining the validity of cyclothymic disorder in a youth sample: Replication and extension

Four subtypes of bipolar disorder (BP) – bipolar I, bipolar II, cyclothymia and bipolar not otherwise specified (NOS) – are defined in DSM-IV-TR. Though the diagnostic criteria for each subtype are intended for both adults and children, research investigators and clinicians often stray from the DSM when diagnosing pediatric bipolar disorder (PBD) (Youngstrom, 2009), resulting in a lack of agreement and understanding regarding the PBD subtypes

Generalizability of evidence-based assessment recommendations for pediatric bipolar disorder.

Bipolar disorder is frequently clinically diagnosed in youths who do not actually satisfy DSM-IV criteria, yet cases that would satisfy full DSM-IV criteria are often undetected clinically. Evidence-based assessment methods that incorporate Bayesian reasoning have demonstrated improved diagnostic accuracy, and consistency; however, their clinical utility is largely unexplored. The present study examines the effectiveness of promising evidence-based decision-making compared to the clinical gold standard. Participants were 562 youth, ages 5-17 and predominantly African American, drawn from a community mental health clinic. Research diagnoses combined semi-structured interview with youths’ psychiatric, developmental, and family mental health histories. Independent Bayesian estimates relied on published risk estimates from other samples discriminated bipolar diagnoses, Area Under Curve=.75, prs =.30. Agreement about an evidence-based assessment intervention “threshold model” (wait/assess/treat) had K=.24, pr=.81,

Is Caregiver-Adolescent Disagreement Due to Differences in Thresholds for Reporting Manic Symptoms?

Cross-informant disagreement is common and results in different interpretations of a youth's behavior. Theoretical explanations for discrepancies typically rely on scale level analyses. This article explores whether caregivers and adolescents differ in when they notice and report symptoms of youth mania depending on the severity of overall manic disturbance

Reward Dysregulation and Mood Symptoms in an Adolescent Outpatient Sample

Research on bipolar spectrum disorders (BPSD) in adolescence has burgeoned in the last decade, but continued work is needed to identify endophenotypic markers associated with illness onset and course. The present study examined reward dysregulation – measured via the behavioral activation system (BAS) – as one putative marker of BPSD in adolescence. A diverse group of 425 outpatient adolescents between 11–17 years of age (52% male) completed the Behavioral Inhibition and Activation Scale (BIS-BAS) scale to measure reward dysregulation. Semi-structured interviews determined diagnoses and severity of mood symptoms. Parent-reported BAS was associated with increased symptoms of mania, and parent and adolescent-reported BAS were associated with symptoms of depression. Parent-reported BIS scores were associated with increased symptoms of mania. Results held independent of diagnostic status. Furthermore, parent BIS/BAS reports were stronger predictors for manic symptoms compared to adolescent-reports. Results extend work in adults with BPSD, suggesting a transdiagnostic association between reward dysregulation and mood symptom severity in adolescence

Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Diagnoses play an important role in treatment planning and monitoring, but extensive research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews. However, most prior studies of agreement have not used research diagnoses based on gold standard methods, and research needs to identify characteristics of diagnostically challenging clients. This study examined agreement between youth diagnoses generated through the research-based LEAD (Longitudinal, Expert, and All Data) Standard to clinician diagnoses

Clinical Decision Making About Child and Adolescent Anxiety Disorders Using the Achenbach System of Empirically Based Assessment

Anxiety disorders are common among children, but can be difficult to diagnose. An actuarial approach to the diagnosis of anxiety may improve the efficiency and accuracy of the process. The objectives of this study were to determine the clinical utility of the Achenbach CBCL and YSR, two widely used assessment tools, for diagnosing anxiety disorders in youth, and to aid clinicians in incorporating scale scores into an actuarial approach to diagnosis through a clinical vignette

Portability of a screener for pediatric bipolar disorder to a diverse setting.

Robust screening measures that perform well in different populations could help improve the accuracy of diagnosis of pediatric bipolar disorder. Changes in sampling could influence the performance of items and potentially influence total scores enough to alter the predictive utility of scores. Additionally, creating a brief version of a measure by extracting items from a longer scale might cause differential functioning due to context effects. The current study examines both sampling and context effects of a brief measure of pediatric mania. Caregivers of 813 youths completed the parent-report General Behavior Inventory (PGBI) at an academic medical center enriched for mood disorders. Caregivers of 481 youth completed the PGBI at a community mental health center. Caregivers of 799 youth completed 10 items extracted from the PGBI at a community setting. Caregivers of 159 youth completed both versions of the PGBI and a semi-structured diagnostic interview. Differential item functioning indicated that across samples some items functioned differently; however, total observed scores were similar across all levels of mania. Receiver Operating Characteristic analysis indicated that the ten extracted items discriminated bipolar from non-bipolar as well as when the items were embedded within the full measure. Findings suggest that the extracted items perform similarly to the embedded items in the community setting. Measurement properties appear sufficiently robust across settings to support clinical applications