The Diagnostic and Statistical Manual presents criteria for mental disorders in a checklist format. In this classification system, a symptom is considered present or absent depending upon whether it meets the established criteria.

In contrast, the phenotypes defined by the JBRF Research Consortium (the Core phenotype and the FOH phenotype) are described by dimensions of behavior that exist on a continuum.

While the dimensional approach is consistent with emerging perspectives of mental disorders, it is as yet an unfamiliar way for professionals and families to evaluate the presence of a condition. Therefore, investigators have adapted the dimensional description of the Core phenotype into the following checklist format.

The Child Bipolar Disorder Questionnaire (CBQ) numbers in parentheses following criteria indicate the items of the CBQ which are keyed to those criteria.

Must meet Criteria A-D for diagnosis

A. Episodic and abrupt transitions in primary mood states accompanied by rapid alternations in levels of arousal, emotional excitability, sensory sensitivity, and motor activity

Primary mood states are: manic/hypomanic, depressed and mixed.

Manic/hypomanic or mixed episode is required for diagnosis.

Episodes are defined by DSM-IV symptom criteria but not by DSM-IV duration criteria.

Manic or hypomanic episodes are associated with:

elated/euphoric (silly-goofy-giddy), and/or

angry/irritable mood states, and

3 or more of the following symptoms and behaviors (4 or more if irritable mood only):

  • more talkative than usual, pressured speech
  • flight of ideas
  • subjective experience of thoughts racing
  • distractibility
  • diminished need for sleep
  • increase in goal directed activity
  • heightened interest, enjoyment, and enthusiasm for usual activities
  • excessive involvement in pleasurable activities that have a high potential for painful consequences
  • overestimation of resources and capacities
  • over-valuation of self and others
  • more argumentative than usual
  • overbearing, bossy, in pursuit of personal needs or agenda

CBQ (11, 12, 25, 26, 28, 29, 30, 36)

Depressive episodes are associated with:

dysphoric/sad/irritable and/or

anxious/fearful mood states

(The above are accompanied with loss of interest and pleasure in previously enjoyed activities often resulting in expressions of boredom and excessive stimulus seeking behaviors.)

4 or more of the following symptoms and behaviors:

  • decreased sense of self-esteem
  • slowed speech
  • paucity of thought
  • increased need for sleep or disrupted sleep
  • loss or increase in appetite
  • decrease or loss of energy
  • difficulty sustaining attention
  • diminished ability to concentrate or indecisiveness
  • psychomotor retardation
  • loss of initiative and motivation
  • under-estimation of resources and capacities
  • devaluation of self and others
  • negative interpretation of events and misattribution of other’s behaviors
  • recurrent thoughts of death, recurrent suicidal ideation

CBQ (37-42, 60)

Mixed episodes are associated with:

overlapping features of the primary mood states (euphoric, anger, dysphoric, anxious) accompanied by other associated symptoms of manic/hypomanic and depressive mood states

Presentation may include:

  • irritability
  • agitation
  • insomnia
  • appetite dysregulation
  • poor control over aggressive impulses

Course modifiers may be aggression directed against self or others (e.g. suicidal thinking or attempts, aggressive displays, rages) or psychotic features.

Mixed episodes may be due to the direct effect of exposure to antidepressants, stimulant medication, electroconvulsive or light therapy, or other medical treatments (e.g. corticosteroids, sympathomimetic agents)

CBQ (11, 12, 25, 26, 28, 29, 30, 36, 37-42, 60)

B. Poor modulation of drives (aggressive, sexual, appetitive, acquisitive) resulting in behaviors that are excessive for age and/or context

This regulatory disturbance is associated with:

  • excessive aggressive/fight-based behaviors (critical, sarcastic, demanding, oppositional, overbearing “bossy”, easily enraged, prone to violent outbursts), and/or self-directed aggression (head-banging, skin-picking, cutting, suicide)
  • premature and intense sexual feelings and behaviors (precocious curiosity about sex and premature expression of sexual impulses, as well as inappropriate public displays)
  • appetite dysregulation (excessive craving for carbohydrates and sweets, binge eating, purging, and anorexia)
  • poor control over acquisitive impulses (relentless pursuit of needs, buying excessively and hoarding)

CBQ (10, 34, 35, 46-49, 51, 53, 55-60, 63)


Episodic and abrupt transitions in mood states (A) and poor modulation of drive (B) are currently present most days and have been present for at least the past 12 months without any symptom free periods exceeding 2 months in duration, and cause functional impairment in 1 or more settings (e.g., significant behavioral problems at home but not necessarily in the school setting).


C. Four (or more) of the following disturbances have been present during the same 12-month period:

1. Excessive anger and oppositional/aggressive responses to situations that elicit frustration.

Compared to his/her peers, the child exhibits difficulties in the postponement of immediate gratification when parents set limits. In particular, when answered “no” to expressed wishes, when having to wait his/her turn, or when there are changes in planned activities or routines.

This deficit results in maladaptive responses, such as seeming not to listen (purposeful), the display of disruptive, intrusive, and overbearing behaviors, or, in the extreme, temper tantrums and aggressive attacks, often followed by sullen withdrawal and expressions of remorse. CBQ (18, 27, 51)

2. Poor self-esteem regulation.

At times is overly-optimistic, defiant arrogant, filled with bravado, and prone to self-aggrandizement, exaggeration of abilities, and has feelings of omnipotence, or, alternatively, is overly-pessimistic, self-critical, and overly sensitive to criticism or rejection, often responding to criticism with intense feelings of humiliation and shame. The child often expresses feelings of insecurity, worthlessness, and is capable of rapid and intense idealization and/or devaluation of self and others.

CBQ (29, 30, 40-42)

3. Sleep/wake cycle disturbances; at least one of the following:

  • Sleep discontinuity (initial insomnia, middle insomnia, early morning awakening, hypersomnia)
  • Sleep arousal disorders (sleep inertia, nightterrors and nightmares – often containing images of gore and mutilation, and themes of pursuit, bodily threat and parental abandonment, sleep-walking, confusional arousals, bruxism and enuresis)
  • Sleep/wake reversals (a tendency toward periodic lengthening or shortening of sleep duration, often dependent on circadian and circannual changes in light/dark and temperature cycles, as well as, the availability of regular social zeitgebers)

CBQ (3, 5-9)

4. Low threshold for anxiety.

A tendency to react with excessive anxiety and fearfulness in response to:

  • novel or stressful situations
  • transitions of context, loss, separation
  • the anticipation of loss/separation from attachment objects
  • loss of social status

Anxiety often arises from fear of harm to self or, alternatively, from the fear that he/she will harm others or self, and expresses itself in the form of anger, rejection, criticism, ostracism.

This deficit can predispose to behavioral inhibition, or flight-based behaviors such as separation anxiety disorder, social phobias, and other anxiety disorders including panic-disorder, obsessive compulsive disorder and posttraumatic stress syndrome.

CBQ (1, 2, 64)

5. Disturbance in the capacity to habituate to sensory stimuli often when exposed to novel, repetitive or monotonous sensory stimulation.

A tendency to over-react to environmental stimuli and to become over-aroused, easily excited, irritated, angry, anxious or fearful when exposed to novel sensory experiences, e.g., crowds, loud or unexpected sounds, (e.g., vacuum cleaners, ticking clocks, thunder and lightening), and dissonant sensations (e.g., shirt tags, fit of clothes or shoes, perceived foul odors). CBQ (21-24)

6. Executive Function Deficits; one or more of the following:

Mental Inflexibility:

  • Difficulty shifting cognitive set, planning ahead, planning strategically as seen in unrealistic estimates of energy resources and time requirements for the accomplishment of tasks (e.g. difficulty adjusting to changes in plans for the day such as planned trips and changes in venue),
  • has difficulty giving up an idea or desire, no matter how unrealistic or unfeasible,
  • has difficulty starting and completing school assignments without a great deal of prompting,
  • often gets caught up on small details of an assignment and misses the larger picture.
  • This executive dysfunction is often associated with working memory deficits, problems making transitions from one context to another, poor organizational skills, distractibility, excessive daydreaming, and performance deficits in school, particularly in the organization of thought for written expression.

CBQ (17-20)

Emotional Inflexibility:

  • impulsive, acts before thinking
  • over-reacts to small events
  • rapidly shifts emotional state
  • can demonstrate sudden anger, resentment, and/or rage for greater than 15 minutes that is unresponsive to reason discussion or soothing
  • can become progressively unrestrained or silly
  • does not appear to gain pleasure from mastering a skill

CBQ (1, 24, 27, 31, 36, 53)

Inflexibility of Motor Activity:

  • initiation of movement directed at the accomplishment of motor tasks is effortful (e.g., has difficulty starting activities in the morning, and requires help in initiating any activity),
  • is often restless and fidgety
  • has trouble initiating and completing written assignments
  • handwriting is poor

CBQ (3, 16, 39, 43)

7. A family history of recurrent mood disorder and/or alcoholism, as well as other bipolar spectrum disorders.

A history of bilineal familial transmission is commonly observed.

D. Symptoms are not due to a general medical condition (e.g. hypothyroidism).

  1. Pingback: pickleball
  2. Pingback: rocky mount
  3. Pingback: interserver coupon
  4. Pingback: Read More
  5. Pingback: read more
  6. Pingback: useful reference
  7. Pingback: my company
  8. Pingback: a fantastic read
  9. Pingback: original site
  10. Pingback: look at this site
  11. Pingback: additional hints
  12. Pingback: More Bonuses
  13. Pingback: Continued
  14. Pingback: Discover More
  15. Pingback: click resources
  16. Pingback: content
  17. Pingback: see post
  18. Pingback: look here
  19. Pingback: read more
  20. Pingback: best info
  21. Pingback: new website
  22. Pingback: news
  23. Pingback: how to
  24. Pingback: about
  25. Pingback: useful reference
  26. Pingback: imp source
  27. Pingback: a fantastic read
  28. Pingback: their explanation
  29. Pingback: Visit Website
  30. Pingback: her latest blog
  31. Pingback: More Bonuses
  32. Pingback: check that
  33. Pingback: you could try here
  34. Pingback: Learn More
  35. Pingback: Get the facts
  36. Pingback: official statement
  37. Pingback: important source
  38. Pingback: click here
  39. Pingback: read more
  40. Pingback: click here
  41. Pingback: click here
  42. Pingback: click here
  43. Pingback: read more
  44. Pingback: read more
  45. Pingback: read more
  46. Pingback: read more
  47. Pingback: click here
  48. Pingback: read more
  49. Pingback: more news
  50. Pingback: official site
  51. Pingback: her latest blog
  52. Pingback: Clicking Here
  53. Pingback: More hints
  54. Pingback: best value
  55. Pingback: new source
  56. Pingback: best news
  57. Pingback: learn now
  58. Pingback: click here
  59. Pingback: read more
  60. Pingback: important
  61. Pingback: find
  62. Pingback: continue reading
  63. Pingback: what to do
  64. Pingback: insight
  65. Pingback: quality article
  66. Pingback: quality article
  67. Pingback: Sperry's for women
  68. Pingback: useful reference
  69. Pingback: their explanation
  70. Pingback: Homepage
  71. Pingback: a fantastic read
  72. Pingback: find this
  73. Pingback: browse this site
  74. Pingback: my response
  75. Pingback: More hints
  76. Pingback: Get the facts
  77. Pingback: official statement
  78. Pingback: try this web-site
  79. Pingback: midogen vitamin
  80. Pingback: read more
  81. Pingback: check my blog
  82. Pingback: click site
  83. Pingback: my review here
  84. Pingback: useful reference
  85. Pingback: Get More Info
  86. Pingback: this website
  87. Pingback: great post to read
  88. Pingback: my company
  89. Pingback: imp source
  90. Pingback: click to read more
  91. Pingback: find more info
  92. Pingback: see it here
  93. Pingback: Homepage
  94. Pingback: a fantastic read
  95. Pingback: this content
  96. Pingback: Bonuses
  97. Pingback: read this article
  98. Pingback: check here
  99. Pingback: original site
  100. Pingback: news
  101. Pingback: Important
  102. Pingback: Read More
  103. Pingback: Read More
  104. Pingback: click here
  105. Pingback: read more
  106. Pingback: read more
  107. Pingback: read more
  108. Pingback: what is new
  109. Pingback: what is new
  110. Pingback: best info
  111. Pingback: what is it
  112. Pingback: nucific bio x4
  113. Pingback: acne
  114. Pingback: more info
  115. Pingback: click here
  116. Pingback: read article
  117. Pingback: website
  118. Pingback: source
  119. Pingback: important
  120. Pingback: news
  121. Pingback: url
  122. Pingback: niagen
  123. Pingback: hosting24 coupon
  124. Pingback: metal awnings
  125. Pingback: read more
  126. Pingback: click here
  127. Pingback: find now
  128. Pingback: news
  129. Pingback: important
  130. Pingback: new article
  131. Pingback: best information
  132. Pingback: exceptional
  133. Pingback: see this here
  134. Pingback: Visit Website
  135. Pingback: what is new
  136. Pingback: keep reading
  137. Pingback: more about this
  138. Pingback: hosting24 coupon
  139. Pingback: hosting24 coupon
  140. Pingback: check my site
  141. Pingback: More Bonuses
  142. Pingback: click resources
  143. Pingback: Get the facts
  144. Pingback: click reference
  145. Pingback: you can look here
  146. Pingback: her explanation
  147. Pingback: why not try here
  148. Pingback: informative post
  149. Pingback: probiotic america
  150. Pingback: read more
  151. Pingback: best information
  152. Pingback: probiotic america
  153. Pingback: click here
  154. Pingback: read more
  155. Pingback: info
  156. Pingback: news
  157. Pingback: link
  158. Pingback: best source
  159. Pingback: ebook
  160. Pingback: post
  161. Pingback: click reference
  162. Pingback: visit site
  163. Pingback: look here
  164. Pingback: Going Here
  165. Pingback: a knockout post
  166. Pingback: look at here now
  167. Pingback: important link
  168. Pingback: Extra resources
  169. Pingback: Niagen
  170. Pingback: read more
  171. Pingback: website
  172. Pingback: webpage
  173. Pingback: visit them
  174. Pingback: important
  175. Pingback: news
  176. Pingback: best info
  177. Pingback: read more
  178. Pingback: information
  179. Pingback: website
  180. Pingback: webpage
  181. Pingback: news
  182. Pingback: best source
  183. Pingback: best source
  184. Pingback: click here
  185. Pingback: Source
  186. Pingback: have a peek here
  187. Pingback: Check This Out
  188. Pingback: navigate here
  189. Pingback: weblink
  190. Pingback: check over here
  191. Pingback: this content
  192. Pingback: click here
  193. Pingback: Source
  194. Pingback: have a peek here
  195. Pingback: Check This Out
  196. Pingback: this contact form
  197. Pingback: navigate here
  198. Pingback: this content
  199. Pingback: check my blog
  200. Pingback: his explanation
  201. Pingback: official site
  202. Pingback: visit
  203. Pingback: check it out
  204. Pingback: see this
  205. Pingback: directory
  206. Pingback: see this here
  207. Pingback: see this here
  208. Pingback: feres
  209. Pingback: feres inşaat
  210. Pingback: feres gayrimenkul
  211. Pingback: feres
  212. Pingback: feres
  213. Pingback: additional hints
  214. Pingback: Bonuses
  215. Pingback: a fantastic read
  216. Pingback: find more info
  217. Pingback: find more info
  218. Pingback: great post to read
  219. Pingback: my company
  220. Pingback: useful reference
  221. Pingback: my review here
  222. Pingback: click site
  223. Pingback: check my blog
  224. Pingback: this content
  225. Pingback: click here
  226. Pingback: midogen reviews
  227. Pingback: read more
  228. Pingback: click here
  229. Pingback: click here
  230. Pingback: niagen review
  231. Pingback: click here
  232. Pingback: click here
  233. Pingback: click here
  234. Pingback: click here
  235. Pingback: check my source
  236. Pingback: Source
  237. Pingback: additional reading
  238. Pingback: great post to read
  239. Pingback: advice
  240. Pingback: more information
  241. Pingback: go now
  242. Pingback: Related Site
  243. Pingback: useful link
  244. Pingback: useful link
  245. Pingback: pop over here
  246. Pingback: Full Article
  247. Pingback: read more
  248. Pingback: click here
  249. Pingback: pop over here
  250. Pingback: Full Article
  251. Pingback: read more
  252. Pingback: pop over here
  253. Pingback: Full Article
  254. Pingback: read more
  255. Pingback: read more
  256. Pingback: click here
  257. Pingback: Full Article
  258. Pingback: read more
  259. Pingback: click here
  260. Pingback: pop over here
  261. Pingback: Full Article
  262. Pingback: Full Article
  263. Pingback: read more
  264. Pingback: click here
  265. Pingback: more info here
  266. Pingback: click site
  267. Pingback: news
  268. Pingback: this content
  269. Pingback: click here
  270. Pingback: check over here
  271. Pingback: my company
  272. Pingback: imp source
  273. Pingback: this page
  274. Pingback: Get More Info
  275. Pingback: Homepage
  276. Pingback: great post to read
  277. Pingback: useful reference
  278. Pingback: my review here
  279. Pingback: a fantastic read
  280. Pingback: official site
  281. Pingback: directory
  282. Pingback: his explanation
  283. Pingback: browse this site
  284. Pingback: dig this
  285. Pingback: read this article
  286. Pingback: original site
  287. Pingback: Bonuses
  288. Pingback: More hints
  289. Pingback: page
  290. Pingback: her latest blog
  291. Pingback: additional hints
  292. Pingback: More Bonuses
  293. Pingback: Continued
  294. Pingback: check over here
  295. Pingback: bio x4 coupon code
  296. Pingback: this content
  297. Pingback: weblink
  298. Pingback: navigate here
  299. Pingback: navigate here
  300. Pingback: this contact form
  301. Pingback: have a peek here
  302. Pingback: Source
  303. Pingback: check my blog
  304. Pingback: great post to read
  305. Pingback: see here
  306. Pingback: useful reference
  307. Pingback: Get More Info
  308. Pingback: click site
  309. Pingback: click site
  310. Pingback: news
  311. Pingback: my company

Comments are closed.