Diagnostic Screening Instruments
Early Identification of Bipolar Disorder in Children
The goal of JBRF is to meet the need for the early identification of bipolar disorder in children. Pediatricians and nurse practitioners are often the first clinicians that parents turn to for help with the early symptoms of bipolar disorder, a condition that is commonly confused with other childhood disorders. The average time between initial symptoms of bipolar disorder and appropriate diagnosis and treatment is estimated at 8-10 years. Treatment with stimulant or anti-depressant medication due to misdiagnosis can worsen the condition.
Objective: To develop a rapid, low-cost screening tool to identify children who may have bipolar disorder.
Accomplished: JBRF funded the development of the Child Bipolar Questionnaire (CBQ). This screening instrument is able to identify those children who are at risk for bipolar disorder. The foundation of this screening instrument is the data collected through the JBRF web-based data acquisition program. Analysis of many thousands of symptom-profiles of children at risk for, or with a diagnosis of bipolar disorder resulted in a screening instrument with a high degree of accuracy to predict various phenotypes of bipolar disorder as well as ADHD. It is inexpensive, requires 15-20 minutes to complete, and does not require a clinician to administer it.
Objective: To develop a screening instrument that would make possible the direct reporting of symptoms by a young child. Experts agree that it is insufficient to interview only the parents to find out the true symptom picture of children with mental disorders. Parents often do not know how depressed a child may feel or be aware that a child is feeling suicidal or having psychotic symptoms.
Accomplished: The Jeannie/Jeffrey Illustrated Interview for Children (J/J) is the pediatric companion instrument to the CBQ. Its comic-strip style illustrations engage the child’s interest while diminishing the threat of self-disclosure. This format promotes the child’s willingness and ability to reveal mood states, fears, suicidal thoughts and/or hallucinations that he or she may be unwilling to talk about with the parent and clinician.
Studies into the Etiology and Expression of Bipolar Disorder in Children
The goal of JBRF is to meet the need for research into the genetic causes of bipolar disorder. Understanding the biological basis of the disorder will lead to better methods of prevention and treatment. Genetic studies conducted with children who have bipolar disorder enhance the chances of finding a genetic cause, because the first-degree relatives of these children – parents and siblings – are more likely to have the disorder.
- Through JBRF’s highly effective recruitment and data acquisition program, over 600 families with more than one bipolar sibling have qualified to participate in a genetic linkage study of bipolar disorder.
- Some of these families have three or more children who have been diagnosed with the disorder.
- DNA has been extracted and archived on 740 individuals (affected children and their family members) representing 255 families.
- Due to the controversy which surrounds the classification of bipolar disorder in children and the newly defined research priorities of the National Institute of Mental Health, public funding of this type of study will not be forthcoming. This shifts the financial burden to the shoulders of concerned individuals and families.
Objective: To continue the lab work required for this study.
The goal of JBRF is to provide objective ways to distinguish ADHD from bipolar disorder in children with overlapping symptoms. There are currently no systematic guidelines for differentiating these two conditions, leading to frequent misdiagnosis and inappropriate treatment, which can worsen the condition in bipolar children. JBRF has funded the neuropsychological testing of 33 bipolar children and 22 children with ADHD-only. A comparison of the data from the two groups revealed specific differences in neuropsychological profile.
Objective: To identify neuropsychological differences between bipolar disorder and ADHD.
Accomplished: JBRF funded a study that compared neuropsychological profiles and severity of impairment data between children with bipolar disorder, children with bipolar disorder and ADHD, and children with ADHD and no bipolar disorder. Measurable neuropsychological differences were identified between the groups. Children with bipolar disorder were more severely impaired than children with ADHD and children who had both conditions were found to be most impaired. The findings of this study can be found in the following published article: Neuropsychological factors differentiating treated children with pediatric bipolar disorder from those with attention-deficit:hyperactivity disorder.
Objective: To compare the brain structure differences between children who have bipolar disorder, children who have ADHD and children with no disorder.
Accomplishment to date: MRI imaging on 12 children with bipolar disorder shows a consistent abnormality in the amygdala of all 12 children. This abnormality may be related to the cognitive and emotional deficits revealed by neuropsychological testing to be unique to the bipolar condition.
The Transfer of Research Findings to the Professional Clinical Community
The goal of JBRF is to meet the urgent need for dissemination of research knowledge about bipolar disorder in children to the gatekeepers of mental health services to facilitate early recognition and appropriate treatment. In a recent study of 391 consecutive admissions to a psychiatric inpatient unit for children and adolescents, nearly 20% were diagnosed with bipolar disorder.
- Through its website, the Juvenile Bipolar Research Foundation (JBRF) has reached thousands of parents whose children (N=5384) have been diagnosed with bipolar disorder (69.9%) or have exhibited associated symptoms.
- These parents, concerned about their children’s futures, have contributed enormous amounts of information about their children’s symptoms by completing several online surveys.
Objective: To develop a training program including a diagnostic manual and a novel interactive web-based training course for clinicians.
Objective: To utilize the training program and diagnostic assessment protocol to assist a community based clinic in a mixed ethnic and racial community to make early indentification of a condition that has a high morbidity and mortality (15% suicide rate).
Objective: To develop a program evaluation format to determine the effectiveness of this strategy in community based clinics.