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Decreasing Rates of Pediatric Bipolar Within an Outpatient Practice.
1Daniel Wesemann, DNP, PMHNP-BC, APRN, is Project Leader, 2917, 28th Ave. A Moline, Illinois.
Summary
Pediatric bipolar disorder (PBD) diagnosis rates decreased in Iowa despite national increases. This study found provider diagnoses of PBD did not align with screening tool results, highlighting a need for better diagnostic criteria.
Area of Science:
- Child and Adolescent Psychiatry
- Mental Health Diagnostics
- Behavioral Science
Background:
- Pediatric bipolar disorder (PBD) prevalence is estimated at 1-3%, with national rates increasing over 400%.
- Contrasting national trends, a decrease in PBD diagnoses was observed in Iowa (33%) and a specific clinic (51.2%) between 2008-2013.
- This discrepancy prompted an examination of diagnostic practices for PBD in an outpatient mental health setting.
Purpose of the Study:
- To investigate the diagnostic practices of pediatric bipolar disorder (PBD) by local providers.
- To compare provider clinical diagnoses with results from standardized screening tools for PBD and ADHD.
- To assess the agreement between screening measures and clinical judgment in diagnosing PBD.
Main Methods:
- Parents completed screening packets including the Child Mania Rating Scale (CMRS), Child Behavior Checklist-Mania Scale (CBCL-MS), and NICHQ Vanderbilt to differentiate PBD from ADHD.
- Symptom agreement analysis was conducted between the screening tools and the provider's clinical diagnoses.
- Statistical analysis, including ANOVA and Tukey HSD posthoc tests, was used to compare screening results and clinical diagnoses.
Main Results:
- Screening tools indicated PBD symptoms in 19.6% (CMRS) and 55.9% (CBCL-MS) of participants; 36.60% screened positive for ADHD (Vanderbilt).
- No significant diagnostic agreement was found between screening data and provider clinical diagnoses for PBD (p < .05).
- Providers' PBD diagnosis rates did not correlate with the prevalence of PBD symptoms identified by the screening instruments.
Conclusions:
- Current screening measures for PBD show low agreement with clinical diagnoses in this outpatient setting.
- Further research is required to refine diagnostic criteria and validate screening tools for distinguishing PBD from related disorders like ADHD.
- Evidence is needed to guide clinical practice in accurately diagnosing PBD in children and adolescents.
Keywords:
ADHDChild Behavior Checklist and the NICHQ VanderbiltChild Mania Rating Scalepediatric bipolar disorderpublic healthscreeningMore Related Videos
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