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Decreasing Rates of Pediatric Bipolar Within an Outpatient Practice

Daniel Wesemann1

  • 1Daniel Wesemann, DNP, PMHNP-BC, APRN, is Project Leader, 2917, 28th Ave. A Moline, Illinois.

Journal of Child and Adolescent Psychiatric Nursing : Official Publication of the Association of Child and Adolescent Psychiatric Nurses, Inc
|January 18, 2017
PubMed

Insights

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.
Abstract

Keywords:
ADHDChild Behavior Checklist and the NICHQ VanderbiltChild Mania Rating Scalepediatric bipolar disorderpublic healthscreening

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