Child Mania Rating Scale: Development, Reliability, and Validity

doi:10.1097/01.chi.0000205700.40700.50

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 45, Issue 5, May 2006, Pages 550-560

https://doi.org/10.1097/01.chi.0000205700.40700.50 Get rights and content

ABSTRACT

Objective

To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IVsymptoms.

Method

A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 ± 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure.

Results

Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (.78-.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist -Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (.29-.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of.91 to.96).

Conclusion

The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania.

Section snippets

Subjects

The subjects for this study were 150 children (42.3% female) ages 10.3 ± 2.9 years. Thirty-one percent were 5 to 8 years old, 50% were between 9 and 12 years old, and 19% were 13 to 17 years old. The sample was evenly divided among healthy controls (HC), children diagnosed as having bipolar disorder, and children diagnosed as having ADHD. Subjects were included if they were between 5 and 17 years of age inclusive, had bipolar disorder I, II, or bipolar disorder-not otherwise specified (NOS);

Demographics and Comorbidity

Table 1 reports the demographic characteristics for the entire sample by diagnosis. There were no significant demographic differences among the three groups. Table 1 also reports the number of comorbid axis I diagnoses for the entire sample and for each diagnostic group. The bipolar disorder group had significantly more comorbid axis I diagnoses than either of the other groups (χ ² [1, N = 150] = 121.2, p <.001). The most frequent comorbid diagnoses for the HC group were elimination disorder

DISCUSSION

The CMRS-P is the first parent report measure developed specifically to assess child and adolescent mania. Internal consistency and retest reliability suggest that the CMRS-P is a reliable and valid instrument. However, because of the small sample, the retest reliability findings should be interpreted with caution. Logistic analysis of the ROC curves suggest that the CMRS-P differentiates bipolar disorder from ADHD and HC, with high sensitivity and specificity, but, consistent with its purpose,

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Citation Excerpt :
According to a meta-analysis, the CMRS-P is one of the top tier measures in terms of discriminative validity for pediatric BD (Youngstrom et al., 2015). Whilst mania-like symptoms can sometimes occur in other disorders, the CMRS-P has high specificity of 0.94 and sensitivity of 0.82 in screening for bipolar disorder in studies that also assessed for other disorders such as ADHD and depression (Pavuluri et al., 2006). Items are scored on a four-point scale: 0 (never/rarely), 1 (sometimes), 2 (often), and 3 (very often).
Adult psychiatric disorders are associated with both childhood traumatic experiences (CTEs) and neurodevelopmental disorders (NDDs). CTEs and NDDs frequently co-occur in childhood, but their combined risk effect on the emergence of juvenile mania symptoms has not yet been examined.
In a population-representative Swedish twin study, CTEs and NDDs were assessed in 3,348 nine-year old twins born between 1998 and 2001, and treated as dichotomous predictors (any CTEs, any NDDs). Follow-up data were gathered at age 15 through parental reports of mania symptoms, yielding a symptom count score.
Both CTEs and NDDs at age 9 contributed uniquely to an increase in mania symptoms at age 15. Children with both risk factors had 1.6 times the rate of mania symptoms as children with CTEs-only (Incidence rate ratio [IRR] 1.63, 95% CI 1.37-1.93), and 1.3 times the rate of mania symptoms as children with NDDs-only (IRR 1.26, 95% CI 1.06-1.50). There was no evidence for an interactive effect of CTEs and NDDs. NDDs showed a trend towards having a larger effect on mania symptoms than CTEs (NDDs-only vs. CTEs-only: IRR 1.29, 95% CI 0.99-1.68).
Although it is a strength of the study that the data on exposures and outcome were collected prospectively, parental recall of CTEs was required and CTEs may be under-reported.
NDDs are at least as important as CTEs in the development of mania symptoms, and their risk is additive. Those with a history of both CTEs and NDDs should be monitored closely for the development of more severe psychiatric presentations.
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Methods: We recruited 35 youth (10–14 years old) with a first-degree family history of BD and mood lability, and 21 age-matched healthy controls. Eligible at-risk youth were scanned pre/post an 8-week MBI and assessed three months later. Healthy controls were scanned at matched timepoints but did not participate in the MBI. The MBI used age-appropriate strategies to promote non-judgmental, present-moment awareness. We assessed pre/post changes in PCC-ECN rsFC and how rsFC changes were related to mood outcomes.
Results: Twenty at-risk youth were scanned pre/post MBI; 16 had high-quality rsFC data. Following MBI, at-risk youth showed increased rsFC between PCC and left dorsolateral prefrontal cortex (DLPFC) (BA 9; k = 28; corrected p=.006); healthy controls did not show this increase. Following MBI, at-risk youth reported more mindfulness (F = 7.15, p=.003), less mood lability (F = 7.2, p=.002), and less suppression of negative emotions (F = 5.05, p=.01). PCC-DLPFC rsFC increases predicted less mood lability (t=−2.25, p=.04) and less emotion suppression (t=−2.75, p=.02) at follow-up.
Limitations: Small sample and lack of a control intervention.
Conclusions: PCC-DLPFC rsFC may be a clinically meaningful neural target of an MBI in at-risk youth, related to improvements in mood lability.

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Preliminary results of this study were presented as a poster at the Society for Biological Psychiatry Annual Conference in New York, the World Congress of International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in Berlin, and the annual meeting of the American Academy of Child and Adolescent Psychiatry, Washington, DC, in 2004.

The authors would like to thank their research staff (Gwen Sampson, M.A., Ryan Shaw, B.A., Lindsay Schenkel, M.A., Valli Ganne, M.D.) and the American Academy of Child and Adolescent Psychiatry Jean Spurlock Fellowship Award recipients (with M.N.P.) for 2002-2004: Lynette Hsu, M.D., Rashida Gray, M.D., and Nafisa Patel, M.D., for data collection and management; Drs. Gabrielle Carlson, M.D., Robert Kowatch, M.D., Ellen Leibenluft, M.D., Mary Fristad, Ph.D., and Elva Poznanski for their invaluable input in shaping this instrument; and Eric Youngstrom, Ph.D., for his valuable remarks on the draft of this manuscript.

Article Plus (online only) materials for this article appear on the Journalapos;s Web site: www.jaacap.com.

Disclosure: Dr. Pavuluri received research support from the Marshall Reynolds Foundation and the Campus Research Board Award that supported the present study. Her work is also supported by Colbeth Foundation, NIH 1 K23 RR018638-01, GlaxoSmithKline-Neuro-Health, Abbott Pharmaceuticals, and Janssen Research Foundation. She serves as a consultant to Bristol-Myers Squibb, Shire, Janssen, Abbott Pharmaceuticals, and GlaxoSmithKline-NeuroHealth. She served as a continuing medical education speaker for AstraZeneca, Janssen, Abbott Pharmaceuticals, Eli Lilly, and GlaxoSmithKline-NeuroHealth. The other authors have no financial relationships to disclose.

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ARTICLESChild Mania Rating Scale: Development, Reliability, and Validity

ABSTRACT

Objective

Method

Results

Conclusion

Section snippets

Subjects

Demographics and Comorbidity

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Affect Disord

J Psychiatr Res

J Am Acad Child Adolesc Psychiatry

J Affect Disord

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Prev Vet Med

Biol Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Biol Psychiatry

Manual for the Child Behavior Checklist and Revised Child Behavior Profile

Diagnostic and Statistical Manual of Mental Disorder

A preliminary study of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children mania rating scale for children and adolescents

J Child Adolesc Psychopharmacol

Convergent and discriminant validation by the multi-trait-multi-method matrix

Psychol Bull

ARTICLES
Child Mania Rating Scale: Development, Reliability, and Validity