Suicide Threat: This child has sometimes made clear threats of suicide.**
**Suicide threat has been found to be associated with parent-reported reckless behavior and psychosis.
Psychosis: This child has sometimes acknowledged experiencing auditory and/or visual hallucinations.
Ultra-rapid cycling: No indication from CBQ.
Child Bipolar Questionnaire (CBQ) Scoring Guidelines
CBQ items are rated on a likert scale of 1-4 for frequency of occurrence. The CBQ provides three indicators of Pediatric Bipolar Disorder (PBD): total score, Core Index Score, and Screening Algorithms. All were found to be reliable and valid in psychometric testing. The Core Index Score and total score are available to parents. Screening Algorithms are available to physicians.
The CBQ Core Index score is the number of 22 core symptoms and features rated "3" or "4." The Core Index score was found to easily distinguish between children with bipolar disorder and those with ADHD and no mood disorder and to be highly concordant between affected sibling pairs.
The CBQ total score is the number of all 65 items rated "3-often" or "4-almost always." In general terms, the higher the total score, the more severe the mood disturbance.
The CBQ screening algorithms are combinations of symptoms rated "3" or "4" that aid in identifying children who may meet DSM-IV symptom criteria for Bipolar Disorder (inclusive of BP I, BPII, and BP-NOS), ADHD without mood disorder, and co-occurring DSM-IV Bipolar Disorder and ADHD.
The CBQ dimensions of impairment are represented by one or more CBQ items. The score for each dimension is depicted graphically on a scale and as a proportion of items endorsed over the total number of items representing that dimension. Suicidality and Fear of Harm, if present, are listed with an explanation of the research evidence related to these CBQ items.
The CBQ was developed by JBRF Director of Research, Demitri Papolos, M.D., to aid clinicians in the early detection of bipolar disorder in children and adolescents. While it is generally agreed that early-onset bipolar disorder has a different presentation than its adult counterpart, the DSM has not yet incorporated a clear clinical definition of the disorder in childhood. The JBRF data acquisition program has made it possible to conduct a dimensional analysis of symptom data from a large sample of children (N=2795) with either a clinical diagnosis of bipolar disorder (inclusive of BPI, BPII, and BP-NOS) or several symptoms of mania. The resulting set of core features and symptoms are measured by the CBQ Core Index. Because of the high heritability of this set of symptoms, scores on these core items may represent persistent traits of a Core Phenotype of PBD.
The Core Phenotype is an alternative to DSM-IV based on JBRF-sponsored research with a very large dataset (N=5300) of children with symptoms of bipolar disorder. Bipolar disorder can present very differently in children than in adults. Children have briefer and more frequent cycles and are developmentally incapable of manifesting some of the classic adult manic symptoms. The Core Phenotype of PBD includes abrupt changes in mood and developmentally different symptoms. A child with the Core Phenotype of PBD, for example, may present with intense symptoms of anxiety, irritability and behavioral aggression alternating rapidly with giddy, goofy periods of intense excitement and periods of despondency.
The Core Phenotype is currently the subject of research being conducted by the JBRF. If you would like to participate in this research program, please click here. To read more about the development of the CBQ and its psychometric properties, please click here. To access recently published articles about the Core phenotype of pediatric bipolar disorder and CBQ-based research on the clinical correlates of suicide threat and aggressive behavior, click http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed.
The CBQ can not make a definitive diagnosis, which requires a careful diagnostic evaluation by a physician, nurse practitioner, or other qualified clinician. Only an experienced diagnostician with a full understanding of the family history, as well as the symptoms and behaviors that the child exhibits, is qualified to make a diagnosis of bipolar disorder. The CBQ may serve as an integral part of such an evaluation. Please contact us with any questions you may have about CBQ administration or scoring by writing to jbrflistadmin@gmail.com.