Child Mania Rating Scale

The Child Mania Rating Scales (CMRS) is a 21-item diagnostic screening measure designed to identify symptoms of mania in children and adolescents ages 9–17 using diagnostic criteria from the DSM-IV.[1] The measure covers mood and behavior symptoms, asking parents or teachers to rate how often the symptoms have caused a problem for the youth in the past month. Clinical studies have found the CMRS-P to be reliable and valid in the assessment of children's bipolar symptoms.[1][2] The CMRS also can differentiate cases of pediatric bipolar disorder from those with ADHD or no disorder, as well as delineating bipolar subtypes.[3] A meta-analysis comparing the different rating scales available found that the CMRS was one of the best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses.[4] It also is sensitive to treatment effects. The combination of showing good reliability and validity across multiple samples and clinical settings, along with being free and brief to score, make the CMRS a promising tool, especially since most other checklists available for youths do not assess manic symptoms.

History and development

Historically, effective rating and diagnosis of mania has been limited. Though many mania scales have been tested on adult populations, the Young Mania Rating Scale (YMRS) – which was the basis for the child version (CMRS) - is the only adult scale that has also been studied for validity and reliability in prepubertal children.[5][6] Previous attempts include the Beigel Scale/Manic State Rating Scale (MSRS) and the Patterson Scale, which used nurse and clinician reports to rate levels of mania. Neither scale effectively and consistently captured levels of mania in patients.[7] Other measures of pediatric mania are generally limited because they are completed by the clinician, introducing potential for bias, and because they lack the depth necessary to differentiate between patient-specific ways in which symptoms are presented.[2] The CMRS Parent and Teacher versions attempt to address some of the limitations by including a checklist that can gather information about behavior at home, school, and other settings, rather than focusing only on what a clinician could directly observe.[8] One study examined the accuracy of a shortened version of the CMRS-P, which included only 10 items, and found that its accuracy was similar to the full scale.[9]

Psychometric properties

Construct validity analyses (Exploratory Factor Analysis and Confirmatory Factor Analysis) for the CMRS-P indicated that the scale is unidimensional. Internal consistency measured by Cronbach's alpha was .96 in a sample consisting of ADHD, Bipolar, and healthy control participants. In a sample of participants with bipolar disorder, the cronbach's alpha is .91. Additionally, it has the ability to accurately differentiate pediatric bipolar disorder from ADHD and healthy controls greater than 90% of the time.

Correlations between CMRS-P and other several clinician-rating scales intended to measure manic symptoms (e.g. Washington University Schedule for Affective Disorder and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scales) were excellent (.78 to .98).[1]

The CMRS-P has also been found to be sensitive in detecting symptom change over the course of pharmacotherapy.[2]

The teacher version (CMRS-T) also has 21 items. The internal consistency, measured by Cronbach's alpha, was .86. Correlations between the parent and teacher versions of the CMRS range from .23[10] to .27.[11] The CMRS teacher version has not been shown to discriminate bipolar from nonbipolar cases at better than chance levels and is not recommended for use in clinical practice for diagnosing bipolar disorder in children.[10]

Impact

Though there is no gold-standard screening tool for Pediatric Bipolar Disorder, the CMRS has been described as a promising and useful tool for such a purpose.[12] For example, institutional protocols for diagnosing and evaluating Bipolar Disorder in children may use the CMRS as an initial screening tool to establish the need to further evaluation of mania symptoms.[13] In addition, the parent version of the CMRS (the CMRS-P) has been used in research studies to detect changes in children's mania symptoms due to pharmacotherapy or psychotherapy.[14][15] The CMRS is the first measure specifically developed for the purpose of screening for Bipolar Disorder in children.[16] As such, it offers an alternative to broadband rating scales like the Child Behavior Checklist, which has been used as a screening tool for Bipolar Disorder in children with mixed findings regarding its reliability.[16][17]

Limitations

The CMRS suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them - in this case, the parent or teacher. Like all questionnaires, the way the instrument is administered can also influence the final score. If a person is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey.[18] The age of the youth also may matter. Although the Child Mania Rating Scale has been shown to be a valid and reliable measure of mania in children, one concern is that its validity might change as the youth becomes an adolescent, and parents or teachers have less influence and awareness about the youth's behavior outside of the home or school.[19]

See also

References

  1. 1 2 3 Pavuluri, MN; Henry, DB; Devineni, B; Carbray, JA; Birmaher, B (May 2006). "Child mania rating scale: development, reliability, and validity.". Journal of the American Academy of Child and Adolescent Psychiatry. 45 (5): 550–60. doi:10.1097/01.chi.0000205700.40700.50. PMID 16601399.
  2. 1 2 3 West, AE; Celio, CI; Henry, DB; Pavuluri, MN (January 2011). "Child Mania Rating Scale-Parent Version: a valid measure of symptom change due to pharmacotherapy.". Journal of Affective Disorders. 128 (1-2): 112–9. doi:10.1016/j.jad.2010.06.013. PMID 20858565.
  3. ↑ Henry, DB; Pavuluri, MN; Youngstrom, E; Birmaher, B (2008). "Accuracy of Brief and Full Forms of the Child Mania Rating Scale" (PDF). Journal of Clinical Psychology. Retrieved 4 October 2015.
  4. ↑ Youngstrom, E. A.; Genzlinger, J. E.; Egerton, G. E.; Van Meter, A. R. (2015). "Multivariate Meta-Analysis of the Discriminative Validity of Caregiver, Youth, and Teacher Rating Scales for Pediatric Bipolar Disorder: Mother Knows Best About Mania". Archives of Scientific Psychology. doi:10.1037/arc0000024. Retrieved 16 June 2016.
  5. ↑ Fristad, MA; Weller, EB; Weller, RA (March 1992). "The Mania Rating Scale: can it be used in children? A preliminary report.". Journal of the American Academy of Child and Adolescent Psychiatry. 31 (2): 252–7. doi:10.1097/00004583-199203000-00011. PMID 1564026.
  6. ↑ Fristad, MA; Weller, RA; Weller, EB (September 1995). "The Mania Rating Scale (MRS): further reliability and validity studies with children.". Annals of Clinical Psychiatry. 7 (3): 127–32. doi:10.3109/10401239509149039. PMID 8646272.
  7. ↑ Beigel, Allan (1 September 1971). "The Manic-State Rating Scale". Archives of General Psychiatry. 25 (3): 256. doi:10.1001/archpsyc.1971.01750150064009.
  8. ↑ Young, R. C.; Biggs, J. T.; Ziegler, V. E.; Meyer, D. A. (1978-11-01). "A rating scale for mania: reliability, validity and sensitivity.". The British Journal of Psychiatry. 133 (5): 429–435. doi:10.1192/bjp.133.5.429. ISSN 0007-1250. PMID 728692.
  9. ↑ Henry, David B.; Pavuluri, Mani N.; Youngstrom, Eric; Birmaher, Boris (2008-04-01). "Accuracy of brief and full forms of the child mania rating scale". Journal of Clinical Psychology. 64 (4): 368–381. doi:10.1002/jclp.20464. ISSN 1097-4679.
  10. 1 2 Youngstrom, Eric A.; Joseph, Megan F.; Greene, Jamelle (2008-04-01). "Comparing the psychometric properties of multiple teacher report instruments as predictors of bipolar disorder in children and adolescents". Journal of Clinical Psychology. 64 (4): 382–401. doi:10.1002/jclp.20462. ISSN 1097-4679.
  11. ↑ Carlson, Gabrielle A.; Blader, Joseph C. (2011-10-01). "Diagnostic Implications of Informant Disagreement for Manic Symptoms". Journal of Child and Adolescent Psychopharmacology. 21 (5): 399–405. doi:10.1089/cap.2011.0007. ISSN 1044-5463.
  12. ↑ Baroni, Argelinda; Lunsford, Jessica R.; Luckenbaugh, David A.; Towbin, Kenneth E.; Leibenluft, Ellen (March 2009). "Practitioner Review: The assessment of bipolar disorder in children and adolescents". Journal of Child Psychology and Psychiatry. 50 (3): 203–215. doi:10.1111/j.1469-7610.2008.01953.x.
  13. ↑ Washburn, Jason J.; West, Amy E.; Heil, Jennifer A. (1 March 2011). "Treatment of Pediatric Bipolar Disorder: A Review". Minerva psichiatrica. 52 (1): 21–35. ISSN 0374-9320. PMC 3150503Freely accessible.
  14. ↑ West, Amy E.; Celio, Christine I.; Henry, David B.; Pavuluri, Mani N. (January 2011). "Child Mania Rating Scale-Parent Version: A valid measure of symptom change due to pharmacotherapy". Journal of Affective Disorders. 128 (1-2): 112–119. doi:10.1016/j.jad.2010.06.013.
  15. ↑ West, Amy E.; Jacobs, Rachel H.; Westerholm, Robert; Lee, Adabel; Carbray, Julie; Heidenreich, Jodi; Pavuluri, Mani N. (1 August 2009). "Child and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorder: Pilot Study of Group Treatment Format". Journal of the Canadian Academy of Child and Adolescent Psychiatry. 18 (3): 239–246. ISSN 1719-8429. PMC 2732730Freely accessible.
  16. 1 2 West, Amy E.; Pavuluri, Mani N. (December 2009). "The State of the Evidence on Pediatric Bipolar Disorder | Psychiatric Times". www.psychiatrictimes.com (26). Psychiatric Times. Retrieved 17 June 2016.
  17. ↑ Moreno, Carmen; Laje, Gonzalo; Blanco, Carlos; Jiang, Huiping; Schmidt, Andrew B.; Olfson, Mark (1 September 2007). "National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth". Archives of General Psychiatry. 64 (9): 1032. doi:10.1001/archpsyc.64.9.1032.
  18. ↑ Bowling A (September 2005). "Mode of questionnaire administration can have serious effects on data quality". Journal of public health (Oxford, England). 27 (3): 281–91. doi:10.1093/pubmed/fdi031. PMID 15870099. Retrieved 2008-10-30.
  19. ↑ Birmaher, B; Axelson, D (2006). "Course and outcome of bipolar spectrum disorder in children and adolescents: a review of the existing literature.". Development and Psychopathology. 18 (4): 1023–35. doi:10.1017/s0954579406060500. PMID 17064427.
  20. ↑ "Child Mania Rating Scale" (PDF). Depression and Bipolar Support Alliance. Retrieved 14 September 2015.
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