Evidence based assessment/Bipolar disorder in youth (assessment portfolio)

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What is a "portfolio?"[edit]

  • For background information on what assessment portfolios are, click the link in the heading above.

Preparation phase[edit]

Diagnostic criteria for Pediatric Bipolar disorder[edit]

Click here for more information on PBD diagnostic criteria
  • Pediatric bipolar disorder (PBD) is characterized by extreme fluctuations in mood or emotional dysregulation that range from mania (as shown by displays or feelings of extreme happiness, unrealistic overachievement, and anger) to depression (as shown by displays or feelings of sadness, changes in appetite or weight, and irritability[1] [2]).
  • It is important to note that these moods exceed normal responses to life events, represent a change from the individual's normal functioning, and cause problems in daily activities. These mood fluctuations result in a child finding it difficult to live and interact with family, friends and teachers, when it was previously not an issue[1].
  • People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes". An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression.
  • People with bipolar disorder also may be explosive and irritable during a mood episode.[1]
    • Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood.
  • It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.[2] [1]
  • A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. These debilitating symptoms can result in an afflicted individual being unable to function adaptively in several settings.

ICD-10 Criteria

F31 Bipolar affective disorder

  • Note. Episodes are demarcated by a switch to an episode of opposite or mixed polarity or by a remission.

F31.0 Bipolar affective disorder, current episode hypomanic

A. The current episode meets the criteria for Hypomania F30.0:

  • (A) The mood is elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least four consecutive days.
  • (B) At least three of the following signs must be present, leading to some interference with personal functioning in daily living
    1. Increased activity or physical restlessness;
    2. Increased talkativeness;
    3. Distractibility or difficulty in concentration;
    4. Decreased need for sleep;
    5. Increased sexual energy;
    6. Mild over-spending, or other types of reckless or irresponsible behavior;
    7. Increased sociability or over-familiarity.
  • (C) The episode does not meet the criteria for F30.1 Mania without psychotic symptoms, F30.2 Mania with psychotic symptoms, F31.- Bipolar affective disorder, F32.- Depressive episode, F34.0 Cyclothymia, or F50.0 Anorexia nervosa.
  • (D) Most commonly used exclusion clause. The episode is not attributable to F10-F19 Psychoactive substance use or in the sense of any F00-F09 Organic mental disorder.

B. There has been at least one other affective episode in the past, meeting the criteria for F30.- Hypomanic or Manic episode, F32.Depressive episode, or F38.00 Mixed affective episode.

Changes in DSM-5

The diagnostic criteria for bipolar disorders changed slightly from DSM-IV to DSM-5. Summaries are available here and here.


Base rates of PBD in different clinical settings and populations[edit]

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rates of PBD that they are likely to see in their clinical practices.

  • To find prevalence rates across multiple disorders, click here.
Setting Base Rate Demography Diagnostic Method Best Recommended For
Community epidemiological

(NCS-A) [3]

3.0% All of U.S.A. CIDI 3.0
Community epidemiologic samples[4] mean= 1.8% (95% CI, 1.1%–3.0%), bipolar I (mean =1.2%; 95% CI, 0.7%–1.9%) U.S.A., Netherlands, U.K., Spain, Mexico, Ireland, New Zealand Structured and semi-structured diagnostic interviews, Combination of broad and specific diagnostic criteria (Meta-Analysis) Schools, nonclinical settings. Minimum for outpatient settings.
Community mental health center[5] 6% U.S.A., Midwestern Urban, 80% non-white, low-income Parent and youth clinical assessment & treatment
General outpatient clinic[6] 6-8% Urban academic research centers WASH-U-KSADS (parent and youth)
Specialty outpatient service[7] 15-17% Boston area, U. S. A. KSADS-E
Inpatient Services/Diagnoses[8] 0.3% All of Germany International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
Community sample[9] 2.9% Oregon LIFE, SCID, DSM-IV
Inpatient service[10] 30% manic symptoms, <2% strict BP I New York City Metro Region DICA; KSADS
NCS-A Clinical Reappraisal Sample[11] p y 6.2% and SE=1.7 (bipolar I and II and sub-threshold bipolar spectrum disorder) U.S.A, NCS-A K-SADS, DSM-IV

criteria were modified from published version for purpose of the study, broad criteria for not otherwise specified

NCS-A Clinical Reappraisal Sample[11] p y 6.6% and SE=1.7 (bipolar I and II and sub-threshold bipolar spectrum disorder) U.S.A, NCS-A CIDI, DSM-IV criteria were modified from published version for purpose of the study, broad criteria for not otherwise specified,
National Cross‐sectional epidemiological sample[12] p y 1.2% (bipolar I and II and not otherwise specified) United Kingdom DAWBA, DSM-IV criteria, broad criteria for not otherwise specified
Community epidemiological samples[13] y 2.5% (bipolar I and II) Mexico City CIDI, DSM-IV Criteria
2-stage epidemiological study[14] p y 0.0% (bipolar I and II, cyclothymia, not otherwise specified Ireland K-SADS, DSM-IV Criteria

p:Parent interviewed as component of diagnostic assessment; y:Youth interviewed as part of diagnostic assessment.

Note:

  • KSADS = Kiddie Schedule for Affective Disorders and Schizophrenia,
  • WASH-U = Washington University version, -PL = Present and Lifetime Version, -E = Epidemiological version of the KSADS
  • LIFE = Longitudinal Interval Follow-Up Evaluation,
  • DICA = Diagnostic Interview for Children and Adolescents
  • CIDI = Composite International Diagnostic Interview
  • DAWBA= The Development and Well-Being Assessment

Prediction phase[edit]

The following section contains a list of screening and diagnostic instruments for bipolar disorder in youth. This section includes administration information, psychometric data, and PDFs or links to the screenings.

Psychometric properties of screening instruments for pediatric bipolar disorder[edit]

  • Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
  • For a list of more broadly reaching screening instruments, click here.
Screening measures for bipolar disorder in youth
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Children's Depression Inventory

*not free

Self-report[15] 7-17 15-20 minutes[15] NA A G G X Not free
Mood and Feelings Questionnaire (MFQ) Self-report 7-18 5-10 minutes[16] NA A G A X
7 Up 7 Down Inventory (7U7D) Self-report[17] 11-86[18] 5-8 minutes NA
Parent General Behavior-10 Item Version (PGBI-10M)[19] Parent-report 5-18[20] 5-8 minutes

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Brief screening tools for PBD[edit]

Extended content

The following are brief screening tools that typically take less than 5 minutes to administer to accurately diagnose pediatric bipolar disorder:

  1. 7 Up 7 Down Inventory (7U7D)
    1. The 7 Up 7 Down Inventory[17] is a recently developed and validated questionnaire with 14 items of manic and depressive tendencies carved from the General Behavior Inventory, a well-validated but cumbersome interview. For both mania and depression factors, 7 items produced a psychometrically adequate measure applicable across both aggregate samples. Internal reliability of the Mania scale was .81 (youth) and .83 (adult) and for Depression was .93 (youth) and .95 (adult).
    2. The 7 Up 7 Down Inventory, along with the accompanying research article, can be found here.
  1. PGBI-10M[21]
    1. The PGBI-10M (we would like to add another version that is better) is a brief (10 item) instrument derived from the Parent General Behavior Inventory (PGBI)[22], a 73-item mood inventory, to assess mania in a large sample of outpatients presenting with a variety of different DSM-IV diagnoses, including frequent comorbid conditions.[15]
    2. The 10-item GBI derived from the 73-item P-GBI had good reliability (alpha = .92), was correlated (r = 0.95) with the 28-item scale, and showed significantly better discrimination of bipolar disorders (area under the receiver operating characteristic [AUROC] curve of 0.856 vs. 0.832 for the 28-item scale, p < .005). The 10-item scale also did well discriminating bipolar disorder from unipolar depression (AUROC = 0.86) and bipolar disorder from attention-deficit/hyperactivity disorder (AUROC = 0.82) cases.
    3. The full version of the scale, the Parent-General Behavior Inventory (P-GBI), is a parent-report measure of depressive and hypomanic/biphasic symptoms adapted from the General Behavior Inventory (GBI).
    4. Classification rates exceed 80%, and receiver operating characteristic analyses showed good diagnostic efficiency for the scales, with areas under the curve greater than .80. Results indicate that clinicians can use the parent-completed GBI to derive clinically meaningful information about mood disorders in youths.

Likelihood ratios and AUCs of screening measures for bipolar disorder in youth[edit]

  • For a list of the likelihood ratios for more broadly reaching screening instruments, click here.

The following table describes the diagnostic likelihood ratios and area under curves for the top pediatric bipolar disorder measures.

Screening Measure AUC (sample size) Very Low risk range DiLR Low risk range DiLR Neutral risk range DiLR High risk range DiLR Very High risk range DiLR DLR+ (score) DLR- (score) Population/Clinical Generalizability Download
Parent General Behavior-10 Item Mania Version (PGBI-10M)[20] .84 (N=617) academic sample,

.78 community sample (N=530)[20]

.07  (0 to 2.59)  .41 (2.6 to 6.99) 1.44 (7 to 10.99)  2.39 (11 to 17.99)  5.38 (18+) Bipolar spectrum vs. all other diagnoses Parent Form[23]
Parent General Behavior-10 Item Depression Version Form A (PGBI-10Da)[20] .84 (N=617) academic sample,

.79 community sample (N=530)[20]

.25  (0 to 1.99) .71 (2 to 5.99)   1.85 (6 to 9.99)   4.52 (10 to 14.99) 8.80 (15+)   Bipolar spectrum vs. all other diagnoses
Parent General Behavior-10 Item Depression Version Form B (PGBI-10Db)[20] .84 (N=617) academic sample,

.80 community sample (N=530)[20]

.22 (0 to 1.99)    .71 (2 to 5.99) 2.69 (6 to 10.99)    5.64 (11 to 14.99)    8.09 (15+) Bipolar spectrum vs. all other diagnoses
Parent General Behavior Inventory (P-GBI)

(Hypomanic/Biphasic Section])[24]

.84 (N=324) (<9) (49+) 9.2 .06 Bipolar spectrum vs. all other diagnoses
Parent Mood Disorder Questionnaire

(P-MDQ)[25]

.84 (N=819) (TBC) (TBC) 4.64 .17 Bipolar spectrum vs. all other diagnoses
Child Mania Rating Scale (Brief)

(Brief CMRS-P)[26]

.85 (N=150) (<11) (11+) 10.5 .17 Bipolar spectrum vs. ADHD
Child Mania Rating Scale (Full)

(Full CMRS-P)[26]

.91 (N=150) (<21) (21+) 13.7 .19 Bipolar spectrum vs. ADHD
Child Bipolar Questionnaire

(CBQ-P)[27]

.74

(N=497)

25.3/

(likelihood ratio +)

/.25 (likelihood ratio -) Bipolar spectrum vs. all other diagnoses

Interpreting bipolar disorder screening measure scores[edit]

For information on interpreting screening measure scores, click here.

Prescription phase[edit]

Gold standard diagnostic interviews[edit]

For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Click here for more details on gold-standard diagnostic interviews
  1. Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (KSADS-PL)
    • The KSADS-PL is a semi-structured diagnostic interview that assesses current and past Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM-IV-TR) Axis I psychopathology in youth[1]. The KSADS-PL diagnostic interviews have good inter-rater (.93 to 1.00) and retest reliability (.77) for mood disorders [28] Here is a link to a PDF of the diagnostic interview for the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime.
  2. Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS)

Recommended diagnostic instruments specific for pediatric bipolar disorder[edit]

Diagnostic instruments for (insert portfolio name)
Measure Format (Reporter) Age Range Administration/

Completion Time

Interrater Reliability Test-Retest Reliability Construct Validity Content Validity Highly Recommended Free and Accessible Measures
Children's Depression Rating Scale - Revised (CDRS-R) Structured Interview[29] 6-12 15-20 minutes G A G G X

Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

Process phase[edit]

The following section contains a list of process and outcome measures for adolescent bipolar spectrum disorder. The section includes benchmarks based on published norms and on mood samples for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information on differences between process and outcome measures, see the page on the process phase of assessment.

Process measures[edit]

There are many processes that may be considered important when evaluating a child or an adolescent with Bipolar Disorder; however, due to the diversity of the population and symptom expression, there are too many to narrow down. Clinical judgment is recommended when deciding what additional measures should be included (e.g. executive functioning, sensory processing, cognitive flexibility). The measures provided below are commonly used to assess and provide important information regarding levels of daily functioning of individuals with Bipolar Disorder.

A. Mood and Energy Thermometer-   This is an improved and practical way of monitoring complex mood cycles and daily schedules. Given that some clinicians and patients may get confused about different 1 to 10 scales (e.g., a 10 could mean extreme depression, extreme mania, or no depression), the Mood & Energy Thermometer improves the language in communicating (and monitoring) mood. Moreover, many children report their energy levels more accurately than their mood and therefore, energy levels have been incorporated in this mood rating. The Mood & Energy Thermometer that was developed at Western Psychiatric Institute and Clinic (WPIC; and used in about 400 kids) rates mania and increased energy on a 1 to 10 scale, rates depression and tiredness on a -1 to -10 scale, and attempts to form a common language between patients, families, and clinicians. This scale also takes into account time spent depressed and/or manic; for example, -4 would mean “mild depression” and “mild tiredness” present ≥50% of the time, and -3 would mean “mild depression” and “mild tiredness” present < 50% of the time. The inclusion of measuring energy levels is consistent with the DSM-5, because energy level is now included in the DSM-5 as a main mood symptom criterion. Bipolar track patients (whether they had mania, depression, or mixed features) rated their mood and energy levels every day on this scale, and a master’s-level clinician met with them on a daily basis to help them better identify and record their mood symptoms, which has significant clinical value for not only treatment but also to prevent future episodes.[11]

B. Life Charts

Outcome and severity measures[edit]

  • Information on how to interpret this table can be found here.
  • Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
  • For clinically significant change benchmarks for the CBCL, YSR, and TRF overall, see here.

Clinically significant change benchmarks with common instruments for bipolar disorder in youth[edit]

Benchmarks Based on Published Norms
Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
A B C 95% 90% SEdifference
Beck Depression Inventory[30] BDI Mixed Depression 4 22 15 9 8 4.8
Benchmarks Based on Bipolar Spectrum Samples
Measure Subscale Cut-off scores Critical Change
(unstandardized scores)
A B C 95% 90% SEdifference
Gracious et al., 2002[31]
Young Mania Rating Scale - Parent
(Full)
n/a 5.2 22.1 14.4 4.3 3.6 2
Young Mania Rating Scale - Parent
(Brief)
n/a 6.8 27.4 17.5 5 4.2 2.5
Carlson & Youngstrom, 2003 [32]
Teacher-Completed Teacher Self-Control Rating Scale n/a 32.4 110.6 72.6 11.6 9.7 5.75
Inpatient Global Rating Scales n/a 1.9 90.7 50.8 15.7 13.2 7.21
Cooperberg, 2002
Young Mania Rating Scale (Clinician Rated) n/a 6 2 2 12 10 6.2
Child Depression Rating-Revised (CDRS-R) n/a n/a 40 29 8 7 4
Parent GBI Hypomanic/Biphasic 7 19 15 8 7 4.2
Depression n/a 18 13 7 6 3.6
Adolescent GBI Hypomanic/Biphasic n/a 32 19 8 7 4.4
Depression n/a 47 27 10 9 5.2
Youngstrom et al., 2018[20]
Parent GBI Short Form 10-item Mania Scale Short Form (10M) 6.22 5.24 3.17
Depression Form A, 10 item Scale (10Da) 5.85 4.93 2.98
Depression Form B, 10 item Scale (10Db) 5.70 4.80 2.91

Treatment[edit]

External resources[edit]

Evidence based assessment/Bipolar disorder in youth (assessment portfolio)
Classification and external resources
ICD-10F31
OMIM125480 Template:OMIM2
DiseasesDB7812
MedlinePlus000926
eMedicinemed/229
MeSHD001714
  1. National Alliance on Mental Illness – the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raise awareness and build a community for hope for all of those in need.[33]
  2. Balanced Mind Foundation – information, articles, parent support chat rooms.[34]
  3. Effective Child Therapy – Information and articles curated by Society of Clinical Child and Adolescent Psychology(SCCAP), a division of the American Psychological Association.[35]
    1. Effective Child Therapy information: Bipolar Disorder
    2. Effective Child Therapy information: Severe Mood Swings and Bipolar Spectrum Disorders
    3. Effective Child Therapy information: Sadness, Hopelessness, and Depression
  1. International Bipolar Foundation – information, help and resources available for caregivers and those afflicted with bipolar disorder.[36]
  2. Bipolar Network News – an online clearinghouse and information on latest treatments, research and psychoeducation about mood disorders.[37]
  3. Depression Alliance – a United Kingdom charity that works to prevent and relieve depression by providing information and support services via supporter services, publications and self-help groups.[38]
  4. Depression and Bipolar Support Alliance (DBSA) – a peer-directed national organization that provides links to resources, support groups, and peer support for individuals and their families suffering from bipolar disorder.
    1. Depression and Bipolar Support Alliance: 7 Up 7 Down Online Screener
  5. Related Wikipedia Pages
    1. Bipolar disorder Wikipedia Page
    2. Cyclothymia Wikipedia Page
    3. Mania Wikipedia Page
    4. Depression Wikipedia Page
  6. Massachusetts General Hospital School Psychiatry Resources for Bipolar Disorder
  7. The Psych Show with Dr. Ali Mattu videos
    1. How to Cope with Bipolar Disorder
    2. Top 10 Bipolar Myths

References[edit]

Click here for references
  1. 1.0 1.1 1.2 1.3 1.4 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  2. 2.0 2.1 Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness. (10th edition). New York, NY: Oxford University Press
  3. Kessler, Ronald C.; Avenevoli, Shelli; Costello, E. Jane; Georgiades, Katholiki; Green, Jennifer Greif; Gruber, Michael J.; He, Jian-ping; Koretz, Doreen et al. (1 April 2012). "Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement". Archives of General Psychiatry 69 (4): 372–380. doi:10.1001/archgenpsychiatry.2011.160. ISSN 1538-3636. http://www.ncbi.nlm.nih.gov/pubmed/22147808. Retrieved 26 January 2016. 
  4. Van Meter, Anna R.; Moreira, Ana Lúcia R.; Youngstrom, Eric A. (1 September 2011). "Meta-analysis of epidemiologic studies of pediatric bipolar disorder". The Journal of Clinical Psychiatry 72 (9): 1250–1256. doi:10.4088/JCP.10m06290. ISSN 1555-2101. http://www.ncbi.nlm.nih.gov/pubmed/21672501. 
  5. Youngstrom, Eric A.; Findling, Robert L.; Youngstrom, Jen Kogos; Calabrese, Joseph R. (September 2005). "Toward an evidence-based assessment of pediatric bipolar disorder". Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 34 (3): 433–448. doi:10.1207/s15374424jccp3403_4. ISSN 1537-4416. PMID 16026213. https://www.ncbi.nlm.nih.gov/pubmed/16026213. 
  6. 6.0 6.1 6.2 Geller, B.; Zimerman, B.; Williams, M.; Bolhofner, K.; Craney, J. L.; DelBello, M. P.; Soutullo, C. (1 April 2001). "Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections". Journal of the American Academy of Child and Adolescent Psychiatry 40 (4): 450–455. doi:10.1097/00004583-200104000-00014. ISSN 0890-8567. http://www.ncbi.nlm.nih.gov/pubmed/11314571. 
  7. Biederman, J.; Faraone, S.; Mick, E.; Wozniak, J.; Chen, L.; Ouellette, C.; Marrs, A.; Moore, P. et al. (August 1996). "Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?". Journal of the American Academy of Child and Adolescent Psychiatry 35 (8): 997–1008. doi:10.1097/00004583-199608000-00010. ISSN 0890-8567. PMID 8755796. https://www.ncbi.nlm.nih.gov/pubmed/8755796. 
  8. Holtmann, M.; Goth, K.; Wöckel, L.; Poustka, F.; Bölte, S. (2008). "CBCL-pediatric bipolar disorder phenotype: severe ADHD or bipolar disorder?". Journal of Neural Transmission (Vienna, Austria: 1996) 115 (2): 155–161. doi:10.1007/s00702-007-0823-4. ISSN 0300-9564. PMID 17994189. https://www.ncbi.nlm.nih.gov/pubmed/17994189. 
  9. Olino, Thomas M.; Shankman, Stewart A.; Klein, Daniel N.; Seeley, John R.; Pettit, Jeremy W.; Farmer, Richard F.; Lewinsohn, Peter M. (1 September 2012). "Lifetime rates of psychopathology in single versus multiple diagnostic assessments: Comparison in a community sample of probands and siblings". Journal of psychiatric research 46 (9): 1217–1222. doi:10.1016/j.jpsychires.2012.05.017. ISSN 0022-3956. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411854/. 
  10. Carlson, Gabrielle A.; Youngstrom, Eric A. (1 June 2003). "Clinical implications of pervasive manic symptoms in children". Biological Psychiatry 53 (11): 1050–1058. ISSN 0006-3223. http://www.ncbi.nlm.nih.gov/pubmed/12788250. 
  11. 11.0 11.1 11.2 11.3 11.4 11.5 Kessler, Ronald C.; Avenevoli, Shelli; Green, Jennifer; Gruber, Michael J.; Guyer, Margaret; He, Yulei; Jin, Robert; Kaufman, Joan et al. (2009-04). "National Comorbidity Survey Replication Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI Diagnoses With Clinical Reassessments". Journal of the American Academy of Child & Adolescent Psychiatry 48 (4): 386–399. doi:10.1097/chi.0b013e31819a1cbc. ISSN 0890-8567. PMID 19252450. PMC PMC3040100. http://linkinghub.elsevier.com/retrieve/pii/S0890856709600460.  Cite error: Invalid <ref> tag; name ":3" defined multiple times with different content
  12. Stringaris, Argyris; Santosh, Paramala; Leibenluft, Ellen; Goodman, Robert (2009-07-22). "Youth meeting symptom and impairment criteria for mania-like episodes lasting less than four days: an epidemiological enquiry" (in en). Journal of Child Psychology and Psychiatry 51 (1): 31–38. doi:10.1111/j.1469-7610.2009.02129.x. ISSN 0021-9630. PMID 19686330. PMC PMC4286871. http://doi.wiley.com/10.1111/j.1469-7610.2009.02129.x. 
  13. Benjet, Corina; Borges, Guilherme; Medina-Mora, Maria Elena; Zambrano, Joaquin; Aguilar-Gaxiola, Sergio (2009-04). "Youth mental health in a populous city of the developing world: results from the Mexican Adolescent Mental Health Survey" (in en). Journal of Child Psychology and Psychiatry 50 (4): 386–395. doi:10.1111/j.1469-7610.2008.01962.x. ISSN 0021-9630. http://doi.wiley.com/10.1111/j.1469-7610.2008.01962.x. 
  14. Lynch, Fionnuala; Mills, Carla; Daly, Irenee; Fitzpatrick, Carol (2006-08). "Challenging times: Prevalence of psychiatric disorders and suicidal behaviours in Irish adolescents". Journal of Adolescence 29 (4): 555–573. doi:10.1016/j.adolescence.2005.08.011. ISSN 0140-1971. http://linkinghub.elsevier.com/retrieve/pii/S0140197105001004. 
  15. 15.0 15.1 15.2 "Children's Depression Inventory 2™". www.pearsonclinical.com. Retrieved 2018-03-01. Cite error: Invalid <ref> tag; name ":0" defined multiple times with different content
  16. "CEBC » Assessment Tool › Mood And Feelings Questionnaire Mfq". www.cebc4cw.org. Retrieved 2018-03-01.
  17. 17.0 17.1 Youngstrom, Eric A.; Murray, Greg; Johnson, Sheri L.; Findling, Robert L. (1 December 2013). "The 7 up 7 down inventory: a 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory". Psychological Assessment 25 (4): 1377–1383. doi:10.1037/a0033975. ISSN 1939-134X. https://www.ncbi.nlm.nih.gov/pubmed/23914960. 
  18. Mesman, E.; Youngstrom, E.A.; Juliana, N.K.; Nolen, W.A.; Hillegers, M.H.J. (2017-01). "Validation of the Seven Up Seven Down Inventory in bipolar offspring: screening and prediction of mood disorders. Findings from the Dutch Bipolar Offspring Study". Journal of Affective Disorders 207: 95–101. doi:10.1016/j.jad.2016.09.024. ISSN 0165-0327. https://doi.org/10.1016/j.jad.2016.09.024. 
  19. Youngstrom, Eric A.; Genzlinger, Jacquelynne E.; Egerton, Gregory A.; Meter, Anna R. Van. "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 3 (1): 112–137. doi:10.1037/arc0000024. http://dx.doi.org/10.1037/arc0000024. 
  20. 20.0 20.1 20.2 20.3 20.4 20.5 20.6 20.7 Youngstrom, E.A., Van Meter, A.R, Frazier, T.W., Youngstrom, J.K., & Findling, R.L. (in press). Developing and validating short forms of the Parent General Behavior Inventory Mania and Depression Scales for rating youth mood symptoms. Journal of Clinical Child & Adolescent Psychology.
  21. Youngstrom EA, Frazier TW, Demeter C, et al. Developing a 10-item mania scale from the Parent General Behavior Inventory for children and adolescents. J Clin Psychiatry. 2008;69(5):831–839.
  22. Youngstrom, Eric A.; Findling, Robert L.; Danielson, Carla Kmett; Calabrese, Joseph R. (2001). "Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory." (in en). Psychological Assessment 13 (2): 267–276. doi:10.1037/1040-3590.13.2.267. ISSN 1939-134X. http://psycnet.apa.org/doi/10.1037/1040-3590.13.2.267. 
  23. "Psychoeducational Psychotherapy". www.moodychildtherapy.com. Retrieved 2018-07-20.
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