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Developing a 10-Item Mania Scale From the Parent General Behavior Inventory for Children and Adolescents

Eric A. Youngstrom, Ph.D.; Thomas W. Frazier, Ph.D.; Christine Demeter, M.A.; Joseph R. Calabrese, M.D.; and Robert L. Findling, M.D.

Objective: Bipolar disorder is being diagnosed and treated in children and adolescents at a rapidly increasing rate, despite the lack of validated instruments to help screen for the condition or differentiate it from more common disorders. The goal of the present study was to develop and validate a brief (10 item) instrument to assess mania in a large sample of outpatients presenting with a variety of different DSM-IV diagnoses, including frequent comorbid conditions.

Method: Parents presenting to a Midwestern academic outpatient medical center for psychiatric evaluation of their child completed the Parent General Behavior Inventory (P-GBI), a 73-item mood inventory that comprises a 46-item depressive symptom scale and a 28-item hypomanic/biphasic scale (1 item is used in both scales), as part of a screening assessment that included a semistructured psychiatric interview of both the parent and the child to determine the child's diagnoses. The study was conducted between the years 1999 and 2004.

Results: Six hundred thirty-seven youths received a diagnostic assessment with either the Epidemiologic or Present and Lifetime Version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children. A 10-item form derived from the 73-item P-GBI had good reliability (alpha = .92), correlated (r = 0.95) with the 28-item scale, and showed significantly better discrimination of bipolar disorders (area under the receiving operating characteristic [AUROC] curve of 0.856 vs. 0.832 for the 28-item scale, p < .005), with good precision for estimation of individual scores for cases up to 2 standard deviations elevated on the latent trait. The 10-item scale also did well discriminating bipolar from unipolar (AUROC = 0.86) and bipolar from attention-deficit/hyperactivity disorder (AUROC = 0.82) cases.

Conclusions: Findings suggest that parents most notice elated mood, high energy, irritability, and rapid changes in mood and energy as the prominent features of juvenile bipolar disorder.


(J Clin Psychiatry 2008;69:831-839. Online Ahead of Print April 29, 2008.)

Received Oct. 8, 2007; accepted Jan. 29, 2008. From the Department of Psychology, University of North Carolina at Chapel Hill (Dr. Youngstrom) and Center for Pediatric Behavioral Health, Cleveland Clinic Foundation (Dr. Frazier) and Departments of Psychiatry, Case Western Reserve University and University Hospitals Case Medical Center (Drs. Calabrese and Findling and Ms. Demeter), Cleveland, Ohio.

This research was supported by a Bipolar Disorder Clinical Research Center Grant (principal investigator, R.F.) from the Stanley Medical Research Institute, Chevy Chase, Md., as well as National Institute of Mental Health grants R01 MH066647 (principal investigator, E.Y.) and R01 MH073967.

The authors thank all of the families that participated in this project.

Financial disclosure appears at the end of this article.

Corresponding author and reprints: Eric A. Youngstrom, Ph.D., Department of Psychology, University of North Carolina, Davie Hall, CB3270, Chapel Hill, NC 27599-3270 (e-mail: