How Accurate is Pediatric Bipolar Disorder Testing?

How Accurate is Pediatric Bipolar Disorder Testing? 1024 555 JoAnna Pendergrass, DVM

Symptom-based bipolar disorder tests accurately diagnose pediatric bipolar disorder, with parent-reported tests being among the most accurate.

According to a systematic review and meta-analysis of studies evaluating the diagnostic accuracy of bipolar disorder index tests, parent-reported tests are more accurate than self- or teacher-reported tests.

The analysis, led by Cristian Alcaíno, a doctoral candidate at the University of Edinburgh in Scotland, is an update of the 2015 meta-analysis conducted by Eric Youngstrom, PhD, director of the Institute for Mental and Behavioral Health Research at Nationwide Children’s Hospital. Dr. Youngstrom is also the senior author of the current review.

Results of the current meta-analysis were published in Early Intervention in Psychiatry.

Pediatric bipolar disorder affects approximately 1% to 4% of children and is often not diagnosed until adulthood.

“Delayed diagnosis of bipolar disorder puts affected children at higher risk of suicide, incarceration, substance misuse and teen pregnancy,” Dr. Youngstrom says.

Children who do receive treatment for the disorder are typically treated for depression, but antidepressants are not only less effective for treating bipolar disorder but are also less effective in children than adults.

Research on pediatric bipolar disorder is now extensive but was limited in the 1990s. “This left an entire generation of clinicians who did not receive adequate training on the disorder,” Dr. Youngstrom explains.

Despite more research, diagnosing bipolar disorder remains challenging because its symptoms are nonspecific and often overlap with disorders like depression and attention-deficit/hyperactivity disorders (ADHD).

Alcaíno and his research team compared the diagnostic accuracy of symptom-based bipolar disorder index tests, evaluating how well they differentiated between bipolar disorder and non-bipolar disorder in children aged 6 to 17.

Using three databases, they identified nearly 2,300 studies on bipolar disorder testing from 1980 to 2022 that measured hypo/manic-depressive symptoms. Of these studies, 28 were included in the final analysis.

The research team also investigated the effect of moderators, such as informant type (e.g., parent), on the relationship between the test and diagnostic accuracy.

The meta-analysis revealed a large average effect size, indicating statistically significant diagnostic accuracy for discriminating between bipolar disorder and non-bipolar disorder.

Parent-reported tests were more accurate than self- or teacher-reported tests.

“The individual experiencing the symptoms may not notice they have them,” Dr. Youngstrom explains, calling them ‘garlic’ symptoms — noticeable by others but not by the affected individual.

Teachers cannot see the entire spectrum of symptoms and may attribute an affected child’s symptoms to ADHD, making their reporting less accurate.

Interestingly, Dr. Youngstrom says cultural differences could affect diagnostic accuracy according to informant type. For example, self-reported tests could be more accurate in cultures where stigma against mental health keeps children from sharing mental health struggles with their parents.

He advises clinicians to use the tests evaluated in the meta-analysis. “Using these tests is better than ‘eyeballing’ the child” and relying on what they say, he says.

Surprisingly, the most accurate tests were free, removing cost as a barrier to using them to help families. Nationwide Children’s has added some of these tests to the Measurement Based Care Toolkit in MyChart.

Dr. Youngstrom’s future research plans include delving more deeply into cultural differences that affect the diagnosis of pediatric bipolar disorder and investigating how gender differences can affect how bipolar disorder symptoms behave.

 

Reference

Alcaíno C, Raouna A, Tunç H, MacBeth A, Bird T, Youngstrom E. Discriminant diagnostic validity of paediatric bipolar disorder screening tests: A systematic review and meta-analysis. Early Interv Psychiatry. 2024 Sep;18(9)669-697. doi: 10.1111/eip13592.

 

About the author

JoAnna Pendergrass

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.