User:Rkang101/Child Mania Rating Scale

The Child Mania Rating Scale (CMRS) is a 21-item questionnaire intended to identify Bipolar Disorder in children. The measure was created by West, Celio, Henry, and Pavuluri. The questionnaire, which is administered to parents, is closely based on DSM-IV symptoms of mania and was designed to differentiate between ADHD-type symptoms, mania, and the various sub-types of Bipolar Disorder. Because the CMRS is only administered to parents, it is also called the CMRS-Parent (CMRS-P).

The full version of the CMRS is 21 items long, but a selection of 10 items from the full questionnaire has been shown to be comparably accurate.

Lead section
The Child Mania Rating Scale (CMRS) was created as a complement already existing measures like the Altman Self-Rating Mania Scale and the Young Mania Rating Scale, which were formulated for adults and adolescents respectively. The purpose of the CMRS is to both assess the symptoms of mania in pediatric bipolar disorder, and to accurately discriminate the symptoms of mania from symptoms of ADHD. It is important that the CMRS accurately discriminate from symptoms of ADHD because core symptoms of adolescent Bipolar Disorder and ADHD are shared between the two disorders: hyperactivity, impulsivity, and distractibility. The CMRS was designed specifically for younger children who may or may not have the ability to accurately answer questions about their behavior. As a result, the questionnaire is filled out by parents are/or caregivers who work with the children on a daily basis.

Typically, the CMRS takes only 10-15 minutes to administer. The questions ask about behavior-specific actions and tendencies the child may have exhibited within the past month. The parent rates the behavior on a scale from 1 to 4, where 1=never/rarely, 2=sometimes, 3=often, and 4=very often. A clinician examines the total score and determines if the child has ADHD or Bipolar Disorder. If a diagnosis Bipolar Disorder is deemed to be appropriate, the clinician will also determine the sub-type.

Previous mania scales were designed for use by either the clinician or the patient. Therefore, the CMRS is unique in that it allows parents and caregivers to contribute information about their child's symptoms. This is especially important in cases where the child may be too young to fill out the questionnaires themselves.

Versions
There is a short version (10 items) of the CMRS called the  Brief CMRS/Brief CMRS-P. The shorter version was created because a shorter version is preferred to longer assessments if the shorter gives similar accuracy, which it does.

Development and history
The CMRS was developed as a shorter, reliable, and valid parent-report screening instrument for mania. It was developed from the Young Mania Rating Scale (YMRS), another popular mania rating scale in children. The YMRS was derived from the Parent-Young Mania Rating Scale (P-YMRS). This scale, developed from the YMRS, was created for use with adult inpatients. The items of the P-YMRS did not include the updated DSM-IV criteria for adolescent Bipolar Disorder, and it includes several items with poor factor loadings. Furthermore, the content is not developmentally appropriate for children, as many of the items require insight or appearance, which are irrelevant to young children. Another promising measure is the GBI as it has good psychometric properties. However, the GBI is lengthy and complicated and requires the child to have at least a 7th-grade reading ability. One of the most widely used measures of mania symptoms is the Kiddie Schedule for Affective Disorders and Schizophrenia mania section. However, this measure is extremely extensive and requires much clinical training to administer.

During the development of the CMRS, researchers found that reliable and more accurate diagnostic accuracy is found in parent reports in comparison to teacher reports or self-reports and that these other reports rarely added new information to the parent report. Furthermore, the areas under the curve (AUC) of parent-rated instruments reported modest to excellent validity. Based on the evidence, the developers of the CMRS chose to create a measure that relied mainly on parent report.

Other parent report measures have been used to screen for Pediatric Bipolar Disorder, but these measures were not developed to look specifically for mani. One such measure is the Child Behavior Checklist (CBCL). The CBCL, in addition to providing markers of psychopathology, has been used to detect mania in children. . However, on the CBCL, researchers saw a consistent pattern of elevated scores, especially on the following symptoms: aggressive behavior, attention problems, delinquency, anxiety, and depression. . This pattern may be due to the high comorbidity of ADHD, oppositional defiant disorder, conduct disorder, and anxiety disorders in children with pediatric Bipolar Disorder. And although the CBCL is a reliable and validated measure, low scores on the CBCL may only rule out mania--conversely, it would be erroneous to rule in mania using CBCL scores alone.

For these reasons, the CMRS was developed to accurately and reliably assess mania in pediatric Bipolar Disorder, and differentiate its symptoms from other disorders with high comorbidity with pediatric Bipolar Disorder.

Impact
CMRS-P (both the brief and full versions) have shown to be effective in distinguishing between mania and ADHD. The brief version effectively retains characteristics of the original CMRS, allowing for wider application and longitudinal use. Psychometric studies of the CMRS has demonstrated that the measure has excellent reliability and validity. Internal consistency is excellent and the measure correlates with clinician-administered interview measures for diagnosing pediatric mania. The measure is also accurately able to differentiate symptoms of pediatric Bipolar Disorder from ADHD and healthy control groups more than 90% of the time. Furthermore, the use of the CMRS in pharmacological research suggests that this measure is sensitive to treatment over time, which means that you can use this measure to assess treatment effectiveness.

Use in other populations
While the CMRS has not been validated in other languages, the CBCL, YMRS, GBI, and KSADS all have. However, the CMRS has been tested and translated into Spanish.

Limitations
Some limitations of the CMRS are its age and reporter errors. The CMRS is one of the newest measures of child mania for pediatric Bipolar Disorder and, as a result, there lack secondary sources such as systematic reviews and meta-analyses that report on its overall psychometric properties. It is also unclear of the CMRS's ability to assess the change in mania systems as a child cycles out of mania and into depression. Additionally, the use of a parent report can be a source of limitations depending on the parent's attentiveness to the child's behavior, the parent's willingness to report, social desirability bias, the inaccuracies of recalling passed behaviors, comprehending the question, recalling all pieces of information in a quick and efficient manner, and so on.

Example page

 * General Behavior Inventory