Children with Early-Onset Bipolar Disorder (EOBD) present with symptoms that can be confused with Attention-Deficit/Hyperactivity Disorder (ADHD). One of the biggest challenges faced by clinicians is differentiating between children with EOBD and those with ADHD. The consequences of falsely diagnosing children with EOBD can lead to inappropriate or harmful intervention. Additionally, failing to identify and treat EOBD children can lead to recurrent mood episodes, and more severe symptoms. At present, there are no validated screening tools or assessment aids for use in Spanish-speaking families, nor is it known whether existing measures could be used in English speaking Hispanic families without clinically meaningful bias. A review of the literature indicates that to date no studies have been conducted on a sample of primarily Hispanic children (Youngstrom, Findling, Youngstrom, &Calabrese, 2005). There are important cultural reasons that the performance of parent-reported instruments might be different in a Hispanic population, such as the primacy of family in the lives of its members (referred to as """"""""familism"""""""" in ethnographic studies). This study will evaluate the extent to which acculturation variables moderate the value or accuracy of information obtained from four different screening instruments for diagnosing EOBD in a group of Hispanic children. In addition to the usual value of validating measures in a new population, we will be using a conceptual framework that examines if familism and attributions about mental illness impact diagnostic accuracy in Hispanics. Data will be collected on a case series of 40 children diagnosed with EOBD and a sample of 40 children that have not been diagnosed with EOBD. The two groups of children will be compared to determine whether parental instruments aid in accurately differentiating children diagnosed with EOBD from non EOBD children. The long term objectives are to evaluate the psychometrics of all the mood rating scales in larger samples of English and Spanish-speaking Hispanic participants.
Given the rapid increase in the size of the Hispanic population and the rate of EOBD diagnosis, the development and testing of assessment tools for these families is of crucial public health importance. The proposed study is directly relevant to the Healthy People 2010 (originally Health People 2000) initiative of NIH (November, 2000), which has made the elimination of health disparities a national priority (see www. healthypeople.gov). Results of this study will improve the ability to diagnose and treat EOBD children in this underrepresented and underserved population.
