Effects of adolescent manic symptoms on agreement between youth, parent, and teacher ratings of behavior problems.

BACKGROUND: Little is known about the extent to which manic symptoms might influence the self-report ratings of adolescents as compared to parent and teacher ratings, although there are clinical reasons to believe that mania would increase disagreement.
METHODS: Parents and youths between the ages of 11 and 17 years were evaluated with the Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS), Young Mania Rating Scale, and Child Depression Rating Scale-Revised. Based on the KSADS results, subjects were assigned to either a bipolar spectrum group (e.g., meeting criteria for a diagnosis of bipolar I, II, cyclothymia, or NOS) or a "nonbipolar" group (including depressive disorders, disruptive behaviors disorders, and other axis I diagnoses). Parents and youths both completed the Achenbach rating scales and the General Behavior Inventory (GBI). Teachers also completed the Achenbach scales.
RESULTS: Youth self-report of manic symptoms showed lower correlations with clinician ratings than did parent ratings. Youths with a bipolar diagnosis also show poorer agreement about their depressive symptoms. There was some evidence that bipolar youths underreported symptoms, even after controlling for parent history of mood disorder. The youth's own manic symptoms partially mediated the effect of a bipolar diagnosis on rater disagreement. LIMITATIONS: Diagnoses and mood ratings were based on both parent and youth interviews.
CONCLUSIONS: Findings strongly suggest that cross-informant agreement can be substantially affected by the youth's own psychopathology. Youths with a bipolar diagnosis tend to underreport their manic symptoms compared to parental report. Results emphasize the importance of gathering collateral sources of information in evaluating juvenile mania, and also suggest that parent reported problems should not be discounted out of hand.