Child Mania Rating Scale: Development, Reliability, and Validity MANI N. PAVULURI, M.D., PH.D., DAVID B. HENRY, PH.D., BHARGAVI DEVINENI, M.D., JULIE A. CARBRAY, D.N.SC., AND BORIS BIRMAHER, M.D. ABSTRACT Objective: To develop a reliable and valid parent-report screening instrument for mania, based on DSM-IV symptoms. Method: A 21-item Child Mania Rating Scale-Parent version (CMRS-P) was completed by parents of 150 children (42.3% female) ages 10.3 T 2.9 years (healthy controls = 50; bipolar disorder = 50; attention-deficit/hyperactivity disorder [ADHD] = 50). The Washington University Schedule for Affective Disorders and Schizophrenia was used to determine DSM-IV diagnosis. The Young Mania Rating Scale, Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, Child Behavior Checklist, and Child Depression Inventory were completed to estimate the construct validity of the measure. Results: Exploratory and confirmatory factor analysis of the CMRS-P indicated that the scale was unidimensional. The internal consistency and retest reliability were both 0.96. Convergence of the CMRS-P with the Washington University Schedule for Affective Disorders and Schizophrenia mania module, the Schedule for Affective Disorders and Schizophrenia Mania Rating Scale, and the Young Mania Rating Scale was excellent (.78Y.83). The scale did not correlate as strongly with the Conners parent-rated ADHD scale, the Child Behavior Checklist -Attention Problems and Aggressive Behavior subscales, or the child self-report Child Depression Inventory (.29Y.51). Criterion validity was demonstrated in analysis of receiver operating characteristics curves, which showed excellent sensitivity and specificity in differentiating children with mania from either healthy controls or children with ADHD (areas under the curve of .91 to .96). Conclusion: The CMRS-P is a promising parent-report scale that can be used in screening for pediatric mania. J. Am. Acad. Child Adolesc. Psychiatry, 2006;45(5):550Y560. Key Words: child, bipolar disorder, rating scale, mania. There is a growing consensus on the existence and description of the core symptoms of pediatric bipolar disorder (PBD; National Institute of Mental Health, 2002). PBD is a serious illness that can lead to high suicide rates, failure in school, aggression, and high-risk behaviors such as sexual promiscuity and substance abuse (Geller et al., 2002a, 2004; Pavuluri et al., 2005; Tondo et al., 1999). It is characterized by high relapse rates and low rates of recovery (Carlson and Kelly, 1998; Geller et al., 2004). Early recognition and accurate identification of PBD are necessary first steps toward prevention and early intervention (Zimmerman et al., 2004). Toward this goal, an instrument that is designed and tested specifically for pediatric mania is essential. In this article, we introduce a parent rating scale that is suitable as a screening instrument in clinical practice and research. An important attribute of a valid screening instru- ment is the ability to distinguish PBD from attention- deficit/hyperactivity disorder (ADHD). These two Accepted November 15, 2005. Drs. Pavuluri, Henry, Devineni, and Carbray are with the Department of Psychiatry, University of Illinois at Chicago; and Dr. Birhamer is with the Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA. Preliminary results of this study were presented as a poster at the Society for Biological Psychiatry Annual Conference in New York, the World Congress of International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in Berlin, and the annual meeting of the American Academy of Child and Adolescent Psychiatry, Washington, DC, in 2004. The authors would like to thank their research staff (Gwen Sampson, M.A., Ryan Shaw, B.A., Lindsay Schenkel, M.A., Valli Ganne, M.D.) and the American Academy of Child and Adolescent Psychiatry Jean Spurlock Fellowship Award recipients (with M.N.P.) for 2002Y2004: Lynette Hsu, M.D., Rashida Gray, M.D., and Nafisa Patel, M.D., for data collection and management; Drs. Gabrielle Carlson, M.D., Robert Kowatch, M.D., Ellen Leibenluft, M.D., Mary Fristad, Ph.D., and Elva Poznanski for their invaluable input in shaping this instrument; and Eric Youngstrom, Ph.D., for his valuable remarks on the draft of this manuscript. Article Plus (online only) materials for this article appear on the Journal`s Web site: www.jaacap.com. Correspondence to Dr. Mani N. Pavuluri, Department of Psychiatry, Institute for Juvenile Research, 912 South Wood Street (M/C 913), Chicago, IL 60612; e-mail: mpavuluri@psych.uic.edu. 0890-8567/06/4505Y0550Ó2006 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000205700.40700.50 550 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 45:5, MAY 2006 Copyr ight © Lippincott Williams & Wilkins. Unauthor iz ed reproduction of this article is prohibited.