Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth

Mian Li Ong, Eric A. Youngstrom, Jesselyn Jia Xin Chua, Tate F. Halverson, Sarah M. Horwitz, Amy Storfer-Isser, Thomas W. Frazier, Mary A. Fristad, L. Eugene Arnold, Mary L. Phillips, Boris Birmaher, Robert A. Kowatch, Robert L Findling, Lams Group The Lams Group

Research output: Contribution to journalArticle


We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p <0.0005; PGBI-10 M: AUC = 0.79, p <0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0–5; PGBI-10 M: 0–6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.

Original languageEnglish (US)
Pages (from-to)1-13
Number of pages13
JournalJournal of Abnormal Child Psychology
StateAccepted/In press - Jul 1 2016



  • Adolescents
  • Assessment
  • Bipolar disorder
  • CASI
  • PGBI-10 M
  • Receiver operating characteristic, diagnostic likelihood ratio

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Ong, M. L., Youngstrom, E. A., Chua, J. J. X., Halverson, T. F., Horwitz, S. M., Storfer-Isser, A., Frazier, T. W., Fristad, M. A., Arnold, L. E., Phillips, M. L., Birmaher, B., Kowatch, R. A., Findling, R. L., & The Lams Group, L. G. (Accepted/In press). Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth. Journal of Abnormal Child Psychology, 1-13.