Child Mania Rating Scale

The Child Mania Rating Scale (CMRS) is a 21 item diagnostic screening measure designed to identify symptoms of mania in children and adolescents ages 9–17 using diagnostic criteria from the DSM-IV. The parent version of this scale (CMRS-P) interviews parents about their child's mood and behavior symptoms, asking them to rate how often the symptoms have caused a problem for the child in the past month. Clinical studies have found the CMRS-P to be reliable and valid in the assessment of children’s bipolar symptoms. The CMRS has also been found to be useful in differentiating cases of pediatric bipolar disorder from ADHD or no disorder, as well as delineating bipolar sub types. A meta-analysis comparing the different rating scales available found that the CMRS was one of the three best performing scales in terms of telling cases with bipolar disorder apart from other clinical diagnoses.

History and development

Historically, effective rating and diagnosis of mania has been limited. Though many mania scales have been tested on adult populations, the Mania Rating Scale (MRS) - which was the basis for the child version (CMRS) - is the only scale of its kind that has been studied for validity and reliability in prepubertal children. Previous attempts include the Beigel Scale and the Patterson Scale, which used nurse and clinician reports to rate levels of mania. Neither scale effectively and consistently captured levels of mania in patients. Other measures of pediatric mania are generally limited because they are completed by the clinician, introducing potential for bias, and because they lack the depth necessary to differentiate between patient-specific ways in which symptoms are presented. The CMRS attempts to address some of the limitations by creating a parent checklist that can gather information about behavior at home and other settings, rather than focusing only on what a clinician could directly observe.

Scoring and interpretation

For each item, parents rate the frequency with which a given mood or behavior has caused a problem for their child in the past month using a Likert-type scale. Each response is assigned a point value for scoring purposes.

• "Never/rarely:" 0 points
• "Sometimes:" 1 point
• "Often:" 2 points
• "Very often:" 3 points

Points are summed to yield a total score. If the total score is 20 or higher, it is recommended that the child or adolescent receive an evaluation from a trained mental health professional. Since the CMRS is only a screening device, it should not be used to make a diagnosis of mania or hypomania without consulting a clinician.

Limitations

The CMRS suffers from the same problems as other self-report inventories, in that scores can be easily exaggerated or minimized by the person completing them - in this case, the parent. Like all questionnaires, the way the instrument is administered can also influence the final score. If a person is asked to fill out the form in front of other people in a clinical environment, for instance, social expectations have been shown to elicit a different response compared to administration via a postal survey. The age of the youth also may matter. Although the Child Mania Rating Scale has been shown to be a valid and reliable measure of mania in children, one concern is that its validity might change as the youth becomes an adolescent, and parents have less influence and awareness about the youth's behavior outside of the home.

See also

• Full CMRS-P
• Bipolar disorder in children
• Bipolar disorder
• Bipolar disorder research
• Diagnostic classification and rating scales used in psychiatry
• AACAP Practice Parameters for Bipolar Disorder
• Bipolar disorder (Effective Child Therapy)