Prevalence of the Child Behavior Checklist-pediatric bipolar disorder phenotype in a German general population sample


  • MH serves on the speakers bureau of Eli Lilly & Co. MD is a member of the advisory boards of Eli Lilly & Co., UCB, Medice, Shire, and Cephalon. JMF has received research funding from the Eli Lilly Foundation, Janssen, Celltech/UCB; travel grants from or consultant to Sanofi-aventis, Bayer, Bristol-Myers Squibb, J&J, Celltech/UCB, Eli Lilly & Co., Medice, Novartis, Pfizer, Ratiopharm, Sanofi-Synthelabo; and is a member of a DSMB for Pfizer. GL is a member of the advisory boards of Medice and Eli Lilly & Co. KS has received research funding from AstraZeneca, Celltech/UCB, Janssen-Cilag, Lundbeck, Medice; and was a member of the advisory board of Eli Lilly & Co. FP is a member of the advisory boards of Eli Lilly & Co., Janssen Cilag, AstraZeneca, and Novartis. SB, KG, JP, and MH do not have any financial relationships to disclose.

Martin Holtmann, MD, Department of Child and Adolescent Psychiatry and Psychotherapy, JW Goethe-University, Deutschordenstrasse 50, D-60528 Frankfurt/Main, Germany. Fax: +49 069 6301 5843;


Background:  In children with pediatric bipolar disorder (PBD), a consistent pattern of elevations in inattention/hyperactivity, depression/anxiety, and aggression has been identified on the Child Behavior Checklist (CBCL-PBD profile). In Germany, no epidemiological study has included PBD to date.

Objectives:  To estimate the six-month prevalence of the CBCL-PBD profile in Germany in a large normative general population sample, and to examine subjects with CBCL-PBD profile with regard to symptoms assumed to coexist with PBD (e.g., suicidality, decreased need for sleep, and hypersexuality).

Methods:  We studied a nationwide representative general population sample of 2,856 children and adolescents aged 4–18 years.

Results:  A total of 21 subjects [0.7% of the sample; 95% confidence interval (CI) = 0.5–1.1] met the criteria for the CBCL-PBD phenotype. CBCL-PBD subjects were more pervasively disturbed than clinical controls (n = 118; 4.1% of total sample; 95% CI = 3.4–4.9), demonstrated in significantly more social problems and delinquent behavior, and showed significantly higher rates of suicidality, decreased need for sleep and hypersexual behavior.

Conclusions:  The prevalence of CBCL-PBD subjects in the general German population compares to rates of PBD in US and Dutch epidemiological samples. Regardless of whether these subjects are affected by ‘real’ PBD or ‘severe, pervasive ADHD’ with pronounced emotional dysregulation, they constitute a group of seriously disturbed children and adolescents. The high rate of suicidality among CBCL-PBD subjects emphasizes the need for the identification and adequate treatment of children meeting this profile.